The type of organ system supported within a CRITICAL CARE PERIOD. This may not necessarily be support for a failing organ. Basic respiratory support is likely to occur simultaneously with advanced respiratory support. If they are both required on the same day, only advanced respiratory support should be recorded. Basic cardiovascular support is likely to occur simultaneously with advanced cardiovascular support. If they are both required on the same day, only advanced cardiovascular support should be recorded.
Basic Respiratory Support
Indicated by one or more of the following:
More than 50% oxygen delivered by face mask.
Close observation due to the potential for acute deterioration to the point of needing advanced respiratory support e.g. severely compromised airway or deteriorating respiratory muscle function.
Physiotherapy or suction to clear secretions at least two hourly, whether via tracheostomy, mini-tracheostomy, or in the absence of an artificial airway.
Patients recently extubated after a prolonged period of intubation and mechanical ventilation, e.g. more than 24 hours of tracheal intubation.
Mask CPAP or non-invasive ventilation.
Patients who are intubated to protect the airway but need no ventilator support and who are otherwise stable.
Advanced Respiratory Support
Indicated by:
Invasive mechanical ventilator support (excluding mask
(CPAP) or non-invasive methods e.g. mask ventilation but including BIPAP or CPAP
applied via a tracheal tube).
Extracorporeal respiratory support
Basic Cardiovascular Support
Indicated by one or more of the following:
Treatment of circulatory instability due to hypovolemia from any cause
Use of a CVP line for basic monitoring or central venous access to deliver therapeutic agents.
Use of an arterial line for basic monitoring of arterial pressure or sampling of arterial blood.
Single intravenous vaso-active drug used to support arterial pressure, cardiac output or organ perfusion.
Intravenous drugs to control cardiac arrhythmias.
Non-invasive measurement of cardiac output e.g. echocardiography, thoracic impedance
Advanced Cardiovascular Support
Indicated by one or more of the following:
Multiple intravenous vaso-active and/or rhythm controlling drugs used to support arterial pressure, cardiac output or organ perfusion e.g. inotropes, amiodarone, nitrates.
Patients resuscitated after cardiac arrest where intensive therapy is considered clinically appropriate.
Observation of cardiac output and derived indices e.g. pulmonary artery catheter, lithium dilution, pulse contour analyses, oesophageal doppler.
Intra aortic balloon pumping.
Insertion of a temporary cardiac pacemaker (criteria valid for each day of connection to a functioning external pacemaker unit).
Placement of a gastrointestinal tonometer
Renal Support
Indicated by: - acute renal replacement therapy e.g. hemodialysis, hemofiltration etc.
Neurological Support
Indicated by one or more of the following:
Central nervous system depression sufficient to prejudice the airway and protective reflexes, excepting that caused by therapeutic sedation prescribed to facilitate mechanical ventilation.
Invasive neurological monitoring e.g. ICP, jugular bulb sampling.
Severely agitated or epileptic patients requiring constant nursing attention and/or heavy sedation.
Gastrointestinal Support
Indicated by: - feeding with parental or enteral nutrition
Dermatological Support
Indicated by one or more of the following:
Patients with major skin rashes, exfoliation or burns e.g. greater than 30% body surface area affected.
Use of multiple trauma dressings e.g. multiple limb or limb and head dressings.
Use of complex dressings e.g. open abdomen or large skin area greater than 30% body surface area.
Liver Support
Indicated by:
Extracorporeal liver replacement device e.g. MARS as manufactured by Teraklin, Rostock, Germany, bio-artificial liver or charcoal hemoperfusion.