Critical care clinics
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Critical care clinics · Jan 1993
ReviewAcute respiratory failure due to Pneumocystis carinii pneumonia.
Pneumonia caused by Pneumocystis carinii is the most frequent indication for admission of AIDS patients to intensive care units. In this article, an approach to the diagnosis and management of this condition will be presented along with prognostic information. Differential diagnosis will be discussed, and characteristic responses to current standard and alternative chemotherapeutic agents and modes of ventilatory support will be reviewed.
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Critical care clinics · Jan 1993
ReviewEthical considerations in the treatment of AIDS patients in the intensive care unit.
The treatment of patients with AIDS in the ICU presents the clinician with special challenges. The admission policies of ICUs are examined, and the authors suggest ways in which ethical difficulties may be minimized. A new concept of futility is suggested, which considers both the patient's holistic needs together with his or her immediate medical prognosis. Changes in the law regarding patient choice are discussed.
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FMCPAP and NCPAP therapy is an effective modality for treating patients with PCP, hypoxia, and respiratory insufficiency. The therapy decreases intrapulmonary shunting and improves oxygenation. It is safe and, in some cases, can be provided outside of an intensive care unit. ⋯ It is conceivable that failure to respond to MCPAP may provide prognostic information to help guide further therapy. Further outcome studies are needed to clarify this issue. Adding MCPAP to mechanical ventilation and conventional mask oxygen therapy increases the options that practitioners can use to provide the best titrated care for their patients.
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Critical care clinics · Oct 1992
ReviewCentral venous catheterization in the critically ill patient.
Central venous catheter placement for access and monitoring purposes is one of the most commonly performed procedures in the intensive care unit. This article details the indications, techniques, and advantages and disadvantages associated with various approaches to central line insertion; complications associated with central venous line insertion are also reviewed briefly.
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After two decades, hemodynamic invasive monitoring using a flow-directed, balloon-tipped, pulmonary artery (PA) catheter has established itself as a significant component of acute clinical care. In spite of continued recommendations for limitations, restrictions, moratoria, and even abandonment, growth in catheter use continues. Attempts to replace it by competing technologies for routine clinical practice have not been successful thus far. ⋯ After a brief history, this article focuses on the technical aspects of the insertion procedure, choice of hardware, and acquisition and analysis of information. Indications, contraindications, and clinical utility are briefly described. Major complications from PA catheterization reported in the literature since clinical introduction of the catheter are summarized.