Journal of intensive care medicine
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J Intensive Care Med · Sep 2003
Randomized Controlled Trial Clinical TrialA prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma.
Study objectives were to evaluate the 1-hour decision point for discharge or admission for acute asthma; to compare this decision point to the admission recommendations of the Expert Panel Report 2 (EPR-2) guidelines; to develop a model for predicting need for admission in acute asthma. The design used was a prospective preinterventional and postinterventional comparison. The setting was a university hospital emergency department. ⋯ No absolute value of peak flow or FEV(1) reliably predicts need for hospital admission. The EPR-2 guideline thresholds for admission are barely adequate as outcome predictors. A clinical model is proposed that may allow more accurate outcome prediction.
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Ultrasound is used worldwide to evaluate patients with blunt abdominal trauma. Sometimes referred to as an extension of the physical exam, ultrasound can rapidly help distinguish patients with injury requiring computerized tomography (CT) or surgery (typically 5%-10%) from those with no abdominal injury (> 90%). ⋯ Limitations of ultrasound include its dependence on operator skill and technique, poor image quality in patients with morbid obesity or extensive subcutaneous gas, limited visualization of the retroperitoneum, and less reliable localization of visceral injury compared to CT. Successful use of abdominal ultrasound in the setting of trauma can be maximized with adequate sonographer training, appreciation of technical limitations, and adherence to an appropriate trauma ultrasound protocol.
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This review of intensive care unit (ICU) radiology has been divided into two sections. In Part 1, previously published, the discussion focused on the role of the portable radiograph in the evaluation of the critically ill patient and the impact of the introduction of digital radiography and picture-archiving communications systems on patient care. Part 2 of this review will emphasize the role of computed tomography and the increasing contribution of image-guided interventional procedures in patient management. The deleterious effects of mechanical ventilation due to barotrauma will also be discussed.
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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.