Specialised critical care
Certain patient populations have more specialised critical care needs that require admission or transfer to a specialist centre. This includes the following treatment areas:
- Extracorporeal membrane oxygenation (ECMO) can provide total cardiac and/or respiratory support for patients. It can bridge patients with acute cardiac/respiratory failure over a period of recovery of native function. ECMO can also be used to support patients with severe chronic heart and lung disease to transplantation if recovery is not possible. Currently there is an NHS England service specification for ECMO (opens PDF, 201.46 KB) for adult patients with respiratory failure but not cardiac failure (312.29KB).
- Cardiothoracic surgery. Usually, cardiac surgery patients will require post-operative care in a unit that conforms to the standards of general level 2 and 3 intensive care facilities. In the UK, most patients will return to a facility providing level 2 care after thoracic surgery.
- Neurocritical care is devoted to the comprehensive care of critically ill patients with neurological or neurosurgical disease. Care of such patients requires an understanding of the physiology and pathophysiology common to brain diseases in general, as well as the skills and knowledge to treat a range of specific conditions.
- Weaning and long-term home ventilation services (opens PDF, 275.23KB). A significant number of ventilated, critically ill patients will suffer from weaning delay, and a smaller number will become ventilator dependent. There is good evidence that a structured approach to the care of this group can reduce the duration of ventilation and improve outcome.
- Burns care (opens PDF, 2.7MB) is advancing, with improvements in outcomes related directly to research from experts in the field.