Critical care medicine
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Critical care medicine · Feb 1983
Emergency cricothyroidotomy in the patient with massive neck swelling: Part 1: Anatomical aspects.
A method for localizing the hyoid bone in normal adult and children subjects is presented. The reliability of this calculated value in permitting localization of the hyoid was examined in 200 adult subjects in relationship to age, sex, neck size, and ethnic origin. ⋯ It was found to be a constant and remarkably predictable dimension which was unaffected by any of these variables. Because the hyoid serves as a frame from which the respiratory passage is suspended, it can be easily located and used to stabilize and retract superiorly and anteriorly the larynx and trachea, allowing easier access to these structures by a tracheotomy or cricothyroidotomy in the patient with massive neck swelling where emergency tracheotomy or cricothyroidotomy are difficult.
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The Therapeutic Intervention Scoring System (TISS) introduced in 1974 has become a widely accepted method of classifying critically ill patients. In response to requests to update the system because of recent innovations in critical care, some items have been deleted, some have been added, and certain point scores have been adjusted. ⋯ A comparison of the new 1983 system to the old 1974 system in 100 consecutive patients reveals no difference in total point scores. We hope this updated explanation will ease the task of assessing use of intensive care services.
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Critical care medicine · Jan 1983
Comparative StudyComparative studies of IPPV and HFPPV with PEEP in critical care patients. II: Studies on intrapulmonary gas distribution.
The ventilatory patterns of a conventional ventilator for volume-controlled ventilation (SV-900) and a low-compression ventilator utilizing the pneumatic valve principle for pressure/flow-generated, volume-controlled ventilation (system H) were studied in a lung model and in 10 patients with respiratory failure. System H was used at frequencies of 20 (H-20) and 60 (H-60 = high-frequency positive-pressure ventilation [HFPPV]) breath/min, and SV-900 at a frequency of 20 (SV-20) breath/min. With system H, inspiration constituted 22% (no inspiratory pause) and with SV-900, 25% (with 10% inspiratory pause). ⋯ This increased velocity increases gas mixing by increasing turbulence in conducting airways. In the 10 patients with respiratory failure, intrapulmonary gas distribution (measured as the nitrogen washout delay) was improved from 106% during SV-20 to 74% with H-60 (p less than 0.05). H-60 also increased carbon dioxide elimination in the 2 patients with the most severe pulmonary dysfunction.
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Critical care medicine · Jan 1983
Comparative StudyComparative studies of IPPV and HFPPV with PEEP in critical care patients. I: A clinical evaluation.
The effects of the ventilatory patterns of a conventional ventilator (SV-900) and a low-compression ventilator (system H) were studied in 12 patients with respiratory failure (RF). Volume-controlled ventilation at frequencies (f) of 20 breath/min (SV-20) with SV-900, and 20 (H-20) and 60 (H-60 = high-frequency positive-pressure ventilation, HFPPV) breath/min with system H was given. Inspiration constituted 25% (with an inspiratory pause of 10%) of the ventilatory cycle with SV-900 and 22% with system H. ⋯ In the most severely ill patients, long-term HFPPV was uneventful. Airway suctioning during ventilation with oxygen was an important feature of the pneumatic valve principle (system H). The results of this study indicate that volume-controlled HFPPV is as efficient and as well accepted by the patient as conventional ventilation (SV-20).
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The primary goal of an interhospital critical care transport program is to provide quality medical care during transit as close as possible to that available in the receiving ICU. Critically ill pediatric patients are transported between hospitals by a variety of transport teams. The skills possessed by physicians, nurses, respiratory therapists, and paramedics overlap. ⋯ Patients were categorized by diagnosis, severity of illness at the time of transport, and the monitoring and life support required during transport. Our data indicate the medical transport team members should have skills required for pediatric critical care diagnosis and management including endotracheal intubation and assisted ventilation; insertion of peripheral, central venous, and arterial catheters; fluid and electrolyte therapy; antibiotic therapy; cardiovascular monitoring; and pharmacological life support. The team members should be chosen based on the particular skills needed for a transport with a goal of providing the patient care required on a consistent basis.