INTENSIVE CARE

From Big Medical Encyclopedia

INTENSIVE CARE — system of the actions directed to prevention or correction of disturbances of vital signs at sharply arisen serious illness or strong impacts on an organism (big operation on volume, blood loss, an injury, cardiogenic shock, etc.) when there is a threat for life of the patient (see. Terminal states ). All actions And. t. are carried out in intensive care units and an intensive care where patients with acute frustration of a hemodynamics of various etiology (acute cardiovascular insufficiency, traumatic shock, hypovolemic shock, cardiogenic shock, etc.), with acute disorders of breath, other acute disorders of functions of vitals and systems are hospitalized (ts.n.s., parenchymatous bodies, etc.), acute disorders of exchange processes, etc., patients in the recovery period after an agony and a wedge, death, after the operative measures which caused dysfunctions of vitals or at real threat of their development, sick with a serious poisoning (at impossibility of hospitalization in the relevant centers).

Main objectives And. t. — intensive observation and actually to lay down. actions.

Methods of intensive observation provide first of all continuous overseeing by a condition of the patient from medical staff. An optimal variant of intensive observation is monitor observation (see) by means of the installations which are automatically registering pulse, breath, the ABP, biocurrents of heart, etc. When these indicators exceed the limit of the established sizes, monitor installations give an alarm signal. Along with monitor observation constant control biol, environments of an organism is necessary: composition of blood, acid-base equilibrium, blood gases, concentration of the main cations (potassium, sodium), chlorine, and also their daily removal with urine, etc.

Intensive observation gives the chance to timely carry out adequate preventive and to lay down. actions which allow to lower a lethality, for example at acute coronary insufficiency by 5 — 10%.

Medical actions are directed to maintenance up to standard of a hemodynamics, gas exchange, structure of internal environment of an organism and to prevention of neurologic disturbances.

For the prevention and elimination of hemodynamic shifts paramount value has infusional therapy (see) and purposeful pharmacotherapy. Infusional therapy provides maintenance of due balance of water in an organism, the volume of the circulating blood and its components, improvement of an organ blood-groove and microcirculation. Special attention is paid to questions of prevention and treatment arrhythmias of heart (see) which often serve directly as the reason of an aggravation of symptoms of patients.

In ensuring appropriate gas exchange especially important role is played by maintenance of passability of upper respiratory tracts by means of systematic clarification of an oral cavity, a nasopharynx, elimination retractions of language (see), uses of air ducts, tongue forceps, intubations of a trachea in the shown cases. Not less prevention and elimination of tracheobronchial impassability for what carry out the corresponding therapy are important (vibration, effleurage of a thorax, a postural drainage, inhalation of the drugs promoting fluidifying of a phlegm and facilitating its evacuation from bronchial tubes).

In the most hard cases resort to stimulation of cough (a microtracheostomy, the device «artificial cough»). Only in exclusive situations use is for this purpose admissible tracheostomies (see). Are recommended according to indications inhalation of the moistened oxygen through the catheter entered into a nasopharynx, continuation of artificial ventilation of the lungs after operations or auxiliary artificial ventilation of the lungs through a mask or an endotracheal tube (see. Artificial respiration, artificial ventilation of the lungs ).

At the correct and timely implementation of infusional therapy and maintenance of due gas exchange, as a rule, there are no rough shifts in a condition of internal environment of an organism. If these shifts take place, the problem of infusional therapy includes also correction of an electrolytic and water balance of an organism, acid-base state, coagulating properties of blood, etc. If good nutrition is impossible through went. - kish. a path, it is not less important to begin timely and to correctly carry out the parenteral food directed to a pas maintenance of the energy balance of an organism and prevention of a catabolism (see artificial nutrition). In such cases providing an organism with necessary amount of energy (30 — 50 kcal/kg a day), nitrogen (0,14 — 0,3 g/kg a day) and waters is shown first of all (20 — 40 ml/kg a day). The ratio of amino acids, fats and carbohydrates in a diet shall make 20, 30 and 50% respectively. Parenteral food is combined using vitamins, electrolytes and microelements.

Special significance is attached to prevention possible psikhonevrol, the complications arising in these conditions most often owing to hypoxemic disturbances. For their prevention the medical events directed to saturation of blood by oxygen, improvement of microcirculation of a brain, decrease in oxidation-reduction processes in it (lytic mixes, the general and local hypothermia, corticosteroids, an artificial respiration in the mode of a moderate hyperventilation) in the early period and use of the means improving a metabolism (glutaminic to - that, Encephabolum, Aminalonum) in later period are held. Apply also tranquilizers and drugs.

To methods I. t. also the general belongs also local anesthesia (see). In some cases, napr, at an injury, ischemia of a myocardium, pain can be so acute that anesthesia gains paramount value. Here a specific place is held by neyroleptanalgeziya and anesthetics of short action, and also a medical anesthesia. An effective remedy is GOMK which, having analgesic and somnolent effect, does not reduce lung ventilation and raises a tone of a cardiac muscle. In certain cases the hyper barotherapy is useful (see. Hyperbaric oxygenation ).

Organization of events of an intensive care. And. t. it is carried out in specially equipped chambers which are a part of intensive care units and an intensive care. These departments will be organized in the cities with the population from 500 thousand people above as a part of large multi-field hospitals with number of beds not less than 800 (in children's hospitals — 400). Number of beds in intensive care unit and an intensive care no more than 20 — 25. Department shall have special rooms for resuscitation (see), for carrying out an intensive care, equipped with the necessary diagnostic and medical equipment, including for artificial maintenance and control of the main functions of an organism, the express laboratory providing the round-the-clock laboratory researches of the major vital signs of an organism. Department can use laboratories, x-ray both other medical and auxiliary and medical and diagnostic offices (departments) of hospital. Department shall be provided with medicines, transfusion means in the quantities necessary for full performing resuscitation and an intensive care. In intensive care unit and an intensive care positions of the doctor of the intensivist (1 round-the-clock post on 6 beds) and the doctor-laboratory assistant are provided (1 round-the-clock post on department).

Big role in work of departments And. t. plays paramedical staff, on to-rogo daily and continuous overseeing is directly assigned by a condition of patients.

See also Resuscitation .


Bibliography Sudden death at acute coronary insufficiency, under the editorship of. I. K. Shkhvatsabaya and M. E. Rayskina, page 31, M., 1968; Bass certain Yu. M. and Rapoport Zh. Zh. An intensive care in pulmonology, L., 1977, bibliogr.; Luzhniki E. A., D and and-e in V. N. and F and r with about in H. H. Fundamentals of resuscitation at acute poisonings, M., 1977, bibliogr.; Michelson W. A. and Manevich A. 3. Bases of an intensive care and resuscitation in pediatrics, M., 1976; Fundamentals of resuscitation, under the editorship of V. A. Negovsky, Tashkent, 1977; Resuscitation, under the editorship of G. N. Tsy-bulyak, M., 1976; Ore M. Ya. Chambers of intensive observation for patients with acute coronary insufficiency, Cardiology, t. 16, No. 4, page 148, 1976; H elements E. And. and Bogolyubov V. M. Disturbances of a heart rhythm, M., 1972; Lehr-buch der Anaesthesiologie, Reanimation und Intensivtherapie, hrsg. v. R. Frey u. a., B. u. a., 1972; StephensonH. E. Cardiac arrest and resuscitation, St Louis, 1974, bibliogr.

V. A. Negovsky.

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