Journal of intensive care medicine
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J Intensive Care Med · May 2010
ReviewPrevention of central venous catheter bloodstream infections.
The majority of nosocomial bloodstream infections in critically ill patients originate from an infected central venous catheter (CVC). Catheter-related bloodstream infections (CRBSIs) cause significant morbidity and mortality and increase the cost of care. ⋯ Evidence-based strategies for the prevention of CRBSI include behavioral and educational interventions, effective skin antisepsis coupled with maximum barrier precautions, the use of antiseptic dressings, and the use of antiseptic or antibiotic impregnated catheters. Achieving and maintaining very low rates of CRBSI requires a multidisciplinary approach involving the entire health care team, the use of novel technologies in patients with the highest risk of CRBSI, and frequent reeducation of staff.
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J Intensive Care Med · May 2010
A descriptive analysis of patients admitted to the intensive care unit of the 10th Combat Support Hospital deployed in Ibn Sina, Baghdad, Iraq, from October 19, 2005, to October 19, 2006.
Although a review of the 1-month experience of a British intensive care unit (ICU) deployed in 2003 to Iraq outlining its care of 47 patients exists, a descriptive study outlining patient characteristics, workload, and outcomes of an ICU during a long-term deployment to Operation Iraqi Freedom is lacking in the medical literature. ⋯ The primary mission of a US military ICU deployed in support of combat operations is the care of its injured troops. However, the 10th CSH deployed in an urban region of Iraq in a mature theater of operations and its ICU more commonly cared for non-US patients during combat medical operations. These patients included pediatric patients as well as admissions for nontrauma illnesses. This mission was accomplished by nurses and physicians faced with unique challenges and resulted in an acceptable ICU mortality rate.
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J Intensive Care Med · May 2010
Structure, process, and outcome of all intensive care units within the province of British Columbia, Canada.
To describe the total and regional capacity for critical care in British Columbia (BC), Canada, and to describe regional variation in number of intensive care units (ICUs), size of ICUs, length of ICU stay, ICU occupancy, key processes of critical care, and hospital mortality for ICU patients in B.C. ⋯ Variation and lack of availability of key processes for care of critically ill patients in this population identifies opportunities for knowledge translation and systematic improvement including regionalization of care.
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J Intensive Care Med · May 2010
Use of a helium-oxygen mixture to facilitate ventilation during bronchoscopy through a laryngeal mask airway.
Flexible fiberoptic bronchoscopy may be performed in infants and children for various diagnostic and therapeutic purposes. In infants and children, general anesthesia may be used to facilitate the procedure. When general anesthesia is used, a laryngeal mask may be used to control the airway. However, as the passage of the bronchoscope decreases the cross-sectional airway inside the laryngeal mask airway (LMA) for gas exchange, increases in respiratory resistance may occur. We present our experience with the use of a helium-oxygen mixture to facilitate bronchoscopy through an LMA during general anesthesia in infants and children. ⋯ A helium-oxygen mixture decreases resistance to gas flow during bronchoscopy through an LMA in infants and children receiving general anesthesia with sevoflurane and pressure support ventilation.