Critical care medicine
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This review examines perspectives of human infection with avian influenza A H5N1 (AI H5N1), specifically focusing on the presentation, diagnosis, and management of those critically ill with AI H5N1. ⋯ Many patients with AI H5N1 are critically ill either at presentation or shortly thereafter. Intensivists and intensive care units are therefore at the front line for this new cause of severe lung injury. Practitioners must be familiar with the nonspecific presentation of AI H5N1 and its diagnostic and therapeutic options. Although treating the infected patient with AI H5N1 is a priority, safeguarding healthcare workers and other patients must be considered of equal priority.
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Critical care medicine · May 2007
ReviewUltrasound-guided interventional radiology in critical care.
Ultrasound-guided intervention is becoming an increasingly popular and valuable tool in the critical care setting. In general, image-guided procedures can expedite wait times and increase the accuracy, safety, and efficacy of many procedures commonly performed within intensive care units. ⋯ These include central venous catheter deployment, thoracentesis, paracentesis, and drainage of a wide variety of abscesses, and percutaneous nephrostomy, percutaneous cholecystectomy, and inferior vena cava filter placement. Although we believe ultrasound is significantly underutilized in critical care today, we anticipate that with the improvement of ultrasound technology and the innovation of new ultrasound-guided procedures, the role of ultrasound in the intensive care unit will continue to expand, with bedside ultrasound-guided interventions increasingly becoming the norm.
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Critical care medicine · May 2007
Relationship between immunosuppression and intensive care unit-acquired multidrug-resistant bacteria: a case-control study.
To determine the relationship between immunosuppression and intensive care unit (ICU)-acquired multidrug-resistant (MDR) bacteria. ⋯ Immunosuppression is not independently associated with ICU-acquired MDR bacteria. However, infection control measures used in our ICU may have influenced this result.
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Transcranial Doppler has several practical applications in neurocritical care. It has its main application in the diagnosis and monitoring of vasospasm in patients with subarachnoid hemorrhage. ⋯ Its ability to measure CO2 reactivity and autoregulation may ultimately allow intensivists to optimize cerebral perfusion pressure and ventilatory therapy for the individual patient. Transcranial Doppler findings of brain death are well described and can be useful as a screening tool.
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Using simple and standardized semiology, the lung appears accessible to ultrasound, despite previous opinions otherwise. Lung ultrasound allows the intensivist to quickly answer to a majority of critical situations. Not only pleural effusion but also pneumothorax, alveolar consolidation, and interstitial syndrome will have accurate ultrasound equivalents, the recognition of which practically guides management. ⋯ It is believed that by using this tool, the intensivist may more confidently manage acute dyspnea and make emergency therapeutic decisions based on reproducible data. Further benefits include reduced requirements for computed tomographic scans, therefore decreasing delay, irradiation, cost, and above all, discomfort to the patient. Thus, ultrasound of the lung can also be added to the classic armamentarium as a clinical tool for emergency use.