Articles: critical-illness.
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Airway management of critically ill patients has been enhanced by the recent introduction of several new types of artificial airways and laryngoscopes. New drugs for sedation and neuromuscular blockade have been developed to facilitate care of the intubated patient. Guidelines for management of the difficult airway have been introduced. ⋯ A consensus is evolving that TLI and tracheotomy each have clear advantages and disadvantages in prolonged airway maintenance and that multiple factors, not simply the duration of TLI, must be considered in the optimal timing of tracheotomy for each patient. Complex medicolegal and ethical issues directly impact intubation, perhaps more so than any other practice in critical care medicine. Physicians who care for critically ill patients should be familiar with these recent developments and concepts in airway management.
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American family physician · Sep 1996
ReviewMonitoring pulmonary artery wedge pressure in medical patients.
Pulmonary artery wedge pressure is used in the diagnosis and management of critically ill patients. This measurement provides an accurate assessment of hemodynamic status, cardiac function and venous oxygen saturation. Wedge pressure monitoring has been used in the management of patients with complicated myocardial infarction, refractory heart failure, circulatory shock, pulmonary edema and other critical illnesses. ⋯ Clinical assessment or noninvasive tests, including chest radiographs and echocardiography, often provide information adequate for planning management. If therapy fails, or if noninvasive data are uncertain, pulmonary artery catheterization is appropriate. Risks and complications may be secondary to either catheter insertion or the continued presence of the catheter.
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Pediatric intensive care units have developed as treatment areas with a concentration of specialized equipment and personnel. Critically ill children often need to be moved to and from these critical care areas for diagnostic or therapeutic procedures. Such transport may pose additional risk to the critically ill patient. ⋯ Our results would suggest that more training regarding the transport of the critically ill child are needed in our area.
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Am. J. Respir. Crit. Care Med. · Sep 1996
ReviewEthical considerations of ensuring an informed and autonomous consent in research involving critically ill patients.
Despite several codes of research ethics, the issuance of comprehensive rules regarding informed consent by governmental agencies, and numerous writings on the subject of informed consent, many commentators still question the quality of the informed consent process in clinical research. A major concern is that investigators emphasize only the information-giving aspect of "informed" consent, whereas moral philosophy stresses a more robust concept of informed consent that incorporates the additional requirements of subject competence and voluntariness of the consent, thus ensuring that a consent is not only informed, but autonomous as well. This article aims to examine the issues involved with disclosure, competence, and voluntariness, especially those related to research involving critically ill patients. Suggestions concerning methods that can promote an informed consent process that is more respectful of autonomous decision making will also be discussed.
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Cardiologia (Rome, Italy) · Sep 1996
Randomized Controlled Trial Clinical TrialTransesophageal echocardiography in critically-ill patients using a miniaturized probe: feasibility, efficacy and indications.
Transesophageal echocardiography (TEE) with standard probes may be unsuccessful in emergencies, and in critically-ill or non collaborative patients. A miniaturized pediatric probe was used to overcome these limitations. Thirty-nine patients (age 18-87 years, height 155-184 cm, weight 45-102 kg) were studied with the pediatric probe, and 21 of them were studied using both the pediatric and adult probes in a random sequence. ⋯ Imaging projections and diagnostic accuracy in a wide range of cardiac, aortic and mediastinal diseases were similar for both the pediatric and adult probes. Patient's compliance was much improved by the pediatric probe. In conclusion, TEE by pediatric probes can be used in critically-ill adult patients when the approach with the standard probe is unfeasible or when sedation is undesirable.