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Pulmonary hypertension and the interdependence of ventricular function part 1: Pathophysiology and diagnosis 肺动脉高压和心室功能的相互依赖性第1部分:病理生理学和诊断
ICU director Pub Date : 2013-07-01 DOI: 10.1177/1944451613490730
S. Afifi, Mandeep Singh
{"title":"Pulmonary hypertension and the interdependence of ventricular function part 1: Pathophysiology and diagnosis","authors":"S. Afifi, Mandeep Singh","doi":"10.1177/1944451613490730","DOIUrl":"https://doi.org/10.1177/1944451613490730","url":null,"abstract":"","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"183-190"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613490730","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898172","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
A Review of the Stellate Ganglion Block/Cervical Sympathetic Block on the Prevention and Therapy of Cerebral Vasospasm After Subarachnoid Hemorrhage 星状神经节阻滞/颈交感阻滞预防和治疗蛛网膜下腔出血后脑血管痉挛的研究进展
ICU director Pub Date : 2013-06-13 DOI: 10.1177/1944451613490731
Ramana K Naidu
{"title":"A Review of the Stellate Ganglion Block/Cervical Sympathetic Block on the Prevention and Therapy of Cerebral Vasospasm After Subarachnoid Hemorrhage","authors":"Ramana K Naidu","doi":"10.1177/1944451613490731","DOIUrl":"https://doi.org/10.1177/1944451613490731","url":null,"abstract":"One of the most dangerous and distressing complications of subarachnoid hemorrhage is the development of delayed cerebral ischemia from cerebral vasospasm. Although the exact mechanism causing cerebral vasospasm remains unclear, current evidence suggests that breakdown products of blood within the subarachnoid space may interact with the sympathetic innervation of the cerebral vasculature to produce vasoconstriction. Therefore, a novel treatment that would lessen these sympathetic effects may be beneficial to patients with cerebral vasospasm. This review will examine the potential benefit to neuro-critical care medicine that ultrasound-guided cervical sympathetic blockade, also known as the stellate ganglion block, could have on cerebral vasospasm.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"161-165"},"PeriodicalIF":0.0,"publicationDate":"2013-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613490731","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
Pulmonary hypertension and the interdependence of ventricular function: Part 2: Evaluating the medical and surgical management 肺动脉高压和心室功能的相互依赖性:第2部分:评估内科和外科治疗
ICU director Pub Date : 2013-06-13 DOI: 10.1177/1944451613490954
Mandeep Singh, M. Afifi
{"title":"Pulmonary hypertension and the interdependence of ventricular function: Part 2: Evaluating the medical and surgical management","authors":"Mandeep Singh, M. Afifi","doi":"10.1177/1944451613490954","DOIUrl":"https://doi.org/10.1177/1944451613490954","url":null,"abstract":"Pulmonary hypertension is a hemodynamic problem that can result in grave morbidity and mortality including right-sided heart failure and sudden death. The nature of the pulmonary circulation makes it highly interdependent with right ventricular function. Thus, the study of functional deterioration in pulmonary blood flow should always take into account the impact on right ventricular function, and vice versa. A rational approach to the management of pulmonary hypertension should focus not only on specific dynamics of that low pressure circuit but also on enhancing the function of the right ventricle. In this article, a comprehensive discussion of recent developments in pharmacologic and surgical therapies is provided for the complicated disorder of pulmonary hypertension.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"191-197"},"PeriodicalIF":0.0,"publicationDate":"2013-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613490954","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Focused Transthoracic Echocardiography Performed and Interpreted by Medical Residents in the Critically Ill 危重病人住院医师的重点经胸超声心动图的执行和解释
ICU director Pub Date : 2013-05-15 DOI: 10.1177/1944451613488798
J. Caronia, R. Kutnick, A. Sarzynski, G. Panagopoulos, Ramyar Mahdavi, B. Mina
{"title":"Focused Transthoracic Echocardiography Performed and Interpreted by Medical Residents in the Critically Ill","authors":"J. Caronia, R. Kutnick, A. Sarzynski, G. Panagopoulos, Ramyar Mahdavi, B. Mina","doi":"10.1177/1944451613488798","DOIUrl":"https://doi.org/10.1177/1944451613488798","url":null,"abstract":"Purpose. Intensivist-performed focused echocardiography (FE) is accepted practice. Whether medical residents can perform and interpret quality FE in the critically ill is unknown. Methods. Novice residents trained in an 8-hour module in FE, evaluating ejection fraction (EF), pericardial effusion, right ventricular (RV) strain, valvular pathology, wall motion abnormalities (WMAs), and inferior vena cava collapsibility in patients awaiting comprehensive echocardiograms. The Fleiss kappa (κ), sensitivity, specificity, positive predictive values, and negative predictive values were calculated against the comprehensive echocardiogram. Results. Seven residents performed 102 FE, demonstrating substantial agreement with cardiologists for EF as decreased versus normal or hyperdynamic (κ = .67, P < .001, sensitivity = 94%, specificity = 93%) and pericardial effusion (κ = .60, P < .001, sensitivity = 85%, specificity = 93%); moderate agreement for aortic stenosis (κ = .54, P < .001, sensitivity = 56%, specificity = ...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"177-182"},"PeriodicalIF":0.0,"publicationDate":"2013-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613488798","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 5
Can the Intracuff Pressure Be Estimated by Palpation of the Pilot Balloon 可通过触诊引航气囊来估计颅内压力吗
ICU director Pub Date : 2013-05-15 DOI: 10.1177/1944451613489310
J. Bryant, J. Werner, E. Moss, J. Tobias
{"title":"Can the Intracuff Pressure Be Estimated by Palpation of the Pilot Balloon","authors":"J. Bryant, J. Werner, E. Moss, J. Tobias","doi":"10.1177/1944451613489310","DOIUrl":"https://doi.org/10.1177/1944451613489310","url":null,"abstract":"Background. Over the past 5 years, there has been a change in the clinical practice of pediatric anesthesiology with a transition to the use of cuffed instead of uncuffed endotracheal tubes in infants and children. However, there has been limited attention to techniques to ensure a safe intracuff pressure. We sought to determine the accuracy of estimating endotracheal tube intracuff pressure by palpation of the pilot balloon by anesthesiologists, anesthesia residents, pediatric anesthesia fellows, certified nurse anesthetists, and student nurse anesthetists. Methods. A tracheal simulation model was constructed with 3 different diameters of polyvinylchloride tubing. Three different-sized endotracheal tubes (4.0, 5.0, and 6.0 mm) were then placed into the tubes and the cuffs inflated to various pressures. Each participant was given 3 different scenarios of cuff pressure for each endotracheal tube size for a total of 9 scenarios per practitioner. By feeling the pilot balloon, the anesthesia provider was aske...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"1 1","pages":"170-172"},"PeriodicalIF":0.0,"publicationDate":"2013-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613489310","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898165","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Emerging Topics in the Surgical and Critical Care Treatment of Trauma Patients 创伤患者外科和重症监护治疗的新课题
ICU director Pub Date : 2013-05-12 DOI: 10.1177/1944451613485420
M. Cripps
{"title":"Emerging Topics in the Surgical and Critical Care Treatment of Trauma Patients","authors":"M. Cripps","doi":"10.1177/1944451613485420","DOIUrl":"https://doi.org/10.1177/1944451613485420","url":null,"abstract":"In 1896, Bridget Driscoll had the dubious honor of becoming the first fatality from an auto versus pedestrian collision. At the coroner’s inquiry, the judge stated that he “trusted that this sort of nonsense will never happen again” (How the UK’s first fatal car accident unfolded. BBC News Magazine. 2010. http://www.bbc.co.uk/news/magazine-10987606). Unfortunately, more than 100 years later, fatalities still occur, but the treatment of trauma patients has greatly improved as a result of both the basic science and clinical research of traumatic injuries. The purpose of this discussion is to include a brief description of 3 topics in the surgery of trauma that have been widely discussed at national conferences and have had important new publications in the past year. Although this discussion cannot be all inclusive, it should highlight the important facts and help provide a general overview of these exciting advances in the critical care of trauma patients.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"173-176"},"PeriodicalIF":0.0,"publicationDate":"2013-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613485420","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Acute Pancreatitis in a Patient With Diabetic Ketoacidosis and Normal Lipase Levels 脂肪酶水平正常的糖尿病酮症酸中毒患者的急性胰腺炎
ICU director Pub Date : 2013-05-12 DOI: 10.1177/1944451613488419
E. Argueta, K. Nugent
{"title":"Acute Pancreatitis in a Patient With Diabetic Ketoacidosis and Normal Lipase Levels","authors":"E. Argueta, K. Nugent","doi":"10.1177/1944451613488419","DOIUrl":"https://doi.org/10.1177/1944451613488419","url":null,"abstract":"The diagnosis of acute pancreatitis requires clinical, biochemical, and occasionally imaging information. Biochemical criteria include serum lipase levels, which are considered both sensitive and specific for the diagnosis of acute pancreatitis. Patients with diabetic ketoacidosis often have abdominal pain that may be related to the ongoing metabolic derangement or to precipitating intra-abdominal pathology. The pain severity in diabetic ketoacidosis helps determine whether abdominal disease should be further investigated. We present a patient with diabetic ketoacidosis and acute pancreatitis who had no significant elevation of amylase and lipase. The patient had abdominal pain that persisted despite ongoing treatment with intravenous insulin for ketoacidosis. The pain was initially located in the epigastrium and then migrated to the right lower quadrant. An abdominal computed tomography scan was obtained to exclude acute appendicitis, and this study revealed peripancreatic fluid consistent with acute pan...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"166-169"},"PeriodicalIF":0.0,"publicationDate":"2013-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613488419","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898109","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 4
A Central Venous Catheter Line Protocol by the Surgical Continuum of Care and Nursing Decreases Line Infection/Complications in All Hospitalized Patients Two Steps Beyond a Checklist 通过外科连续护理和护理的中心静脉导管方案减少了所有住院患者的线感染/并发症
ICU director Pub Date : 2013-05-01 DOI: 10.1177/1944451613480180
Garry Ritter, Mike Kuncewitch, Alison Roditi, Thomas Bily, Llene Lennon, Elissa Wolff, Tara Laumenede, R. Barrera
{"title":"A Central Venous Catheter Line Protocol by the Surgical Continuum of Care and Nursing Decreases Line Infection/Complications in All Hospitalized Patients Two Steps Beyond a Checklist","authors":"Garry Ritter, Mike Kuncewitch, Alison Roditi, Thomas Bily, Llene Lennon, Elissa Wolff, Tara Laumenede, R. Barrera","doi":"10.1177/1944451613480180","DOIUrl":"https://doi.org/10.1177/1944451613480180","url":null,"abstract":"Background. Central line–associated bloodstream infection (CLABSI) is the third most common nosocomial infection reported from the medical/surgical ICU setting. Rationale. The implementation of a central line protocol using a 3-part checklist would help ensure that all processes related to central line placement are executed for each line placement during the time it is used, thereby leading to improved outcomes. Physician assistants and nurses would be empowered to supervise the checklist and to stop or change the process if warranted. Methods. The intensivists performed a daily needs assessment of all central venous catheters (CVCs) in their respective ICUs. If the CVC was deemed unnecessary it was removed. The Surgical Continuum of Care comprised surgical physician assistants who made daily assessments of all CVCs among non-ICU inpatients. We hypothesized that these physician assistants would expedite the removal of CVCs among non-ICU inpatients. This would lead to a decreased number of central line da...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"121-127"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613480180","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
Repeated Respiratory Failure and Failed Extubation Following Intraoperative Advanced Airway Device Endotracheal Intubation 术中先进气道设备气管插管后反复呼吸衰竭和拔管失败
ICU director Pub Date : 2013-05-01 DOI: 10.1177/1944451613483551
K. Hatton, A. Rebel, A. Layon
{"title":"Repeated Respiratory Failure and Failed Extubation Following Intraoperative Advanced Airway Device Endotracheal Intubation","authors":"K. Hatton, A. Rebel, A. Layon","doi":"10.1177/1944451613483551","DOIUrl":"https://doi.org/10.1177/1944451613483551","url":null,"abstract":"Intraoperative airway management by anesthesiology providers has evolved over the years to include many specialized devices and techniques that can have tremendous impact on the care of the perioperative critically ill patient. When perioperative patient care issues arise, anesthesiologists and perioperative critical care specialists should both be actively involved in a dialogue regarding many the relevant patient care issues, including any airway and respiratory function problems. Additionally, critical care specialists should be familiar with the use and potential complications of the increasingly diverse airway (and non-airway) tools and devices used by anesthesiologists in the operating room. The authors present a case report of a 66-year-old man who suffered repeated postoperative respiratory failure following an uncomplicated upper extremity orthopedic procedure. The patient developed unexplained, repeated postoperative respiratory failure that necessitated reintubation related to the accidental an...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"128-131"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613483551","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65898029","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Malignant Hyperthermia or Not Malignant Hyperthermia A Diagnostic Conundrum 恶性热疗或非恶性热疗:诊断难题
ICU director Pub Date : 2013-05-01 DOI: 10.1177/1944451613479400
A. Bautista, S. Tongprasert
{"title":"Malignant Hyperthermia or Not Malignant Hyperthermia A Diagnostic Conundrum","authors":"A. Bautista, S. Tongprasert","doi":"10.1177/1944451613479400","DOIUrl":"https://doi.org/10.1177/1944451613479400","url":null,"abstract":"In an acute event, the diagnosis of malignant hyperthermia (MH) in patients in the ICU can be challenging. Initial presentation may be attributed to a gamut of causes, making the diagnosis complicated. This example is the case of a 46-year-old African American man who was admitted to the Stroke Service and intubated for respiratory distress. To facilitate intubation, he was given etomidate and succinylcholine. Within an hour, a sustained increase in arterial carbon dioxide concentration, rhabdomyolysis, and later on, hyperthermia, developed. He was started on broad-spectrum antibiotics, aggressive fluid hydration, and mechanical ventilation. He had had one previous uneventful anesthesia exposure and he denied having any family member having anesthesia complications. With a very convoluted presentation, a high degree of suspicion for MH warranted appropriate treatment to avoid significant morbidity and/or mortality. Moreover, until the diagnosis is confirmed, education regarding the disease process to pati...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"143-146"},"PeriodicalIF":0.0,"publicationDate":"2013-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451613479400","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897629","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 3
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