Do your ICUs/hospitals offer all therapies?

Specialties MICU

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Specializes in multispecialty ICU, SICU including CV.

So, I work in a relatively small urban facility (250-300 beds.) Our SICU is 8 beds only and we take multispecialty surgical admits including CV surgery. There is a fair amount of stuff my SICU doesn't do -- CVVHD being one of them, ECMO being another, NO being another. We don't do off pump CABGs. There are no long term vent-weaning beds in my facility, so we end up keeping patients forever for this (and our docs don't really do that, they are all surgeons.) Eventually 6-8 weeks down the road, we send them to an outside vent-weaning facility.

Seems like the ICUs should offer this stuff as it is pretty standard everywhere -- well, I know CVVHD is, and I think NO is pretty common. Maybe ECMO is only used at bigger facilities. Do most hospitals have somewhere where there vent-dependent patients go in-house or are they all sent away?

Just wanting to see what other people's experiences are. Thanks.

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We have a 14 bed ICU. We don't offer PRISMA, HFOV, ECMO, we have NO but have not used it in 3 yrs. Any heart pts get transferred out to other hospitals for surgery. Our long term vents get transferred to general wards, until they can be placed in long term care facilities in approx. 6 mnths.

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Specializes in CVICU.

Whats NO?

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Whats NO?

Nitric Oxide.

We do NO, CVVH/CRRT, IABP, HFOV, Bilevel ventilation, rotoprone, bedside ex-laps, etc.

Vent patients who don't require an ICU nurse/interventions are transferred to Progressive Care and then go from there to Select Specialty and some other vent-facilities.

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I've never heard of NO before, so we don't do that at my hospital. No ECMO. Plenty of CVVHD, IABP, any CABGs, rotoprone.

Long term stable vents CAN go to a special floor, but very very rarely do. Usually they are on the list to go to an LTAC and we keep them until they get transferred, which can be a while.

(30 bed ICU)

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Nitric, CRRT (correct nomenclature for what many call CVVHD), HFOV, and ECMO are all higher-tech therapies. ECMO or ECLS -extracorporeal lung support is very technically demanding and requires MD's who understand bypass both veno-arterial (VA) and veno-venous (VV) VERY well, not to mention understanding of pulmonary physiology more than a genrealist intensivist. You have one problem, and you'd better know your stuff..RIGHT NOW.

Nitric and HFOV- (high frequency oscillatory ventilation) are also higer tech specilaites, and again, a generalist ICU doc -especially if they never read the most recent research ain't gonna make outcomes change. It's evidence-based medicine- therefore impacting outcomes. Not only do you need an MD with a complete pulmonary understanding, the nurse needs to understand the therapy and implications also. CRRT is, and should be, standard in all ICU's..Anyone who allows their patients to have hemodialysis and drop their BP because they are too unstable for hemo ought to be shot. Just my opinion..It is simple, but STILL, if the Nephrologist thinks they understand it and have no clue (i.e, doesn't do much reading in this area) disaster can happen.

Bottom line: you need dedicated, knowledgeable, people who make it their business to read and keep abreast of this stuff, AND you need the in-house nursing support to teach it and maintain it as a program for your critical care courses. If you do not have all of this, you ought not be messing with this stuff. Send it out to the Big Dogs. Would you want your family men=mber to be treated at an institution that does 2 open hearts a year or 2000? It's simple matter of better outcomes with a program. does not mean smaller ICU's have nothing to offer, they meet a need for communities. But if it is serious, it should go to experts...unless you do not care about outcomes. Make sense?

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We do everything. There is no other facility we send people to, which was a big attraction to the job for me at the start. If we can't fix someone in our hospital, their next stop is the morgue.

As for weaning, they took away our step-downs and made them full-time ICU's. Quite often we have stable vents that hog up a bed some sick person in the ER could really use, but such is life.

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Hey, wondered if you could give me a little info on your Progressive Care unit...sounds like it takes vents and I'm also thinkin it may be a med-surg unit? How many beds? thanks

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Specializes in MICU, neuro, orthotrauma.

No, NO, HFOV, ECMO. We do bilevel, prone (got rid of rotoprone because of the inherent dangers and cost, but we just turn 'em on their belly), IABP and, of course, CRRT.

We are in a small city (300k city and surrounding area population) and the only trauma unit within a few hundred miles. If we can't fix them, they go to the big city (Pittsburgh).

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