Special Devices in the ICU and the Brain Death Determination

by Brian Warriner, MD

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    I mentioned briefly Continuous Renal Replacement Therapy. And this is a diagram of how that therapy works. And the sort of ball in the middle of the diagram is a series of filters and pumps that moves the blood through the circulation, from the circulation of the patient into a machine. And in the machine, the blood is filtered and materials that are in excess, such as nitrogenous wastes, are removed just like the kidney would do it. But it's done slowly and continuously So this is a 24 hour process. It's on all the time. And the nurses have to monitor this and make sure that it's working appropriately. This has caused an improvement in Acute Renal Failure Outcomes. And often complete recovery. So patients recover completely and do not have to go on hemodialysis necessarily after they're discharged from the ICU. And this has really improved how patients feel afterward as well. Because hemodialysis is not fun, and if you can keep people off of it, it's a big plus in their lives. This is a large left-ventricular assist device, a bedside one. These devices actually can be quite small and can actually be basically in the chest with a pack that you carry at your waist and you can go home with them. But, that's not a common situation. The left-ventricular assist device is placed by a cardiac surgeon. It has a balloon that inflates during cardiac diastole. So, when the heart is relaxed, the balloon in the left-ventricular assist device inflates. And we'll see in a subsequent slide that this actually increases diastolic pressure in the aorta, which improves coronary blood flow, and improves oxygenation of the heart, so that's good for the heart muscle. Then, during cardiac systole when the heart contracts, the balloon in...

    About the Lecture

    The lecture Special Devices in the ICU and the Brain Death Determination by Brian Warriner, MD is from the course Anesthesiology: Advanced. It contains the following chapters:

    • Continuous Renal Replacement Therapy
    • Left Ventricular Assist Device
    • Systemic Inflammatory Response Syndrome
    • Sedation in the ICU
    • Brain Death Determination

    Author of lecture Special Devices in the ICU and the Brain Death Determination

     Brian Warriner, MD

    Brian Warriner, MD

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