Articles: intensive-care-units.
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Ann Otolaryngol Chir Cervicofac · Jan 1988
[Nosocomial sinusitis in an intensive care unit. Role of nasotracheal intubation].
Hospital infectious sinusitis resulting from nasotracheal intubation is common. A prospective study was undertaken between October 1986 and January 1988 of 46 patients who had undergone nasotracheal intubation. ⋯ In 21 cases the existence of a complication (chest infection and/or septicemia) raised the possibility of the role played by sinusitis in their etiology. The prevalence of gram negative bacilli sinusitis in patients with a nasotracheal tube is felt to require the following from the 8th day onwards: a CT scan to detect the existence of sinusitis, sinus puncture for bacteriological identification of the organism.
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The allocation of critical care resources must follow criteria of distributive justice. Because most societies cannot indefinitely expand medical care costs, difficult decisions on the quality and quantity of care that can be rendered to each patient are inevitable. ⋯ It is reasonable to anticipate that over the next few years regulations will be formulated to decide which patients can be admitted to the ICU. Critical care physicians have the right and obligation to be involved in all aspects of these decision-making processes.
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Five years' experience of paediatric intensive care in a district general hospital were analysed retrospectively. A total of 54 infants and children required respiratory support during this time--21 on a high dependency area of the children's ward and 33 on a general intensive care unit. Forty two (78%) of the patients survived, and 33 (61%) of the patients required respiratory support within four hours of admission, thus the experience of the local paediatric and anaesthetic team was crucial to the management of these children. Good intensive care for children can be provided within a district general hospital.