Critical care medicine
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Critical care medicine · Apr 1993
Massive airway leaks: an analysis of the role of endotracheal tubes.
To determine the abnormalities present in endotracheal tubes removed from mechanically ventilated patients for "massive airleak." "Massive airleak" was defined as a leak that the attending physician felt was indicative of endotracheal tube defect such that extubation (and reintubation, if needed) would be indicated. ⋯ A large number of endotracheal tubes removed for presumed defect are flawless. The authors speculate that tube malposition is the most likely explantation for this phenomenon. Our findings suggest that patient care might improve with more meticulous daily attention to the airway, as well as a more analytical rather than action-oriented approach to the leaking endotracheal tube.
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Critical care medicine · Apr 1993
Multicenter Study Comparative Study Clinical TrialClinical performance of a blood gas monitor: a prospective, multicenter trial.
To prospectively assess the clinical performance of a fluorescent optode-based blood gas monitoring system that is designed to perform arterial pH, PCO2, and PO2 measurements as frequently as clinically required without violating the integrity of the arterial catheter tubing system or permanently removing blood from the patient. ⋯ Clinical performance of this fluorescent, optode-based blood gas monitoring system demonstrates stability, consistency, and accuracy comparable to modern blood gas analyzers. This system withstood the normal abuse and rigors of clinical conditions common to the ICU while reliably performing in critically ill patients for up to 80 hrs. Use of the device did not significantly alter the function or longevity normally expected from a 20-gauge radial artery catheter. We submit that this blood gas monitoring system can replace the use of blood gas analyzers for ICU patients with indwelling arterial catheters.
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Critical care medicine · Apr 1993
Review Practice Guideline GuidelineA model for technology assessment applied to pulse oximetry. The Technology Assessment Task Force of the Society of Critical Care Medicine.
To test a model for the assessment of critical care technology. To develop practice guidelines for the use of pulse oximetry. ⋯ The model developed for technology assessment proved to be appropriate for assessing pulse oximetry. The available data have allowed us to develop an evidence-based practice policy for the use of pulse oximetry in critical care. Critical care clinicians, researchers, and industry have a shared responsibility to provide valid outcome and efficacy studies of new technologies.
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Critical care medicine · Apr 1993
Randomized Controlled Trial Comparative Study Clinical TrialA clinical evaluation of a blood conservation device in medical intensive care unit patients.
This study was designed to a) document the efficacy of a device intended to conserve blood in critically ill patients; b) determine the effect of this blood conservation on hemoglobin concentration and the need for blood transfusions; c) determine if the blood conservation device resulted in interference with arterial pressure waveforms; d) determine if use of the blood conservation device resulted in a difference in the number of accidental needle punctures suffered by healthcare workers. ⋯ The conservation of blood in critically ill patients must be a high-priority concern of all healthcare workers. Our data indicate that the blood conservation system eliminates a significant factor in the decline in hemoglobin concentration. With devices as described here, there is no reason to continue the practice of wasting the blood of critically ill patients in order to prevent preanalytic error.
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Critical care medicine · Apr 1993
ReviewCivilian triage in the intensive care unit: the ritual of the last bed.
To evaluate the numerous problems that exist when there is an acute shortage of trained critical care nurses, no triage officer is available or designated, there is no cooperation among intensive care units (ICUs) or alternative sites, or there is excessive political or financial pressure applied to maintain a referral practice or to fill all the beds, or limited ability to divert ambulances to other hospitals. The Joint Commission on Accreditation of Health Care organizations now mandates a written policy: "when patient load exceeds optimal operational capacity" (1992). ⋯ It is necessary to have public disclosure of the broader issues related to high-level triage. The first issue is recognition that there are periods of time when ICU capacity is exceeded or skilled critical care nurse availability is reduced. The next issue is the decision of who is best suited to make complex and dynamic triage decisions and what kind of oversight should be provided. Other issues relate to whether there should be patient or family consent, and what to do about patients receiving marginal benefit or who are considered hopeless or unsalvageable, yet the family or surrogate decision maker (or perhaps one of the consultants) wants to continue active care in the ICU. In the conflict between individual and community rights and benefits, there should be a nonlitigious approach when a patient is harmed during these periods of high census or limited capacity. In recognition of these complex issues (including potential conflicts among ICUs, hospital administration, individual physicians, and the various medical and surgical programs feeding patients into special care units), the Society of Critical Care Medicine has organized a Task Force on the legal and ethical justification for triage.