Articles: critical-care.
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As this article demonstrates, tremendous progress has been made in the techniques of oxygen measurement and monitoring over the past 50 years. From the early developments during and after World War II, to the most recent applications of solid state and microprocessor technology today, every patient in a critical care situation will have several continuous measurements of oxygenation applied simultaneously. Information therefore is available readily to alert personnel of acute problems and to guide appropriate therapy. ⋯ The next generation of devices will attempt to provide information about living tissue. Unlike the devices monitoring arterial or venous oxygen content, no "gold standards" exist for tissue oxygenation, so calibration will be difficult, as will interpretation of the data provided. The application of these devices ultimately may lead to a much better understanding of how disease (and the treatment of disease) alters the utilization of oxygen by the tissues.
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The initial work-up of a critically ill patient with fever begins with a hunt for an infectious cause. A positive urine culture, or the presence of dysuria or suprapubic tenderness, suggests urinary tract infection. ⋯ Other common causes of fever in the ICU include abdominal abscesses and catheter-related infections; atelectasis has not been shown to cause fever. If the initial work-up fails to establish a cause of postoperative fever, and the fever resolves within 4 days, no further work-up is required.
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Ann Fr Anesth Reanim · Jan 1995
Review Practice Guideline Guideline[French Society of Anesthesia and Intensive Care. Arterial catheterization and invasive measurement of blood pressure in anesthesia and intensive care in adults].
A group of 13 experts appointed by the French Society of Anaesthesia and Intensive Care has produced the following guidelines for arterial catheterisation and invasive measurement of systemic arterial blood pressure in adults. Teflon or polyurethane catheters are recommended with a maximal size of 18 gauge for femoral and axillary arteries and 20 gauge for the others. For small arteries (radial and pedious arteries) a maximal length of 3-5 cm should be preferred. ⋯ The catheter removal should be considered as an aseptic surgical procedure. The catheter completeness has to be checked. A systematic culture of the catheter is not required.
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Meta Analysis
[Can selective decontamination of the digestive tract as a routine procedure on intensive care units be recommended?].
After giving an overview on the epidemiological and microecological background, the applicable drugs, and the necessary microbiological surveillance for Selective Decontamination of the Digestive tract (SDD), the results of 2 new metaanalyses of 22 and 25 individual randomized studies are discussed. A 50%-reduction of the pneumonia incidence results in an only marginal reduction of the mortality rate in the subgroup of topically plus for the first few days systemically treated patients in mixed intensive care units. ⋯ The chance and the need to confirm a mortality benefit in multicentre trials enrolling large numbers of homogeneous surgical patients are explained. At the present time, SDD as a routine can not (yet) be recommended.
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The role of the fiberscope in the management of difficult and failed intubations has been well established and the importance of learning this valuable skill has been emphasized. Nonetheless, the fiberscope is underutilized in anesthesia and critical care practices because of a high rate of intubation failure. The main cause of failure is lack of expertise in maneuvering the fiberscope. ⋯ The fiberscope is best used in patients after learning to perform three simultaneous movements--advancing the fiberscope, coordinated rotation of the insertion cord, and bending the tip of the fiberscope while traversing the airway. After the technical skills of the fiberscope become second nature, the endoscopist can give more attention to patient-related factors to improve the success rate of tracheal intubation. Expert use of the fiberscope can be a life-saving measure through alleviating major airway complications and unnecessary tracheostomies.