Critical care medicine
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Critical care medicine · Sep 1990
Expansion of the medical intensive care unit: clinical consequences in a large urban hospital.
We examined how a permanent expansion of the medical ICU (MICU) affected resource utilization and severity of illness for intensive care admissions within a 700-bed urban teaching hospital. On our 162-bed medical service, construction of a separate cardiac care unit and the expansion of the MICU increased the number of core intensive care beds by 100%. We prospectively analyzed noncardiology MICU admissions 2 months before, immediately after, and 4 months after MICU expansion. ⋯ In contrast, the volume and severity of illness of MICU transfers from the inpatient medical floor service were constant in all time periods. These results suggest that, while MICU expansion increased patient volume, physician utilization of the MICU resources was unchanged. Our physicians used high-intensity ICU beds in a consistent fashion in response to external factors, such as ED activity, intramural ICU transfers, and referrals from other hospitals.
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Critical care medicine · Sep 1990
Editorial CommentTo transfuse or not to transfuse--that is the question!
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The FFB may facilitate airway management and offers utilization in intubation, extubation, diagnosis of airway damage, ET tube changing, and simultaneous diagnosis and therapeutic intervention in UAO. The FFB may also be used to facilitate insertion of a double-lumen EB tube to initiate dual lung ventilation. In addition to development of technical skills, the ICU physician should know the indications and complications of FOB in the critically ill patient.
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Critical care medicine · Aug 1990
Randomized Controlled Trial Comparative Study Clinical TrialUse of a nasal continuous positive airway pressure mask in the treatment of postoperative atelectasis in aortocoronary bypass surgery.
Pulmonary oxygen transfer, defined by PaO2/FIO2, and radiologic presence of atelectasis were measured pre-, intra-, and postoperatively to postoperative day 9 in elective cardiac aortocoronary bypass surgical patients, who were randomly allocated either to receive 18 h PEEP while on the ventilator followed by 12 h of nasal continuous positive airway pressure (nasal CPAP) or to be control subjects. The two groups were comparable in age, sex, forced expiratory volume in 1 sec (FEV1), the ratio of FEV1 over forced vital capacity (FVC), time on pump, units of blood transfused, New York Heart Association grading, and cardiac performance indices. ⋯ We conclude that nasal CPAP is well tolerated as a treatment of hypoxemia in the immediate postoperative period of aortocoronary bypass patients. CPAP does not change the course of postoperative atelectasis.