The Intensive Care Unit (ICU) at Bumrungrad International Hospital is equipped with a comprehensive range of up-to-date medical technologies that contribute greatly to the care of ICU patients. The advanced technology can be seen in the ICU’s state-of-the-art ventilators, in the mechanical devices delivering 24-hour Continuous Renal Replacement Therapy (CRRT), and in the Extra Corporeal Membrane Oxygenation (ECMO) machines that provide critical heart and lung support.
 
Here is a closer look at these three technology-driven devices and the specific purposes they serve in the ICU at Bumrungrad International.

1. Ventilators are machines that support breathing, helping patients who are unable to breathe on their own, or whose breathing is insufficient to keep their body functioning properly. A ventilator’s primary tasks are to get oxygen into the lungs and remove carbon dioxide from the body through an airway tube such an endotracheal or tracheostomy tube inserted through the mouth or trachea. Ventilators are a common presence in hospital surgical wards, as they are typically used for short periods to support the breathing of a patient undergoing surgery that requires general anesthesia.
 
In the ICU, ventilators are among the most widely used life-support technologies. They may be required to support the breathing of patients with severe lung conditions or lung diseases, including acute conditions such as respiratory failure and acute respiratory distress syndrome (ARDS). Patients recovering from complex surgeries who are not yet strong enough to breathe fully on their own may benefit from ventilator support. Ventilators are occasionally used to help patients who are awaiting organ transplants.
 
Advances in technology have improved the reliability and accuracy of ventilator devices, ensuring, for example, that the concentration of oxygen delivered to the patient does not vary over time. Their reliability also continues to increase from one generation of devices to the next. The doctors and staff nurses of the ICU continue to closely monitor each patient’s ventilator tube to ensure it is cleaned frequently to minimize the risk of infection at the tube insertion site.

2. Continuous Renal Replacement Therapy (CRRT) supports kidney function when a patient is unable to support them on their own. The goal of CRRT is to take the burden off damaged kidneys by assuming responsibility for gradually flushing waste products out of the body.
 
CRRT is a form of hemodialysis, a treatment process that replaces the function of the kidneys, filtering out waste materials and water from a patient’s blood. Hemodialysis is a treatment process that — just as healthy kidneys would normally do — filters out waste materials and water from a patient’s blood, making it easier to maintain stable blood pressure and ensure a proper amount of minerals such as calcium, potassium and sodium remain in the blood.
 
Patients with mild to moderate kidney failure but whose blood pressure is stable typically undergo hemodialysis in an outpatient clinic setting, with the process requiring about 4 hours to complete. In the context of the ICU, CRRT typically extends over a longer period of time, perhaps several days, and patients may not have the kind of stable blood pressure normally required with outpatients.
 
Conventional hemodialysis operates at a high flow rate, meaning the blood is cleaned and returned quickly. The patient’s stable blood pressure makes this possible. With CRRT in the ICU, the flow rate is significantly slower, with the blood removal and cleaning done little by little over a continuous period of time. Advances in technology have enabled the newest generation of CRRT devices to deliver 24-hour hemodialysis even during periods of low blood pressure, providing a new treatment option for intensive care patients with acute kidney injuries, advanced kidney failure, and other conditions that impair normal kidney function.

3.  Extra Corporeal Membrane Oxygenation (ECMO): ECMO is essentially a heart / lung life support machine that takes over the heart pump and oxygenation functions normally done by the patient’s heart and lungs. The pump provides support for the heart, while the oxygenation function involves the blood being removed from the body, where oxygen is added (and carbon dioxide is removed) and the blood is returned back into the body.
 
ECMO can be used briefly, for example, during heart surgery requiring that circulation be stopped temporarily to enable the surgeon to perform the operation. But in the context of the ICU, ECMO is typically used for a period of days to support patients experiencing respiratory failure or cardiac failure whose condition is severe yet potentially reversible, such as acute viral cardiomyopathy or acute respiratory distress syndrome (ARDS).
 
ECMO is not considered as a first-line treatment, so its use generally occurs only after conventional therapies and first-line treatments, such as ventilators, have failed. Having ECMO temporarily taking over provides an opportunity for the patient’s own heart and lungs to recover while giving the ICU medical team additional time to determine the optimal treatment strategy and plan next steps.

Patient Experiences
The combination of state-of-the-art medical equipment, advanced technologies, a highly knowledgeable and skilled team of intensive care experts inspires a high level of trust in the ICU at Bumrungrad International. The experiences of both Thai and international patients and their family members are reflected in the strong global reputation Bumrungrad’s ICU continues to enjoy. By maintaining patient safety and standards at world-class levels, the ICU medical team continues to pursue medical excellence, so that patients receive the quality care they deserve.
 
By Dr. Worakij Chalermskulrat, Chief of Critical Care Medicine and Pulmonology, Bumrungrad International Hospital