International journal of critical illness and injury science
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Int J Crit Illn Inj Sci · Jan 2016
Impact of chlorhexidine mouthwash prophylaxis on probable ventilator-associated pneumonia in a surgical intensive care unit.
Prevention of ventilator-associated pneumonia is a healthcare goal. Although data is inconsistent, some studies suggest that oral chlorhexidine may decrease rates of pneumonia in mechanically-ventilated patients. We sought to assess the rate of pneumonia in the Surgical Intensive Care Unit (SICU) pre and post implementation of routine chlorhexidine mouthwash prophylaxis. ⋯ Use of chlorhexidine mouthwash prophylaxis may reduce rates of probable VAP. Further study is warranted.
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Int J Crit Illn Inj Sci · Oct 2015
Postoperative sciatic and femoral or saphenous nerve blockade for lower extremity surgery in anesthetized adults.
Guidelines warn of increased risks of injury when placing regional nerve blocks in the anesthetized adult but complications occurred in patients that received neither sedation nor local anesthetic. This restriction of nerve block administration places vulnerable categories of patients at risk of severe opioid induced side effects. Patient and operative technical factors can preclude use of preoperative regional anesthesia. The purpose of this study was to assess complications following sciatic popliteal and femoral or saphenous nerve blockade administered to anesthetized adult patients following foot and ankle surgery. ⋯ 190 anesthetized adult patients were administered 357 nerve blocks. No major nerve injury or deficit was reported. One patient had numbness in the toes not ascribed to a specific nerve of the lower extremity. Perioperative opioid dose differences were noted between male and female and between opioid naïve and tolerant patients.
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Int J Crit Illn Inj Sci · Oct 2015
Endotracheal cuff pressure changes with change in position in neurosurgical patients.
Placement of a cuffed endotracheal tube for the administration of general anesthesia is routine. The cuff of the endotracheal tube is inflated with air to achieve an adequate seal to prevent micro-aspiration. Over inflation of the cuff can decrease the mucosal perfusion, leading to pressure necrosis and nerve palsies. Inadequate seal can lead to micro aspiration. So the cuff pressure has to be monitored and kept within the prescribed limits of 20-30 cms of water. ⋯ Cuff pressure has to be checked after achieving the final positioning of the patient and adjusted to the prescribed limits to prevent micro aspiration.
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Int J Crit Illn Inj Sci · Jul 2015
Regional anesthesia for management of acute pain in the intensive care unit.
Pain is a major problem for Intensive Care Unit (ICU) patients. Despite numerous improvements it is estimated that as many as 70% of the patients experience moderate-to-severe postoperative pain during their stay in the ICU. Effective pain management means not only decreasing pain intensity, but also reducing the opioids' side effects. ⋯ Furthermore, recent studies suggest that effective acute pain management may be helpful in reducing the development of chronic pain. When used appropriately, and in combination with other treatment modalities, regional analgesia techniques (neuraxial and peripheral nerve blocks) have the potential to reduce or eliminate the physiological stress response to surgery and trauma, decreasing the possibility of surgical complications and improving the outcomes. Also they may reduce the total amount of opioid analgesics necessary to achieve adequate pain control and the development of potentially dangerous side effects.
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Flexible and rigid bronchoscopes are used in diagnosis, therapeutics, and palliation. While their use is widespread, effective, and generally safe; there are numerous potential complications that can occur. ⋯ Attributable mortality rates remain low at < 0.1% for fiberoptic and rigid bronchoscopy. Here we review the complications (classified as mechanical or systemic) of both rigid and flexible bronchoscopy in hope of making practitioners who are operators of these tools, and those who consult others for interventions, aware of potential problems, and pitfalls in order to enhance patient safety and comfort.