Icu Case Study

Case Study A 45 year old male was admitted to ICU following an exploratory laparotomy which showed a ruptured appendix and peritonitis. The procedure began as a laparoscopic cholecystectomy but the initial finding was pus throughout the peritoneal cavity and a normal gallbladder. An open exploratory laparotomy where a ruptured appendix was discovered which was removed and a washout was performed. The patient had a two day history of abdominal pain prior to his admission through A&E. He had no previous medical or surgical history. The patient smoked 20/day and drank alcohol at the weekends. Once admitted to ICU, he was intubated and ventilated on bilevel ventilation and sedated with propofol and fentanyl. In theatre he received two litres of hartmanns solution as a fluid load, however in ICU was commenced on maintenance of normal saline at 100mls/hr. Feeding was ruled out on admission as it was thought that the patient would have extubated the following day. However, the patient was in ICU six days prior to extubation, therefore TPN was commenced. Noradrenaline was used for a MAP above 70mmhg rather than a fluid load. The patients clinical scenario was more in depth as outlined above. However, these are outside the scope of this case study. The medical and nursing interventions discussed in this assignment is mechanical ventilation, total parental nutrition and vasopressors. Mechanical Ventilation Bilevel ventilation is a relatively new setting. (Mireles-Cabodevila et al, 2009) The ventilator maintains a high pressure setting for the bulk of the respiratory cycle, which is followed by a release of low pressure. (Mireles-Cabodevila et al, 2009) The release to a low PEEP is the expiration phase and aids the elimination of CO₂. The release periods are kept short to prevent derecruitment of alveoli and encourage spontaneous breathing. (Mireles-Cabodevilla et al, 2009) The advantages of bilevel include an increase in mean alveolar pressure with recruitment,

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