Journal of intensive care medicine
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J Intensive Care Med · Jul 2007
ReviewComplications of emergency tracheal intubation: immediate airway-related consequences: part II.
Airway management in the stable, elective operating room patient is typically exceptionally safe. Conversely, the acute deterioration of an intensive care unit or floor patient being rescued by a clinician unfamiliar with the patient's past and current history combined with an incomplete physical examination places the critically ill patient in a precarious, potentially life-threatening position. ⋯ Consequences of airway management should be openly discussed as a first step toward improving airway safety. This is the second of 2 reviews, "Complications of Emergency Tracheal Intubation," and focuses on the immediate airway-related consequences during emergency tracheal intubation in the remote location.
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J Intensive Care Med · May 2007
ReviewQuantifying risk and benchmarking performance in the adult intensive care unit.
Morbidity, mortality, and length-of-stay outcomes in patients receiving critical care are difficult to interpret unless they are risk-stratified for diagnosis, presenting severity of illness, and other patient characteristics. Acuity adjustment systems for adults include the Acute Physiology And Chronic Health Evaluation (APACHE), the Mortality Probability Model (MPM), and the Simplified Acute Physiology Score (SAPS). ⋯ Demand for outcomes data is likely to grow with pay-for-performance initiatives as well as for routine clinical, prognostic, administrative, and research applications. It is important for clinicians to understand how these scores are derived and how they are properly applied to quantify patient severity of illness and benchmark intensive care unit performance.
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J Intensive Care Med · May 2007
ReviewComplications of emergency tracheal intubation: hemodynamic alterations--part I.
Emergency airway management outside the elective operating room presents considerable risks to the patient and significant challenges to the practitioner. Complications and adverse consequences are commonplace, yet they have not received their justified discussion or scrutiny in the literature. ⋯ Part 1 will focus on alterations in the heart rate and blood pressure, new onset cardiac dysrhythmias and cardiac arrest. Part 2 will explore airway related consequences such as hypoxemia, esophageal intubation, multiple intubation attempts, and aspiration.
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J Intensive Care Med · May 2007
Case ReportsMinimizing tolerance and withdrawal to prolonged pediatric sedation: case report and review of the literature.
Midazolam and fentanyl infusions are commonly used for prolonged sedation and analgesia in the pediatric intensive care setting. Tolerance and withdrawal are major concerns when these infusions are used for days or weeks. Here, we review the current approaches to prolonged pediatric sedation using midazolam and fentanyl and discuss newer strategies to avoid tolerance and withdrawal syndromes. ⋯ Prolonged sedation is often necessary in treating critically ill children, and tolerance and abstinence syndrome can complicate a successful recovery. Scoring systems can be used to minimize oversedation and to titrate effectively. "Drug cycling," "wake-up protocols," and weaning regimens, possibly combined with adjuvant drugs, are being implemented successfully. Such novel approaches may decrease the incidence of tolerance and withdrawal associated with prolonged sedative and analgesic use.