Crit Care Resusc
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To review the management of the difficult airway in the intensive care unit patient. ⋯ The principles of difficult airway management, including a back-up plan and calling for assistance early, hold true in the intensive care setting as much as in any other clinical setting. It is vital that clinicians develop their own difficult airway algorithm based on their training and experience.
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To review alternative airway management techniques and their suitability to the intensive care setting. ⋯ There is a wide range of techniques available to manage the difficult airway. Due to the limited opportunity to train in the use of alternative airway techniques, such techniques should ideally involve an extension of those skills commonly practised by intensivists (e.g. bronchoscopy). Ultimately, the most important features when choosing a technique to manage a difficult airway are the training, knowledge and experience of the practitioner.
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To present a review on the use of prolonged intermittent renal replacement therapy in the intensive care patient. ⋯ Information is now being obtained on the efficacy and safety of PIRRT in the ICU. Several units in Australia have started applying this technology to patient care. It is now important that critical care physicians and nurses become familiar with its principles and practice.
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To review the use of indomethacin in the management of traumatic brain injury. ⋯ Indomethacin should only be considered as an experimental therapy for refractory intracranial hypertension in TBI patients, as current evidence is not available to support its routine use in the management of an elevated ICP. Its use in patients with cerebral vasospasm, renal failure, bleeding disorders, peptic ulceration and coagulopathies is contraindicated.
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To review the technology and the role of monitoring tissue oxygenation in critical illness. ⋯ Monitoring of tissue oxygenation is largely a research tool. For its application in the critically ill patient there needs to be a greater understanding of normal values of PO2 and PCO2 at the various tissue beds, dysoxic thresholds for the various tissues and optimal sites for monitoring.