Critical care medicine
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Critical care medicine · Feb 2013
Size variation between contralateral infraclavicular axillary veins within individual patients-implications for subclavian venous central line insertion.
Vein size and use of dynamic ultrasound guidance have been shown to be directly related to a reduction in insertion failure and complication rates during subclavian vein catheterization. We hypothesized that contralateral infraclavicular axillary vein sizes are significantly different within the same patient. We also aimed to demonstrate the relationship of subject's anthropomorphic indices with vein size and contralateral vein size difference. ⋯ Contralateral infraclavicular axillary vein sizes within the same patient are significantly different in the adult surgical population and bear no clear relation to patient hand dominance. The magnitude of contralateral difference or absolute ipsilateral infraclavicular axillary vein size cannot be predicted by a subject's anthropomorphic indices. All patients in whom subclavian central line insertion is planned should have both sides examined by ultrasound to determine which side has the largest vessel.
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Critical care medicine · Feb 2013
Rescue therapy by switching to total face mask after failure of face mask-delivered noninvasive ventilation in do-not-intubate patients in acute respiratory failure.
To evaluate the impact of switching to total face mask in cases where face mask-delivered noninvasive mechanical ventilation has already failed in do-not-intubate patients in acute respiratory failure. ⋯ In patients in hypercapnic acute respiratory failure, for whom escalation to intubation is deemed inappropriate, switching to total face mask can be proposed as a last resort therapy when face mask-delivered noninvasive mechanical ventilation has already failed to reverse acute respiratory failure. This strategy is particularly adapted to provide prolonged periods of continuous noninvasive mechanical ventilation while preventing facial pressure sores.
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Critical care medicine · Feb 2013
Imaging the interaction of atelectasis and overdistension in surfactant-depleted lungs.
Atelectasis and surfactant depletion may contribute to greater distension-and thereby injury-of aerated lung regions; recruitment of atelectatic lung may protect these regions by attenuating such overdistension. However, the effects of atelectasis (and recruitment) on aerated airspaces remain elusive. We tested the hypothesis that during mechanical ventilation, surfactant depletion increases the dimensions of aerated airspaces and that lung recruitment reverses these changes. ⋯ Overdistension of aerated lung occurs during atelectasis is detectable using clinically relevant magnetic resonance imaging technology, and could be a key factor in the generation of lung injury during mechanical ventilation. Lung recruitment by higher positive end-expiratory pressure and surfactant administration reduces airspace distension.
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Critical care medicine · Feb 2013
Editorial CommentFailure of noninvasive ventilation: one more chance?