Journal of intensive care medicine
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J Intensive Care Med · Sep 2009
ReviewConfirmation of endotracheal tube position: a narrative review.
Endotracheal tube (ETT) insertion is the primary method of definitive airway protection and control in critically ill patients. Detection of ETT malposition in a timely fashion is crucial in both elective and emergent intubation. In this review, we describe classic tests and highlight several new technologies that may assist the practitioner in determining ETT position within the esophago-tracheal complex, namely ultrasonographic and impedance-based methods. ⋯ New methods such as ultrasonic location of the ETT show promise but require further study. The clinician performing ETT insertion should have multiple confirmation methods that allow the practitioner to adapt to a variety of clinical situations, depending on local costs and availability. Finally, when the clinician still has uncertainty, or multiple tests give conflicting results, the availability of bronchoscopy at the bedside to visualize the carina through the ETT is useful.
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J Intensive Care Med · Sep 2009
ReviewTechniques for assessment of intravascular volume in critically ill patients.
Fluid replacement is considered the cornerstone of resuscitation in the ICU. However, only about 50% of critically ill hemodynamically unstable patients are fluid responsive; furthermore, both under-resuscitation and overzealous fluid administration adversely affect outcome Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients' intravascular volume status and their volume responsiveness. This paper reviews the evolution and accuracy of methods for assessing fluid responsiveness in critically ill patients.
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J Intensive Care Med · Jul 2009
ReviewHigh-frequency oscillatory ventilation (HFOV) and airway pressure release ventilation (APRV): a practical guide.
Despite advances in ventilator management, 31% to 38% of patients with adult respiratory distress syndrome (ARDS) will die, some from progressive respiratory failure. Inability to adequately oxygenate patients with severe ARDS has prompted extensive efforts to identify what are now known as alternative modes of ventilation including high-frequency oscillatory ventilation and airway pressure release ventilation. ⋯ Although a mortality benefit has not been proven, some patients may benefit from these alternative modes of ventilation as rescue measures while the underlying process resolves. The purpose of this article is to review the evidence and mechanisms underlying each modality and to describe the fundamental steps in initiating, adjusting, and terminating these modes of ventilation.
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J Intensive Care Med · May 2009
ReviewCoronary angiography predicts improved outcome following cardiac arrest: propensity-adjusted analysis.
Determine if clinical parameters of resuscitated patients predict coronary angiography (CATH) performance and if receiving CATH after cardiac arrest is associated with outcome. ⋯ CATH is more likely to be performed in certain patients and identifies a significant number of high-grade stenoses in this population. Receiving CATH was independently associated with good outcome.
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J Intensive Care Med · Mar 2009
ReviewConsiderations in caring for the critically ill older patient.
People over age 65 are the fastest growing segment of the population and account for 42% to 52% of the intensive care unit admissions in the United States. There are many physiologic changes that occur with aging which can impact on both the presentation and management of older patients with critical illness. ⋯ While outcome studies suggest that chronologic age itself is not a risk factor for poor outcomes after adjusting for severity of illness, older patients clearly have physiologic changes which need to be considered when providing critical care. This article will review important physiologic changes of aging, as well as sepsis and delirium and outcomes of older ICU patients.