Respiratory care clinics of North America
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The use of early tracheostomy in the multiply injured trauma patient has many advantages both in terms of patient management and reduction of morbidity associated with prolonged translaryngeal intubation. Tracheostomy (percutaneous or open technique) has been associated with very low risk of mortality and comparable morbidity to prolonged endotracheal intubation. ⋯ A delay in converting translaryngeal intubation to tracheostomy had been associated with longer ICU stays; conversely, early tracheostomy has been associated with a reduction in ICU stays, incidence of hospital-acquired pneumonias, mechanically ventilated days, and length of hospital stay. Thus, the benefits of early tracheostomy are improved care for patients in the trauma or critical care setting and reduced hospital and patient costs.
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Respir Care Clin N Am · Mar 1997
ReviewTo everything turn, turn, turn.... An overview of continuous lateral rotational therapy.
Continuous lateral rotational therapy can be a significant adjunct in the care of the critically ill patient. CLRT has a great impact on both patient outcomes as well as cost containment in the care of the critically ill. These systems should be used with clear guidelines to determine when CLRT is indicated, its therapeutic benefit, and when to discontinue the therapy. Much research is needed to validate efficacy of particular systems, cost-effectiveness, and necessary frequency and degree of rotation to attain optimal clinical benefits.
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The selection of pharmacologic agents for the sedation and paralysis of critically ill patients should be based on clinical and pharmacoeconomic trials in this patient population. There is a need for the design and evaluation of cost-effective regimens, especially with the continued development and release of newer agents. Additionally, clinicians must continue to be sensitive to the monitoring techniques of sedation and paralysis to ensure maximal clinical benefit while minimizing the adverse effect profile of pharmacologic agents.
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Respir Care Clin N Am · Mar 1997
ReviewVentilatory support following burns and smoke-inhalation injury.
The first major improvement in the treatment of burn injury came with the recognition of the importance of fluid resuscitation to prevent shock and renal failure. Subsequently, the use of topical antibiotics to control burn-wound infection and prevent invasive burn-wound sepsis led to the next significant reduction in morbidity and mortality of burn patients. ⋯ A better understanding of pathogenic mechanisms will lead to the development of therapeutic agents and treatment regimens that will modulate the cascades of humoral mediators of organ dysfunction and reduce the morbidity and mortality associated with inhalation injury. The recognition of ventilator-induced lung injury has led to adoption of alternative ventilatory techniques such as high-frequency percussive ventilation, which has been shown to substantially reduce the morbidity associated with inhalation injury.