CCT in ICM - programme overview unit ... - London Deanery

are separate paediatric liver ITU beds within the department of paediatrics).
The unit admits patients from the local ward environment, (liver and
hepatobiliary), theatres (transplant and hepatobiliary) and other referring
hospitals for the provison of tertiary liver and hepatobiliary intensive care.
Approximately 500 patients per year are admitted to the ITU, with a mean
age of 48 years and an average mortality of 26%. Approximately 80% of
patients are ventilated and 42% have renal failure. Approximately 100 cases
per year will be admitted with acute liver failure. This cohort of patients are at
risk of developing cerebral oedema and intracranial pressure bolts are
frequently inserted in those that become deeply encephalopathic.
Hepatobiliary surgery accounts for 60-70 admissions a year , comprising a
mixture of elective surgery and liver trauma. Last year the Unit undertook 180
liver transplants with adult cases accounting for 120. The other source of
admissions are patients with sepsis and multiple organ failure who have had
previous transplants or surgery and those with decompensated chronic liver
disease. Increasingly there are developments in the area of extracorporeal
liver assist devices which are utilised in these patients groups.
The liver surgery is performed in a dedicated theatre which is co-located with
the Liver ITU and liver wards. One floor above the ITU there are laboratory
services for the clinical service and research components of the Institute.
There is active clinical research being undertaken within the ITU area and
staff are all encouraged to participate in such programmes.
The ITU is staffed on a 1:1 nurse to patient ratio with a high proportion of
ITU trained nursing staff. The medical cover at consultant level is provided by
2 full-time intensivists, undertaking weekday cover in one week blocks. Junior
cover is provided by a full-time shift system of registrars from a background
of internal medicine, surgery and/or anaesthesia. The rota involves a work
pattern of 1 night shift in 7 and is compliant with junior doctors hours.
Anaesthetic registrars from the liver rotation are also attached to the Unit as
thetare commitments allow. A senior house officer is also attatched to the
ITU, but does not partake in the on-call service. The on-call service for ITU
trainees would probably be as on on-call form home if they wished in a
“senior registrar “ type capacity with support from one of the consultant staff.
The ITU is supported by a dedicated consultant microbiologist and 2 specialist
pharmacists are attached to the liver service. The activity of the unit is
audited using “R.I.P.” software, data is input is undertaken by a dedicated
nurse. All routine investigations are retrievable electronically. A consultant
from radiology reviews the imaging of the patients on a daily basis within the
liver ITU. There is excellent support from interventional radiology and a
weekly X-ray meeting to review the images. Additionally there are dedicated
dieticians and physiotherapists all of whom play integral roles in patient care.
The unit is equipped to provide full ventilatory support at all beds, with a full
range of invasive monitoring techniques. Renal support is achieved with
haemofiltration and diafiltration and facilities exist to provide this in seven