Journal of intensive care medicine
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J Intensive Care Med · Jul 2003
Case ReportsPercutaneous dilatational tracheostomy for emergent airway access.
The study objective of this article was to evaluate percutaneous dilatational tracheostomy (PDT) for emergent airway access. This is a case series of 9 patients who presented over a 58-month period. All patients were in severe respiratory difficulty where intubation by conventional means was unsuccessful. ⋯ The authors conclude that PDT can effectively establish a surgical airway in an emergent setting. The major advantage of this technique is the ability to gain and maintain competence in an elective, controlled environment. The authors believe that PDT may play a role in the management of the emergent surgical airway.
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J Intensive Care Med · Jul 2003
ReviewNosocomial pneumonia in the intensive care unit: controversies and dilemmas.
Nosocomial pneumonia (NP), and its most serious form, ventilator-associated pneumonia (VAP), is a major cause of morbidity and mortality in the ICU. Numerous controversies exist, from diagnostic criteria to prevention and treatment, including the issues of attributable mortality of VAP, differences in the approach to early and late VAP, and the best diagnostic methods. Initial, accurate therapy is one of the most important factors determining outcome in VAP. ⋯ The role of airway and gastrointestinal colonization and innovative preventive strategies such as noninvasive ventilation, antibiotic rotation, and aerosolized antibiotics are discussed. No uniform standards exist for the approach to VAP. The authors highlight the major controversies and dilemmas in the clinical approach to VAP, with recommendations for the bedside management of these patients.
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The increasing complexity of the intensive care patient combined with the recent advances in imaging technology has generated a new perspective on intensive care radiology. The purpose of this 2-part review article is to describe the contribution of radiology to the management of these critically ill patients. ⋯ In particular, the implementation of CT pulmonary angiography in the evaluation of pulmonary emboli and the introduction of the new multislice detector CT scanners that allow even the most dyspneic patient to be evaluated. Pleural complications in the intensive care unit and image-guided intervention will also be discussed.
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J Intensive Care Med · Jul 2003
Editorial Comment ReviewNosocomial pneumonia: the gorilla in the ICU.