Critical care medicine
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Critical care medicine · May 2007
Calculation of intratracheal airway pressure in ventilated neonatal piglets with endotracheal tube leaks.
In ventilated neonates, only the applied pressure of the ventilator is adjusted and monitored. When an endotracheal tube leaks, intratracheal pressure decreases depending on the size of the endotracheal tube and of the leak. Furthermore, an increase in resistance and/or compliance might delay the increase of intratracheal pressure during inspiration and its decline during expiration. Short inspiratory time can cause insufficient ventilation, because intratracheal pressure peak might not be reached. Short expiratory time may lead to air trapping, because intratracheal pressure could not return to baseline. The aim of this study was to develop a mathematical algorithm to calculate intratracheal pressure continuously during ventilation and to evaluate the accuracy of this method. ⋯ The accuracy of the calculation of intratracheal pressure ensures adequate monitoring of artificial ventilation, even in the presence of endotracheal tube leaks. This might decrease the risk of barotrauma and improve the effectiveness of ventilation.
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Critical care medicine · May 2007
ReviewRole of ultrasound in the airway management of critically ill patients.
Ultrasound imaging of the upper airway in critically ill patients offers a number of attractive advantages compared with competitive imaging techniques or endoscopy. It is widely available, portable, repeatable, relatively inexpensive, pain-free, and safe. ⋯ The role of ultrasound in endotracheal tube placement, including preintubation assessment, verification of tube position, double-lumen intubation, and extubation outcome, are explained. Also, ultrasound-guided percutaneous tracheostomy, the role of ultrasound in using the laryngeal mask airway, and upper airway anesthesia are described.
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Critical care medicine · May 2007
Randomized Controlled TrialPhase II, randomized, controlled trial of high-dose N-acetylcysteine in high-risk cardiac surgery patients.
To assess the effect of high-dose N-acetylcysteine on renal function in cardiac surgery patients at higher risk of postoperative renal failure. ⋯ In this phase II, randomized, controlled trial, high-dose N-acetylcysteine was no more effective than placebo in attenuating cardiopulmonary bypass-related acute renal failure in high-risk cardiac surgery patients.
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Critical care medicine · May 2007
Comparative StudyComparison of three different methods of evaluation of metabolic acid-base disorders.
The Stewart approach states that pH is primarily determined by Pco2, strong ion difference (SID), and nonvolatile weak acids. This method might identify severe metabolic disturbances that go undetected by traditional analysis. Our goal was to compare diagnostic and prognostic performances of the Stewart approach with a) the traditional analysis based on bicarbonate (HCO3) and base excess (BE); and b) an approach relying on HCO3, BE, and albumin-corrected anion gap (AGcorrected). ⋯ In this large group of critically ill patients, diagnostic performance of the Stewart approach exceeded that of HCO3- and BE. However, when AGcorrected was included in the analysis, the Stewart approach did not offer any diagnostic or prognostic advantages.
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Critical care medicine · May 2007
CommentSpecific skill set and goals of focused echocardiography for critical care clinicians.
Echocardiography in the critical care setting can provide crucial information about the patient's cardiac anatomy, ejection fraction, valvular function, and volume status. There is a need for more involvement by intensivists in performing focused echocardiographic studies as this modality has been well shown to improve patient care. Several factors limit the widespread use of this technology by intensivists that are noncardiologists. ⋯ Programs for intensivists should cover both the transthoracic and transesophageal approach. Focused training with the transthoracic approach should be offered to all intensivists, while training with the transesophageal approach should be offered to intensivists who desire more advanced training. This article will go over important issues regarding current and potential avenues for training of critical care physicians in performance of focused bedside echocardiography.