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Transesophageal Echocardiography–Guided Hemodynamic Assessment and Management 经食管超声心动图引导下的血流动力学评估与处理
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611434514
H. Hastings
{"title":"Transesophageal Echocardiography–Guided Hemodynamic Assessment and Management","authors":"H. Hastings","doi":"10.1177/1944451611434514","DOIUrl":"https://doi.org/10.1177/1944451611434514","url":null,"abstract":"Hemodynamic instability (shock) poses a major challenge in intensive care and is associated with increased mortality, morbidity, length of stay, and costs. The purpose of hemodynamic assessment and management is to detect the cause of hemodynamic instability in a given patient, provide actionable information for the physician, and thus help guide the management and resolution of hemodynamic instability. Although transesophageal echocardiography (TEE) has been the gold standard for hemodynamic assessment and management in the cardiac operating room, the invasive nature of conventional TEE has limited its use as a management tool in intensive care. Instead, one has seen a variety of indirect hemodynamic monitors used, despite now well understood limitations as described in a previous Critical Conversation in the July 2011 issue of this journal. Here we describe the use of TEE in intensive care as well as a new TEE system (the ImaCor hTEE system, ImaCor, Garden City, NY) with a miniaturized (approximately na...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"38-41"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611434514","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895527","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
The Patient With Suspected Obstructive Sleep Apnea Guidelines for Perioperative Management and ICU Care 疑似阻塞性睡眠呼吸暂停患者围手术期管理和ICU护理指南
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611431697
C. Tam, D. Claman
{"title":"The Patient With Suspected Obstructive Sleep Apnea Guidelines for Perioperative Management and ICU Care","authors":"C. Tam, D. Claman","doi":"10.1177/1944451611431697","DOIUrl":"https://doi.org/10.1177/1944451611431697","url":null,"abstract":"Obstructive sleep apnea is a commonly encountered problem in the perioperative period. In this article, guidelines are proposed to help physicians identify at-risk patients preoperatively and to guide subsequent intraoperative and postoperative monitoring and management.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"21-26"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611431697","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895796","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
Pre-ICU Management of Patients With Head Trauma 颅脑外伤患者的icu前处理
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611431451
Julin F. Tang, S. Stiver
{"title":"Pre-ICU Management of Patients With Head Trauma","authors":"Julin F. Tang, S. Stiver","doi":"10.1177/1944451611431451","DOIUrl":"https://doi.org/10.1177/1944451611431451","url":null,"abstract":"Patients presenting with traumatic brain injury (TBI) pose special challenges for critical care personnel throughout the hospital, especially for emergency depart- ment and operating room personnel who care for TBI patients during their initial evaluation. Many of these patients proceed from the emergency department to an operating room for emergent cranial decompression en route to the ICU. At the authors' hospital, a level I trauma center, steps have been taken to improve treatment in this pre-ICU care setting. In this report, the authors describe changes that have been made over time in the care of patients with TBI and the improved patient mortality that occurred after the introduc- tion of these practice changes. The measures consisted of early goal-directed flresusci- tation to correct intravascular volume deple- tion and vigilant hemodynamic monitoring by arterial line, central venous pressure, and transesophageal echocardiography. Despite these improved results, additional studies are needed to better defi ne the best early treat- ment practices for the TBI patient.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"42-47"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611431451","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895513","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
Cuff Leak Tests at the Time of Extubation Correlate With Voice Quality Assessment 拔管时袖带泄漏测试与语音质量评估相关
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611433836
S. Radhi, D. Guerra, R. Alalawi, R. Raj, K. Nugent
{"title":"Cuff Leak Tests at the Time of Extubation Correlate With Voice Quality Assessment","authors":"S. Radhi, D. Guerra, R. Alalawi, R. Raj, K. Nugent","doi":"10.1177/1944451611433836","DOIUrl":"https://doi.org/10.1177/1944451611433836","url":null,"abstract":"Background. Endotracheal intubation frequently causes laryngeal injury, including edema, ulceration, and vocal cord immobility. These problems can complicate the immediate postextubation course. Methods. The authors measured the cuff leak and made bedside assessment of the voice in 51 patients requiring mechanical ventilation for acute respiratory failure. Results. The median tidal volume was 450 mL (range = 300-600 mL). The median duration of ventilation was 3 days (range = 0-19 days). The median cuff leak was 180 mL (range = −33 to 460 mL); the median percentage cuff leak was 40.9% (range = −7.75% to 99.2%). Women had significantly smaller cuff leaks (18.6% of tidal volume vs 50.3% in men, P = .01). Patients with hoarseness frequently had smaller cuff leaks (median 24.1% vs. 46.7% in nonhoarse patients). Eleven patients (84.6%, 11/13) with a cuff leak 15% had hoarseness (P = .01). Four patients had stridor, and all had a cuff leak >15% of the ti...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"108 1","pages":"27-30"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611433836","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895411","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
Early Mobilization in Critically Ill Patients 危重患者的早期动员
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611435275
N. Lunardi, M. Bryant, Kellen Smith, S. Lowson
{"title":"Early Mobilization in Critically Ill Patients","authors":"N. Lunardi, M. Bryant, Kellen Smith, S. Lowson","doi":"10.1177/1944451611435275","DOIUrl":"https://doi.org/10.1177/1944451611435275","url":null,"abstract":"Mortality in the ICU has dramatically decreased over the past decades because of a clearer understanding of disease pathophysiology, improved technology, and novel therapies. This success has led to the new challenge of treating patients with chronic disabilities resulting from prolonged ICU stays. In this review, the authors (a) describe the emerging understanding of the basis for ICU-acquired weakness, including contributing factors such as prolonged bed rest; (b) provide the background for the safety and efficacy of early mobilization; and (c) give practical guidance for the implementation of ICU early mobilization based on their experience over the past 8 years.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"17-20"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611435275","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65896115","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: 7
Aortic Dissection: Emergency Department Care Expedited by The Use of Ultrasonography 主动脉夹层:超声检查加速急诊科护理
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611433357
G. A. Dagher, M. Favot, M. Njeim, Ralph Bou Chebel, M. Younes
{"title":"Aortic Dissection: Emergency Department Care Expedited by The Use of Ultrasonography","authors":"G. A. Dagher, M. Favot, M. Njeim, Ralph Bou Chebel, M. Younes","doi":"10.1177/1944451611433357","DOIUrl":"https://doi.org/10.1177/1944451611433357","url":null,"abstract":"Aortic dissection is a potentially catastrophic disease with significant mortality and morbidity. Presentations are often atypical and the physician needs to have a high index of suspicion and low ...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"31-37"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611433357","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895388","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
Early Mobilization in the Intensive Care Unit: Evidence and Implementation 重症监护病房的早期动员:证据与实施
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611434930
Angela Lipshutz, Heidi J. Engel, K. Thornton, M. Gropper
{"title":"Early Mobilization in the Intensive Care Unit: Evidence and Implementation","authors":"Angela Lipshutz, Heidi J. Engel, K. Thornton, M. Gropper","doi":"10.1177/1944451611434930","DOIUrl":"https://doi.org/10.1177/1944451611434930","url":null,"abstract":"As mortality from critical illness continues to decrease, focus has shifted to long-term outcomes of ICU survivors. Neuromuscular weakness is a common sequela of critical illness. This weakness prolongs duration of mechanical ventilation, increases ICU and hospital length of stay, increases mortality, and can persist for years after hospital discharge. The differential diagnosis of weakness in the ICU is long, and includes critical illness polyneuropathy (CIP) and critical illness myopathy (CIM). Immobilization and bed rest likely contribute to the development of CIP/CIM. Thus, early mobilization therapy has been suggested as an intervention to prevent or ameliorate ICU-acquired weakness. Early mobilization is safe, feasible, and associated with improved ICU outcomes. Emerging evidence suggests patients receiving early mobilization are more likely to be discharged home, making early mobilization therapy a potential mechanism to contain health care costs. Successful implementation of an early mobilization ...","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"10-16"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611434930","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895661","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: 8
Drop and Give Me 30 给我30英镑
ICU director Pub Date : 2012-01-01 DOI: 10.1177/1944451611435222
C. S. Yost
{"title":"Drop and Give Me 30","authors":"C. S. Yost","doi":"10.1177/1944451611435222","DOIUrl":"https://doi.org/10.1177/1944451611435222","url":null,"abstract":"","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"3 1","pages":"8-9"},"PeriodicalIF":0.0,"publicationDate":"2012-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611435222","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895882","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
Nabokov’s Passion Nabokov’s激情
ICU director Pub Date : 2011-11-01 DOI: 10.1177/1944451611430822
S. Yost
{"title":"Nabokov’s Passion","authors":"S. Yost","doi":"10.1177/1944451611430822","DOIUrl":"https://doi.org/10.1177/1944451611430822","url":null,"abstract":"","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"2 1","pages":"193-194"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611430822","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895416","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
Does Early Tracheostomy Affect ICU Outcome? A Review of the Literature 早期气管切开术影响ICU预后吗?文献综述
ICU director Pub Date : 2011-11-01 DOI: 10.1177/1944451611424407
Brian G. Ash, C. Yost
{"title":"Does Early Tracheostomy Affect ICU Outcome? A Review of the Literature","authors":"Brian G. Ash, C. Yost","doi":"10.1177/1944451611424407","DOIUrl":"https://doi.org/10.1177/1944451611424407","url":null,"abstract":"The timing of performing a tracheostomy in patients needing prolonged mechanical ventilation has been the subject of many studies over the years. This review surveys the published literature on this topic and describes the findings from the most recent multicenter randomized trials. These data are then used to form the most up-to-date conclusions regarding best practices to guide decisions on timing of tracheostomy in ventilated ICU patients.","PeriodicalId":89772,"journal":{"name":"ICU director","volume":"2 1","pages":"207-210"},"PeriodicalIF":0.0,"publicationDate":"2011-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/1944451611424407","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65895059","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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