Thomas Jefferson UniversitySidney Kimmel Medical College

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Specilaized Intensive Care Unit Therapies

Continuous Renal Replacement Therapy (CRRT): For critically-ill patients with renal failure that require renal replacement therapy, traditional intermittent hemodialysis may be impossible due to hemodynamic instability. CRRT addresses the needs of the critically ill patient with renal dysfunction and/or fluid volume excess by providing slow, continuous removal of toxins and fluids. By removing fluids continuously, CRRT mimics the native kidney and hemodynamic instability is significantly reduced.

Extracorporeal Membrane Oxygenation (ECMO) is a technique that provides cardiac and respiratory support oxygen to patients whose heart and/or lungs are so severely damaged that they cannot serve their function. Blood is drained from the venous system, oxygenated outside of the body, and returned to the patient’s circulation. ECMO is indicated for acute cardiac or pulmonary failure that is unresponsive to conventional management and potentially reversible.  Indications for ECMO include:

  • Acute hypoxemic respiratory failure (such as the acute respiratory distress syndrome) refractory to conventional mechanical ventilation and high levels of inspired oxygen with positive end-expiratory pressure.
  • Refractory and potentially reversible cardiogenic shock.
  • Failure to wean from cardiopulmonary bypass after cardiac surgery.
  • As a bridge to cardiac transplantation or placement of a ventricular assist device.

The Molecular Adsorbents Recirculation System (MARS). The prognosis of patients with liver failure still remains poor. The mainstay of treatment is supportive but in some cases advanced techniques like extracorporeal liver dialysis may be indicated. The Jefferson MICU, in conjunction with our transplant hepatology team, can in selected cases employ the MARS system. It consists of two separate dialysis circuits. The first circuit using human serum albumin utilizes a semipermeable membrane and has two special filters to clean the albumin after it has absorbed toxins from the patient's blood. The second circuit uses a traditional hemodialysis machine and cleans the albumin from the first circuit, before it is recirculated. The MARS system can remove a number of hepatic toxins and may be used as a bridge to liver transplantation.

Invasive and Non-invasive Cardiac Output Monitoring: The Jefferson MICU is equipped with traditional and advanced equipment for the monitoring of cardiac output in critically-ill patients. The MICU employs a range of techniques including pulmonary artery catheterization, pulse contour analyses, focused point-of-care ultrasound, continuous transesophageal ultrasound and continuous fiberoptic mixed venous oximetry.