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Perioperative Management of the Fontan Operation in an Adolescent With a Single Lung 青少年单肺Fontan手术的围手术期处理
ICU director Pub Date : 2012-10-30 DOI: 10.1177/1944451612464237
P. Kim, Jacob Bettesworth, M. Corridore, M. Galantowicz, J. Tobias
{"title":"Perioperative Management of the Fontan Operation in an Adolescent With a Single Lung","authors":"P. Kim, Jacob Bettesworth, M. Corridore, M. Galantowicz, J. Tobias","doi":"10.1177/1944451612464237","DOIUrl":"https://doi.org/10.1177/1944451612464237","url":null,"abstract":"The Fontan operation is performed to correct complex cardiac malformations characterized by single ventricle physiology. Following the procedure, the systemic venous blood flows directly into the lungs without passing through the single ventricle. Consequently, the Fontan circulation requires passive venous flow to the lungs, making it imperative for the pulmonary vascular resistance to be kept low in order to maintain adequate pulmonary blood flow and cardiac output. Given that the pulmonary circulation is important for a successful Fontan physiology, it would be intuitive that a single lung Fontan operation would do poorly because of the major loss in pulmonary vascular bed and the subsequent increase in pulmonary vascular resistance. The authors present a 14-year-old adolescent who was born with tricuspid atresia, pulmonary atresia, and right ventricular hypoplasia who underwent a successful Fontan operation into a single right lung, the left pulmonary artery being hypoplastic and disconnected from the...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"265-270"},"PeriodicalIF":0.0,"publicationDate":"2012-10-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612464237","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896961","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: 2
Respiratory Complications and Management of Mechanical Ventilation in Cervical Spine Injury 颈椎损伤机械通气的呼吸并发症及处理
ICU director Pub Date : 2012-10-01 DOI: 10.1177/1944451612457568
M. Kearns, David Shimabukuro
{"title":"Respiratory Complications and Management of Mechanical Ventilation in Cervical Spine Injury","authors":"M. Kearns, David Shimabukuro","doi":"10.1177/1944451612457568","DOIUrl":"https://doi.org/10.1177/1944451612457568","url":null,"abstract":"It is estimated that the annual incidence of spinal cord injury in the United States is 12 000 new cases per year. Victims of spinal cord injury are prone to developing respiratory complications such as atelectasis, pneumonia, and ventilatory failure secondary to physiologic derangements resulting from spinal shock and paralysis. Respiratory complications are the leading cause of death in those who survive the initial injury. The goal in ventilator management of spinal cord injury patients in the intensive care unit setting is to prevent these complications and optimize patients for early transfer to a spinal cord rehabilitation facility. To minimize atelectasis, current guidelines recommend the use of very high tidal volumes (15 mL/kg) or setting high tidal volumes (10 mL/kg) in addition to using positive end-expiratory pressure. In this article, the authors discuss the pulmonary complications that affect the mortality of these patients and review the evidence behind the current high tidal volume ventila...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"220-223"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612457568","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896853","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: 6
Management of the Complex Trauma Patient With Limited Resources 资源有限的复杂创伤患者的处理
ICU director Pub Date : 2012-10-01 DOI: 10.1177/1944451612460401
Panna A Codner, K. Brasel
{"title":"Management of the Complex Trauma Patient With Limited Resources","authors":"Panna A Codner, K. Brasel","doi":"10.1177/1944451612460401","DOIUrl":"https://doi.org/10.1177/1944451612460401","url":null,"abstract":"Trauma systems provide lifesaving care for complex trauma patients but at a significant cost. With both government and private funding sources becoming scarce, the business principles of process improvement and control have been applied to health care, simultaneously shifting the focus to quality and profit. Expenses are decreased by limiting costs for materials, limiting unnecessary training, and reducing both variability and complications. Training requirements for any particular task or patient care activity are reduced by establishing routine protocols to enable physician assistants and nurse practitioners to perform duties that at one time were performed only by physicians. Routine algorithms for items such as ICU and postoperative management all reduce variability and result in standardized care. This permits analysis and performance improvement within a hospital and across hospitals nationally. To this end, the American College of Surgeons National Surgical Quality Improvement Project is a risk-adj...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"261-264"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612460401","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896902","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
Prolonged Profound Hypoxia and Cardiac Failure in a Young Woman Presenting to the Emergency Department Unexpected Pulmonary Embolus, Catheter-Directed Thrombolysis, and Subsequent Multi-Organ Failure 一名年轻女性因意外肺栓塞、导管溶栓和随后的多器官衰竭而就诊于急诊科的长期深度缺氧和心力衰竭
ICU director Pub Date : 2012-10-01 DOI: 10.1177/1944451612455500
K. Breyer, Joel Ou, J. Durack, A. Prakash
{"title":"Prolonged Profound Hypoxia and Cardiac Failure in a Young Woman Presenting to the Emergency Department Unexpected Pulmonary Embolus, Catheter-Directed Thrombolysis, and Subsequent Multi-Organ Failure","authors":"K. Breyer, Joel Ou, J. Durack, A. Prakash","doi":"10.1177/1944451612455500","DOIUrl":"https://doi.org/10.1177/1944451612455500","url":null,"abstract":"Pulmonary emboli are rare occurrences in young patients, especially those who present precipitously to the emergency department. In a young unresponsive patient, recognition of thromboembolic etiology may be delayed due to atypical presenting physiology or competing diagnoses. In this report, the authors describe an initially confounding case of catastrophic bilateral pulmonary emboli in a young woman who presented to the emergency department having been found unconscious on the street. Despite severe and prolonged hypoxia as well as multi-organ failure, the patient achieved a near complete recovery. © 2012 The Author(s).","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"215-219"},"PeriodicalIF":0.0,"publicationDate":"2012-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612455500","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897242","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
Neuro Excellence in the ICU Another Model for a Neuro-ICU 神经ICU的另一种模式
ICU director Pub Date : 2012-09-01 DOI: 10.1177/1944451612455663
H. Peled, L. Ramos, M. Katz
{"title":"Neuro Excellence in the ICU Another Model for a Neuro-ICU","authors":"H. Peled, L. Ramos, M. Katz","doi":"10.1177/1944451612455663","DOIUrl":"https://doi.org/10.1177/1944451612455663","url":null,"abstract":"There is significant literature showing improved outcomes in patients who are cared for in a specialized neurocritical care unit. The authors propose a model where the key aspects of specialized neurocrticial care can be provided within the framework of an existing ICU in an efficient and effective manner as an alternative to a separate neurocritical care unit. The key aspects of programmatic success are described.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"235-239"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612455663","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896793","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
Updates in the Acute Respiratory Distress Syndrome: Definitions, Epidemiology, Pathogenesis, and Treatment 急性呼吸窘迫综合征的最新进展:定义、流行病学、发病机制和治疗
ICU director Pub Date : 2012-09-01 DOI: 10.1177/1944451612457409
E. Seeley
{"title":"Updates in the Acute Respiratory Distress Syndrome: Definitions, Epidemiology, Pathogenesis, and Treatment","authors":"E. Seeley","doi":"10.1177/1944451612457409","DOIUrl":"https://doi.org/10.1177/1944451612457409","url":null,"abstract":"Acute respiratory distress syndrome (ARDS) is a common cause of respiratory failure in medical and surgical ICUs, totaling an estimated 200 000 cases per year in the United States. Despite improved supportive care, the mortality associated with ARDS remains high (30% to 40%). ARDS results from a variety of direct or indirect insults, including sepsis, aspiration, and trauma, all of which lead to pulmonary endothelial and epithelial injury. Several recent trials have led to improvements in the care of patients with ARDS, including the use of a fluid conservative treatment strategy and the use of neuromuscular blockade for severe ARDS. Patients with refractory hypoxemia due to ARDS may benefit from advanced therapies, including inhaled nitric oxide and extracorporeal life support; however, evidence from large clinical trials is lacking. Currently, clinical trials are underway for the treatment of ARDS with statins and inhaled heparin and preclinical evidence is promising for adoptive cellular therapy with m...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"224-229"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612457409","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896845","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
The Thief in the Night 夜贼
ICU director Pub Date : 2012-09-01 DOI: 10.1177/1944451612460437
C. S. Yost
{"title":"The Thief in the Night","authors":"C. S. Yost","doi":"10.1177/1944451612460437","DOIUrl":"https://doi.org/10.1177/1944451612460437","url":null,"abstract":"","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"171 1","pages":"213-214"},"PeriodicalIF":0.0,"publicationDate":"2012-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612460437","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896918","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
Initial experience with Imacor hTEE-guided management of patients following transplant and mechanical circulatory support. Imacor htee引导下移植和机械循环支持患者管理的初步经验。
ICU director Pub Date : 2012-08-22 DOI: 10.1177/1944451612456703
Christpher Y. Kang, H. Hirose, H. Hastings, N. Cavarocchi
{"title":"Initial experience with Imacor hTEE-guided management of patients following transplant and mechanical circulatory support.","authors":"Christpher Y. Kang, H. Hirose, H. Hastings, N. Cavarocchi","doi":"10.1177/1944451612456703","DOIUrl":"https://doi.org/10.1177/1944451612456703","url":null,"abstract":"This study reviews an initial experience using a miniaturized transesophageal echocardiography (TEE) probe (ImaCor, Garden City, NY) with 3 patients in whom Imacor hTEE intervention was used as a point-of-care device to manage extracorporeal membrane oxygenation cannula placement, cardiac hemodynamics, and postoperative cardiac pathophysiology. The management of transplant or mechanical circulatory support (MCS) patients is especially challenging: Transplanted hearts pose unique pathophysiological challenges, and MCS significantly alters pressure–volume–flow relationships. Real-time “hemodynamic” TEE (hTEE) can help provide effective management by direct visualization of cardiac filling and function and help guide hemodynamic management. In the authors’ initial experience, hTEE can provide point-of-care management following transplant or MCS.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"230-234"},"PeriodicalIF":0.0,"publicationDate":"2012-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612456703","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896810","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: 2
Successful ICU Care of a 14-Year-Old With Total Artificial Circulation Using Two Ventricular Assist Devices for 118 Days 一名14岁全人工循环使用两种心室辅助装置118天的成功ICU护理
ICU director Pub Date : 2012-08-22 DOI: 10.1177/1944451612456702
R. Silverman, Sean M. Quinn
{"title":"Successful ICU Care of a 14-Year-Old With Total Artificial Circulation Using Two Ventricular Assist Devices for 118 Days","authors":"R. Silverman, Sean M. Quinn","doi":"10.1177/1944451612456702","DOIUrl":"https://doi.org/10.1177/1944451612456702","url":null,"abstract":"Within the first year following orthotopic heart transplantation, the patient is at risk of graft failure, rejection, and infection. Late mortality is often due to allograph vasculopathy. Most of the patients with primary graft failure will usually recover with temporary mechanical ventricular assist support; however, on occasion the patient must be retransplanted. For the patient who suffers primary graft failure necessitating explanation and bridging until a new suitable graft is found, there are several total artificial heart options. However, in the pediatric population these options are limited. The authors’ surgical colleagues were able to fashion a paracorporeal total artificial heart constructed with 2 ventricular assist devices. In this case report, the authors discuss a pediatric patient who had to be explanted and supported for an extended amount of time. This article describes the incidence of cardiomyopathy in juvenile rheumatoid arthritis patients, the choice of extracorporeal membrane oxyge...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"59 1","pages":"240-246"},"PeriodicalIF":0.0,"publicationDate":"2012-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612456702","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896799","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
The Effects of Hypertriglyceridemia on Plasma Free Hemoglobin Levels and Extracorporeal Membrane Oxygenation Support 高甘油三酯血症对血浆游离血红蛋白水平和体外膜氧合支持的影响
ICU director Pub Date : 2012-08-07 DOI: 10.1177/1944451612452593
J. Ruiz, Veronica Armijo-Garcia
{"title":"The Effects of Hypertriglyceridemia on Plasma Free Hemoglobin Levels and Extracorporeal Membrane Oxygenation Support","authors":"J. Ruiz, Veronica Armijo-Garcia","doi":"10.1177/1944451612452593","DOIUrl":"https://doi.org/10.1177/1944451612452593","url":null,"abstract":"Exposure of patients to significant hemolysis can lead to serious clinical sequelae. Plasma free hemoglobin (pFHgb) is used during extracorporeal membrane oxygenation (ECMO) support to monitor ongoing hemolysis that is a consequence of mechanical forces applied to the red blood cells. This publication presents the case of a 3-year-old child who required ECMO support due to severe pneumonia. During her ECMO course, she developed severe elevations of pFHgb that were of questionable validity. Additional laboratory findings suggested a concurrent hypertriglyceridemia to be the potential cause for these false elevations. Linear regression analysis was employed and revealed a statistically significant (P = .006) moderate correlation between pFHgb and triglyceride levels (R = .69). The analysis reinforces the theory that hypertriglyceridemia may lead to false increases in pFHgb, which may complicate a patient’s clinical picture and influence management decisions. Therefore, it should not be the sole value used t...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"176-178"},"PeriodicalIF":0.0,"publicationDate":"2012-08-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451612452593","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65897106","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
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