Articles: critical-illness.
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To evaluate the usefulness of transesophageal echocardiography (TEE) in the treatment of critically ill patients, 80 patients (51 male and 29 female; mean age, 53 years) undergoing both transthoracic echocardiography (TTE) and TEE were studied in a 2-year period. Of these, 48 patients were studied in the ICU, while the other 32 patients were directly referred from the emergency departments. Indications for the study included suspected aortic dissection (34 patients), hemodynamic instability (22 patients), suspected cardiac source of embolism (11 patients), evaluation of the severity of mitral regurgitation (7 patients), and suspected infective endocarditis (6 patients). ⋯ Transesophageal echocardiography provided critical information that was not obtained by TTE in 39 of 78 studies (50 percent, p < 0.005). Cardiac surgery was prompted by TEE findings in 14 patients (18 percent) and these findings were all confirmed at operation. Transesophageal echocardiography was a safe, well-tolerated, and valuable diagnostic approach for the rapid detection of specific cardiac abnormalities in patients with critical illness; TEE should be considered in the treatment of critically ill patients especially when TTE provided inadequate information.
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The metabolic response to critical illness is an integrated process producing profound changes to multiple systems. The altered metabolism of carbohydrates, lipids, and proteins in critically injured patients, and the crucial role of cytokine mediators such as tumour necrosis factor, interleukins, and interferons are described in detail. ⋯ The research on specifically enriched amino acid formulations with glutamine, branched-chain amino acids, and arginine solutions is reviewed with emphasis on both theoretical and clinical issues. The role of dietary lipids in the production of specific modulators of immunoresponsiveness and investigations focusing on metabolic modulation relating to nutritional support are summarized.
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Case Reports
Correlation between clinical diagnoses and autopsy findings in critically ill children.
To examine the correlation between clinical diagnoses and autopsy findings in children who die in the pediatric intensive care unit (PICU). ⋯ Despite modern diagnostic techniques, the autopsy continues to reveal valuable and unsuspected information.
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Bedside percutaneous dilational tracheostomy was performed by critical care attending physicians or supervised pulmonary and critical care fellows on 100 patients in the ICU at Cook County Hospital, Chicago, over a 3-year period. A needle is inserted in the first or second tracheal interspace followed by a guidewire. The tract is enlarged with a series of dilators to allow placement of a standard tracheostomy tube. ⋯ Comparison of percutaneous dilational tracheostomy with two other techniques of percutaneous tracheostomy reveals a similar success rate with a lower incidence of serious complications. Bedside percutaneous dilational tracheostomy can be performed in the ICU by trained physicians with a low complication rate. We believe it to be the procedure of choice for many critically ill patients who require tracheostomies.