This document summarizes specific organ support considerations in the ICU, including the brain, heart, lungs, kidneys, liver, hematology/coagulation, skin/soft tissue, and endocrine system. Key points covered include oxygenation and ventilation strategies for respiratory support, indications for renal replacement therapy, transfusion thresholds for blood products, and general measures to prevent complications like bed sores.

1. Specific Organ Support in ICU
Fakhir Raza
SIUT

2. Specific Organ Support
• We need to support following organs
• Brain
• Heart
• Lungs
• Kidneys
• Liver
• Hematology & Coagulation
• Skin and soft tissue
• Endocrine

3. Brain
• No parenteral non-ionic fluid must be given
• Keep plasma sodium concentration >140 mmol/l. A fall produces an
osmotic gradient across the blood-brain barrier and aggravates cerebral
oedema
• Avoid hyperglycaemia and hypoglycaemia. Hyperglycaemia may aggravate
ischaemic brain injury by increasing cerebral lactic acidosis. Blood glucose
levels >11 mmol/l should be treated
• Feed through an orogastric tube. Gastric motility drugs can be given as
required
• Anti-thromboembolism stockings; avoid low dose heparin
• 15-30° head up tilt with the head kept in a neutral position may improve
cerebral perfusion pressure

4. ICP management
• Hypertonic saline
• Mannitol
• Hyperventilation
• Sedation and paralysis
• EVD
• Craniectomy
• Non invasive and invasive monitoring of ICP

5. Brain Perfusion
• Perfusion pressure depends upon ICP and MAP
• Increasing Mean Arterial pressure or decreasing Intracranial pressure

6. Heart support
• Hemodynamic support – Already discussed in general organ support
• Arrythmias
• Myocardial infarction
• Pericardial tamponade

7. Arrythmias
• All unstable tachyarrythmias should be treated with shock
• Broad complex tachycardia with shock should be treated as
ventricular fibrillation
• Amiodarone is drug of choice in ICU in most supraventricular and
ventricular tachyarrythmias
• Electrolytes should be corrected to prevent recurrent arrythmias
• Potassium, Magnesium and calcium are important

8. Myocardial infarction
• Mostly in ICU, MI is due to systemic illness and can’t be treated with
PCI or thrombolysis
• Supportive treatment and anticoagulation is indicated along with
antiplatelet therapy (if no contraindications exist)

9. Pericardial temponade
• It is treated with symptomatic and causing right heart dysfunction

10. Respiratory support
• Mechanical Ventilation
• Oxygenation
• How much oxygen to be given
• Ventilation

11. Respiratory Support
• Oxygenation:
• Nasal canulla
• Venturi mask
• Non rebreathing mask
• Mechanical ventilation
• PEEP
• I:E ratio
• FiO2
• Proning
• ECMO /ELS

12. Liver Support
• Portal Hypertension
• Hepatorenal syndrome
• Hepatic encephlopathy
• SBP
• GI bleeding
• https://aasldpubs.onlinelibrary.wiley.com/doi/10.1002/lt.24815

13. Liver support
• ABC
• Maintaining sugar
• Making sure that patient moves bowel
• Medicines for decreasing portal hypertension
• Antibiotics for SBP
• Terlipressin when indicated
• GI clearance
• Coagulopathy

14. Kidney Support
• Fluid balance
• Electrolyte balance
• Acid base balance
• Solute balance (urea)
• Renal replacement therapy

15. Indication of RRT in ICU
• Acute kidney failure
• Acute on chronic kidney failure
• On going dialysis for End stage kidney failure patients admitted for
any other reason

16. Indications of dialysis
• Without RRT mortality from the complications of fluid overload,
refractory hyperkalaemia, and metabolic derangement would be far
higher

17. Hematologic support
• Packed RBC transfusion
• Platelet transfusion
• FFP transfusion
• Clotting factors replacement
• Plasmapheresis

18. Transfusion of blood products
• Most critically ill patients do not need RBC transfusions when Hgb is
greater than 7 g/dL
• Hb target may be above 8 g/dL for those with non-STEMIs and
perhaps as high as 10 g/dL for patients with STEMIs
• Although FFP often is transfused to correct coagulopathy and prevent
bleeding in a nonbleeding coagulopathic critically ill patient, there is
no evidence to support its use
• little evidence exists to support the prophylactic transfusion of
platelet concentrates in nonbleeding thrombocytopenic patients

19. Skin and soft tissue
• Turning the patient with care is the best way of preventing bed sores
in ICU patients
• Soft tissue infections and DVT should be actively searched with the
help of ultrasound and treated promptly
• These two conditions are confusing and may be overlapping
• Any breach in skin should be taken seriously as it can progress quickly
• General measures like good nutrition, moisturizing the skin and
regular washing can prevent bed sores

20. Endocrine
• Blood sugar control is important as a general measure in all ICU
patients
• The target is less then 10 mmoles or less then 180mg% in all patients
• IV insulin infusion is needed in ICU patients especially in the presence
of shock
• Hydrocortisone is indicated in refractory septic shock patients (need
of vasopressors despite of adequate fluid resuscitation)
• Thyroid disease should be suspected in unexplained hyponatremia,
somnolence and hypothermia

21. Blood components
• Function of RBC _______________________
• Function of Platelet ____________________
• Function of Plasma ____________________

22. What precautions should be taken while
transferring patient from one bed to another
• A team should take care of patient
• Airway should be protected
• All lines should be secured
• Monitoring should be continued