ICU director最新文献

{"title":"Cuffed Endotracheal Tubes in Infants and Children A Technique to Ensure an Acceptable Intracuff Pressure","authors":"J. Tobias, S. Gopalakrishnan, J. Rice, K. Jatana, Charles A. Elmaraghy, Meredith N. Merz","doi":"10.1177/1944451612471190","DOIUrl":"https://doi.org/10.1177/1944451612471190","url":null,"abstract":"Background. Over the past 5 to 10 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 (ETTs) in infants and children. When such tubes are used in clinical practice, it is imperative to ensure that the intracuff pressure is ≤30 cm H2O. To date, there are limited data regarding techniques to ensure this practice. Methods. Following endotracheal intubation with a cuffed ETT, a stethoscope was placed in the sternal notch and continuous positive airway pressure of 20 to 25 cm H2O held. The fresh gas flow was increased as needed to achieve a gradual rise of the airway pressure. Using a syringe, air was added to the cuff until no air escape or leak was heard. The intracuff pressure was checked using a handheld manometer (Posey Cufflator Endotracheal Tube Inflator and Manometer, JT Posey Company, Arcadia, CA). Results. The cohort for the study included 200 patients ranging in age from 6 months to 18 years...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"140 1","pages":"62-64"},"PeriodicalIF":0.0,"publicationDate":"2013-01-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612471190","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897159","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}

{"title":"Clinical Research in the ICU: A Program for Success in Challenging Times","authors":"E. E. Turner, M. Rosen, M. Hosseini","doi":"10.1177/1944451612467535","DOIUrl":"https://doi.org/10.1177/1944451612467535","url":null,"abstract":"In times of shrinking departmental budgets, physician attrition, restricted house staff work hours, and reductions in grant funding, there has been a trend towards migration of physicians away from academic medicine. Creative solutions to maintain clinical research programs are frequently necessary. At the University of California Irvine Medical Center, a clinical research program has been created that has allowed research to both survive and thrive in challenging times. The MICU Research Associates Program (MICU-RAP) provides a longitudinal experience for select undergraduate students to facilitate research as part of the MICU team while receiving academic credit and valuable experience. The MICU-RAP student coordinator and faculty advisor work together to recruit research associates, organize weekly meetings, create and implement research protocols, and mentor students and future physician-scientists. Student research associates are trained to develop and maintain a secure database, assist in the author...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"40-43"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612467535","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897115","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}

{"title":"Red Blood Cell Transfusion Practices Can High-Intensity ICU Staffing Stem the Tide?","authors":"Edwin L. Annan, K. Fless, N. Jasani, F. Pierre-Louis, F. Rezai, P. Yodice","doi":"10.1177/1944451612467534","DOIUrl":"https://doi.org/10.1177/1944451612467534","url":null,"abstract":"","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"11-14"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612467534","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897019","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}

{"title":"Comparison of Two Rapid Response Teams Models Reduction of Rapid Response Triggers and Cardiac Arrests by the Continuum of Care Model Compared With Traditional Rapid Response Team","authors":"Garry Ritter, T. Johnson, H. Walden, Cordelia Sharma, Alison Corley, T. Ravikumar, R. Barrera","doi":"10.1177/1944451612470446","DOIUrl":"https://doi.org/10.1177/1944451612470446","url":null,"abstract":"Background. Although rapid response teams (RRTs) decrease in-house cardiac arrests, significant debate exists surrounding their impact on patient outcomes. We have implemented the continuum of care...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"6-10"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612470446","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896936","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}

{"title":"Ventricular Assist Devices in the ICU: Indications, Physiology, and Management","authors":"R. Joshi","doi":"10.1177/1944451612470447","DOIUrl":"https://doi.org/10.1177/1944451612470447","url":null,"abstract":"Since 2001, ventricular assist devices (VADs), total artificial hearts, and a growing number of devices have become increasingly more commonplace options to heart failure management and viable alternatives to heart transplantation. Cardiothoracic step-down and intensive care units will likely be managing more and more patients on mechanical circulation in the future. This review will briefly give an introduction to VAD function, types of VADs, the characteristics of VAD patients, and management issues in the ICU that may arise with these patients.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"15-21"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612470447","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897086","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}

{"title":"Cerebral Oximetry During Prolonged Cardiac Arrest and Percutaneous Coronary Intervention : A Report on Five Cases","authors":"H. Wagner, Bjarne Madsen-Hardig, M. Rundgren, J. Harnek, Matthias Götberg, G. Olivecrona","doi":"10.1177/1944451612469225","DOIUrl":"https://doi.org/10.1177/1944451612469225","url":null,"abstract":"Objective. To evaluate the feasibility of cerebral oximetry (SctO2) with arterial blood pressure (ABP), central venous pressure (CVP), end tidal carbon dioxide (ETCO2), pulse oximetry (SpO2), and arterial blood gases during resuscitation in the coronary catheterization laboratory (cath-lab) setting. Design. We have implemented SctO2 in our cath-lab when cardiac arrest patients are in the need of prolonged resuscitation efforts with mechanical chest compressions (MCC) during simultaneous percutaneous coronary intervention (PCI). Setting. An academic coronary catheterization laboratory. Patients. Five cardiac arrest patients required prolonged resuscitation efforts with MCC in the cath-lab during simultaneous PCI. Results. During MCC, median SctO2 (n = 5) was 47%, median systolic ABP (n = 5) was 88 mm Hg, mean ABP (n = 5) was 58 mm Hg, coronary perfusion pressure (n = 3) was 19 mm Hg, SpO2 (n = 4) was 81%, and ETCO2 (n = 4) was 18.8 torr (2.5 kPa). Four patients had a successful PCI, including 1 patient wit...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"22-32"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612469225","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897126","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}

{"title":"Challenges in the Management of the Open Abdomen","authors":"David J. Worhunsky, G. Magee, D. Spain","doi":"10.1177/1944451612469628","DOIUrl":"https://doi.org/10.1177/1944451612469628","url":null,"abstract":"First described more than 60 years ago, the open abdomen has now become a relatively common entity in surgical ICUs. Although the indications for an open abdomen have evolved since the original description of the damage control laparotomy, the goal remains to provide an unstable or critically ill patient time to correct their physiologic derangements. Temporary abdominal closure is thus used as a bridge to definitive repair and closure. Unfortunately, the open abdomen is associated with significant morbidity and mortality, and recent studies have suggested an overuse of the technique. Once the decision is made to proceed with an open abdomen, multiple options exist for temporary abdominal closure. The hope is to obtain definitive closure shortly thereafter in an attempt to reduce potential complications including intra-abdominal infection or enteroatmospheric fistula. Options for temporary closure range from the Bogota bag to vacuum-assisted techniques; a combined technique of sequential fascial closure w...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"4 1","pages":"33-39"},"PeriodicalIF":0.0,"publicationDate":"2013-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612469628","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897264","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}

{"title":"Updates in the Management of Acute Lung Injury","authors":"A. Dharia, C. Calfee","doi":"10.1177/1944451612466107","DOIUrl":"https://doi.org/10.1177/1944451612466107","url":null,"abstract":"Acute lung injury (ALI) is commonly encountered in the ICU and is associated with significant mortality. The mainstay of therapy continues to be aggressive supportive care, including low tidal volume ventilation and fluid conservative strategies. Recent developments in the field of ALI include a proposal to modify the diagnostic criteria for ALI in the Berlin Definition and recent randomized controlled trials of the use of neuromuscular blockade, beta-agonists, and feeding strategies. The goal of this article is to review, summarize, and comment on these emerging data and offer practical recommendations for the evidence-based management of ALI.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"287-292"},"PeriodicalIF":0.0,"publicationDate":"2012-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612466107","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896975","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}

{"title":"Therapeutic Hypothermia after Perioperative Cardiac Arrest in Cardiac Surgical Patients.","authors":"Thomas W Rinehart,&nbsp;Matthias J Merkel,&nbsp;Peter M Schulman,&nbsp;Michael P Hutchens","doi":"10.1177/1944451612461526","DOIUrl":"https://doi.org/10.1177/1944451612461526","url":null,"abstract":"<p><p>BACKGROUND: Therapeutic hypothermia (TH) has been established as an effective treatment for preserving neurological function after out of hospital cardiac arrest (CA). Use of TH has been limited in cardiac surgery patients in particular because of concern about adverse effects such as hemorrhage and dysrhythmia. Little published data describe efficacy or safety of TH in cardiac surgical patients who suffer unintentional CA. However, the benefits of TH are such as may suggest clinical equipoise, even in this high risk patient population. OBJECTIVE: To report a series of three patients in our institution's cardiac surgery intensive care unit who suffered unintentional CA within 48 hours of cardiac surgery and were treated with TH. METHODS: After institutional review board approval, study patients were identified by diagnosis of undesired intraoperative CA or arrest on ICU days 1-2, as well as having documented TH. The institution's electronic medical record and the Society of Thoracic Surgeons database were retrospectively reviewed for demographic information, comorbid diagnoses, surgical procedure, and outcomes including hemorrhage, re-warming dysrhythmias, infection, in-hospital mortality, and neurologic outcome were assessed. TH was initiated and monitored using active cooling pads according to written institutional protocol. RESULTS: Four patients received TH after perioperative arrest. One patient was inadequately cooled and had massive surgical bleeding, and was therefore excluded from this review. The remaining three patients had a predicted mortality of 14.6% (±13.3) based on Euroscore calculation, and were cooled for 17.6±4.0 hours after CA. Coagulopathy, hypovolemia, severe electrolyte abnormalities, and re-warming dysrhythmias were not identified in any patient. 2 patients were discharged home and 1 was discharged to a long-term care facility. CONCLUSION: Herein we report the safe and successful use of TH after unintentional perioperative CA in 3 cardiac surgery patients. These data suggest that further investigation of this therapy may be warranted given the potential benefit and apparent safety in a small series.</p>","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 6","pages":"271-278"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612461526","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"31248579","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"When the Critically Ill Patient Requires Surgery: A Review of Perioperative Considerations for the Surgical Patient With ALI/ARDS","authors":"Anne L. Donovan, Matthew J. Haight","doi":"10.1177/1944451612457569","DOIUrl":"https://doi.org/10.1177/1944451612457569","url":null,"abstract":"Patients with acute lung injury or acute respiratory distress syndrome present many challenges in the perioperative setting. Maintaining oxygenation and hemodynamic stability requires a comprehensi...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"279-286"},"PeriodicalIF":0.0,"publicationDate":"2012-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612457569","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896861","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}