Annals of the Royal College of Surgeons of England
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Ann R Coll Surg Engl · Nov 1984
The provision of junior anaesthetic staff for the intensive care unit of a district general hospital: a workable solution?
The problems of staffing an ICU in a District General Hospital at junior level are discussed. The needs of the Unit, the junior staff and the Anaesthetic Department and possible ways of reconciling these are outlined. A system of providing cover using pairs of junior anaesthetists is described in detail. This has been successfully in operation for 18 months and its merits are discussed.
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Although the incidence of cuff induced tracheal damage has been considerably reduced by judicious use of tracheal tubes with large-volume, low-pressure cuffs, aspiration continues to be a major problem. A study was conducted to determine the maximum hydrostatic pressure that can be produced by a column of liquid above the tracheal cuff. ⋯ The maximum vertical and horizontal distance between the upper central incisor teeth and suprasternal notch was 9 cm and 21 cm respectively. The implication of these findings are discussed and it is suggested that a fixed intracuff pressure in the range of 2.5 to 3kPa should be used to obtain an optimal tracheal seal.