Articles: critical-care.
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Information on the role of the intensivist in postoperative cardiovascular patient care was obtained from a national survey of cardiac surgeons. The cardiac surgeon today retains overall responsibility for patient care. ⋯ Intensivists are less likely to practice in nonteaching hospitals and less likely to be present in those cardiac surgical units that are not combined with other services. Because of the preponderance of intensivists in training programs, the surgical resident's role in patient care may be reduced in the future.
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In spite of good correlations between cardiac output measurements by impedance and established invasive procedures (dye- and thermo-dilution) reported by numerous authors it is doubtful uptil now whether calculations of stroke volume according to the formula of Kubicek et al. (1974) can provide absolutely reliable results. The origin of the dz/dt curve and influencing factors of impedance wave have to be cleared up prior to the total acception of impedance cardiography as a reliable method for determining non-invasive stroke volume. This is true in spite of the agreement of all authors we know, that the reproducibility of the impedance cardiography values is as good as in dye or thermo-dilution measurements. ⋯ The reason for interindividual differences in the thoracic impedance at a given reduction of body water are due to anatomical differences, intrapulmonary air volume and pressure, location of the electrodes, electrical conductivity of the tissue and, above all, due to the position of the body. Therefore if transthoracic impedance is determined sequentially measurements must be performed with special attention to the position of the body to get reproducible results. Rapid infusion of colloids or blood transfusion may decrease transthoracic impedance due to intravascular volume expansion even at a net fluid lost during forced furosemide-induced diuresis or extracorporal hemodialysis.(ABSTRACT TRUNCATED AT 400 WORDS)
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Anasth Intensivther Notfallmed · Feb 1984
[Indications for tracheotomy in long-term ventilated critically ill patients].
In order to evaluate the frequency and indication of tracheotomy in long-term ventilated critically ill patients we analysed retrospectively patients requiring artificial ventilation for periods of more than 7 days. During 1974-75 30 out of 55 of these patients were tracheotomised. In accordance with common practice, early tracheotomy (14 patients) was performed when ventilatory support was expected to exceed 8 to 10 days. ⋯ No late laryngeal sequelae after prolonged tracheal intubation were observed. The risks have been reduced by the use of recently introduced tube materials. Prolonged tracheal intubation has become a safe alternative to tracheotomy.