Current UCL Hospitals principles of management

Respiratory

SaO2>90-95% (may have to settle for lower) Permissive hypercapnia

Cardiovascular

Maintain cardiac output/oxygen delivery and blood pressure compatible with adequate organ perfusion (e.g. no metabolic acidosis)

Renal

Maintain adequate metabolic and fluid homeostasis by intravascular filling, diuretics, vasoactive agents, and/or haemo(dia)filtration

Haematological

Maintain haemoglobin >7g/dl (unless cardiorespiratory problems), platelets >20-40 x 109/l, INR <1.5-2.5

Gastrointestinal

Stress ulcer prophylaxis (generally by enteral nutrition), pancreatitis, acalculous cholecystitis

Infection

Antibiotics, pus drainage, good infection control

Nutrition

Preferably early and by enteral route

Pressure area/mouth/joint care

Frequent turns, low pressure support surfaces, nursing care and physiotherapy

Psychological

Support to both patient and family

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