Intensive care medicine
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Intensive care medicine · Jan 2002
Randomized Controlled Trial Comparative Study Clinical TrialThe use of the laryngeal mask airway as an alternative to the endotracheal tube during percutaneous dilatational tracheostomy.
To evaluate the safety and efficiency of the use of the laryngeal mask airway (LMA) during percutaneous dilatational tracheostomy under bronchoscopic guidance comparing with the ventilation via endotracheal tube (ET). ⋯ LMA is an effective and successful ventilatory device during percutaneous dilatational tracheostomy. It improves visualization of the trachea and larynx during fiberoptic-assisted percutaneous dilatational tracheostomy and prevents the difficulties associated with the use of ET such as cuff puncture, tube transection by the needle, and accidental extubation. The use of a bronchoscope and the puncture of the ET cuff cause major increases in PaCO2.
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Intensive care medicine · Jan 2002
ReviewCentral venous catheter use. Part 1: mechanical complications.
Central venous catheters are being increasingly used in both intensive care units and general wards. Their use is associated with both mechanical and infectious complications. ⋯ The most important risk factors are patient characteristics (morbidity, underlying disease and local anatomy), the expertise of the doctor performing the procedure, and nursing care. Placement aids, such as ultrasound-guided catheter insertion, are also discussed.
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Intensive care medicine · Jan 2002
Randomized Controlled Trial Comparative Study Clinical TrialProne positioning, systemic hemodynamics, hepatic indocyanine green kinetics, and gastric intramucosal energy balance in patients with acute lung injury.
To investigate the effects of prone positioning on systemic hemodynamics, intra-abdominal pressure (IAP), plasma disappearance rate of indocyanine green (PDR(ICG)), and gastric intramucosal to arterial PCO2 difference (Pi-aCO2). ⋯ Prone positioning in mechanically ventilated patients with acute lung injury, despite a small increase in IAP, does not negatively affect the hepatic capacity to eliminate ICG and gastric intramucosal energy balance when systemic blood flow and oxygenation are improved.
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Intensive care medicine · Jan 2002
Incidence of recall, nightmares, and hallucinations during analgosedation in intensive care.
To define the incidence of recall and dreams during analgosedation in critically ill patients. ⋯ Critically ill patients reported a high incidence of recall for unpleasant events, which they thought to have taken place before they regained consciousness. The patients, who stayed longer than 24 h at the ICU, indicated vivid memory for nightmares and hallucinations. Further studies are suggested to evaluate: 1) whether there is an impact of the present findings on outcome; and 2) whether clinical scores for sedation or neurophysiological monitoring help to define the exact time, when recall happens, in order to guide therapeutic intervention.