Articles: critical-care.
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Ultrasonography plays an increasingly important role in the evaluation of the vascular system. It is especially useful for the intensive care patient because of its ability to be performed at the patient's bedside, as well as the relatively high frequency of vascular complications in the ICU. Ultrasonography is the method of choice for evaluation of deep vein thromboembolic disease of the lower extremity in all patients, demonstrating excellent sensitivity and specificity for this condition. ⋯ It may be limited in this assessment, however, because it does not reliably demonstrate the central subclavian and innominate veins, and therefore may be inadequate for evaluation of malfunctioning central venous catheters. Ultrasonography can reliably identify the presence of abdominal aortic aneurysms, although computed tomography is better able to demonstrate location and extent of these lesions. Finally, ultrasonography can be used to diagnose complications of arterial catheterization and, in selected patients, may direct compression of pseudoaneurysms, resulting in thrombosis and thereby averting surgical repair.
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In summary, ultrasonography and its recent advances appear ideally suited to a number of conditions common in the critically ill patient and the ICU setting. Depending on the clinical situation, and, providing appropriate technical expertise is available, ultrasonography can both gather diagnostic information and, where indicated, guide therapeutic intervention.
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In summary, interventional techniques are well-established and offer safe and effective alternatives for management of patients in the intensive care unit or other setting. It is likely that the radiologist will become more involved in the management of ill children and adults. It is hoped that this will reduce the need for opened surgical procedures, reduce the complexity of surgery, and provide treatment options for complications.
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Anaesth Intensive Care · Apr 1994
Intensive care costing methodology: cost benefit analysis of mask continuous positive airway pressure for severe cardiogenic pulmonary oedema.
Costing data for intensive care admissions is important, not only for unit funding, but also for cost outcome analysis of new therapies. This paper presents an intensive care episode costing methodology using the example of a cost-benefit analysis of mask CPAP for severe cardiogenic pulmonary oedema (CPO). This analysis examines the intervention of admitting all patients with severe CPO to the intensive care unit for mask CPAP, compared with the previous practice of admitting only patients failing conventional non-CPAP treatment and requiring mechanical ventilation. ⋯ The major contributors to cost in both groups were nursing and medical salaries, and hospital overheads. The cost of previous estimated yearly caseload of 35 ventilated patients ($176,925) was greater than the cost associated with an increased caseload of 100 mask CPAP patients ($115,600). We conclude that, despite an increase in admissions, mask CPAP for severe CPO is cost-effective.
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In this issue, we evaluate seven models of disposable breathing circuits from seven manufacturers; the evaluated circuits are intended to be used for adult patients on critical care ventilators. This study is a follow-up to our earlier Evaluation of disposable breathing circuits for use with portable ventilators, published in Health Devices 22(7), July 1993. We based our ratings on the breathing circuits' ability to function properly with minimal intervention from the healthcare provider. ⋯ We caution readers not to base purchasing decisions on our ratings alone, but on a thorough understanding of the issues surrounding our conclusions, which can be gained by reading this study in its entirety. We offer additional guidance and discuss important selection factors and usage issues in the Selection and Use Guide for Disposable Breathing Circuits included at the end of the Evaluation. Also see "Pre-use Verification of Breathing Circuits" in this issue for step-by-step guidelines to help healthcare providers and caregivers verify proper performance and identify the defective circuits that inevitably reach the clinical setting.