Critical care medicine
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To ascertain the problems and needs of surgical ICUs, questionnaires (prepared by the author) were submitted to 50 medical directors and ICU head nurses at major hospital centers throughout the country. Is there a demand for intensive care not being met? If so, why? What is the frequency of overcrowding or need for triage? Thirty-one of the 50 questionnaires were returned, most fully completed. Demographic information about the hospital and surgical ICU itself was obtained. ⋯ The ICU nursing turnover rate was extremely variable, ranging from 50-75% per year in seven units to as low as less than 15% in six units. This survey suggests that both large and small hospitals have difficulty carrying out their surgical ICU mission because of the demand for more ICU facilities is outstripping the supply of ICU staff. The medical and nursing critical care societies must address these problems and attempt to solve them.
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Critical care medicine · Apr 1981
Ultrasonographic anatomy of the internal jugular vein relevant to percutaneous cannulation.
Ultrasonographic scans of the right side of the neck of 16 subjects were done in order to determine the anatomical features relevant to efficient cannulation of the internal jugular vein. The cross sectional area of the jugular vein was estimated from scans at the level of the cricoid as well as 1.5 cm cephalad and caudad to the cricoid; the jugular was significantly larger caudad to the cricoid. A head-down tilt of 14 degrees provided significant distension of the jugular, similar to that produced by a Valsalva maneuver. Both palpation of the carotid and extreme rotation of the head produce anatomical changes that seem to make cannulation of the jugular difficult.
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Critical care medicine · Feb 1981
Comparative StudyComparison of electronic and manometric central venous pressures. Influence of access route.
Manometric central venous pressure (CVP) measurements are still routinely used as indicators of intravascular volume, particularly during surgery and when cardiorespiratory function is assumed to be normal. The difference between manometric measurements of CVP, from a 16-gauge polyvinylchloride catheter, and those obtained electronically from the level of the right atrium through the proximal port of a pulmonary artery catheter was studied in 40 patients admitted to the ICU. ⋯ When catheters were inserted from the left subclavian vein or the internal jugular, on the other hand, manometric CVP was consistently 4-6 cm H2O higher than the electronic pressure determination. If a manometric CVP catheter is to be used, the internal jugular or left subclavian routes appear preferable.
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Critical care medicine · Feb 1981
Temporal responses of functional residual capacity and oxygen tension to changes in positive end-expiratory pressure.
PEEP is widely accepted as a therapy for some forms of acute respiratory failure (ARF). PEEP increases functional residual capacity (FRC), decreases intrapulmonary shunt fraction, and improves arterial oxygenation. The time required for FRC and arterial oxygen tension (PaO2) to stabilize after an adjustment in the level of PEEP is not clearly established. ⋯ After PEEP was applied, an average of 15 sec was required to increase FRC; the less compliant the lung, the more rapid the change. After PEEP was removed, FRC stabilized within an average of 22 sec. When PEEP, 25 cm H2O, was removed, arterial oxygenation decreased suddenly and substantially which suggests that PEEP, especially at higher levels, should not be discontinued, even momentarily, for nonessential maneuvers.