Crit Care Resusc
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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 review the management of persistent hypertension and hypertensive crisis in the critically ill patient. ⋯ A mean arterial pressure in the critically ill is often tolerated up to a value of 135 mmHg for some hours. However in some disorders (e.g. dissecting aortic aneurysm, cardiac failure, angina, acute myocardial infarction, pre-eclampsia or eclampsia and following cardiac, vascular or cerebral surgery) a mean arterial blood pressure of 90 mmHg or greater should be treated urgently.
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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.
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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.