A close relationship should exist between the respiratory service and the ITU. The respiratory unit will need ITU expertise when patients deteriorate and need close monitoring or invasive ventilation; conversely, ITU will call upon the respiratory services when patients take longer to wean from invasive ventilation, usually via tracheostomy. This short chapter provides guidance on liaising with the ITU for help and details the use of the recent National Early Warning Score for assessing if patients need high dependency, or intensive care, involvement.
This chapter considers the patient who may present critically ill with either an exacerbation of known respiratory disease, a first presentation of respiratory disease, or respiratory involvement of a systemic disease. An approach to the initial assessment is suggested, including ways to consider the possible underlying cause and with practical guidance regarding airway management, assessment of breathing, circulation, and disability. Determining the treatment options for the different possible causes is discussed in general terms, including assessment of prior disease extent, baseline function, patient wishes. Organ support on the intensive care unit or non-invasive ventilation may be appropriate, and these should certainly be considered in the patient who is deteriorating, in whom a full assessment is not possible or in whom full information is not available. There are links to specific conditions and their presentations in other chapters, along with specific treatment links.
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