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Intubation critical care

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https://www.readbyqxmd.com/read/27907956/intensive-care-management-of-the-endovascular-stroke-patient
#1
Julian Bösel
Acute ischemic stroke caused by the occlusion of large brain vessels can be treated effectively by mechanical thrombectomy, as proved by recent strong and consistent evidence from high-quality randomized trials. This new era of endovascular stroke treatment, however, poses particular challenges that go far beyond the so far gold standard of intravenous thrombolysis alone. Because these stroke patients usually present with severe neurologic deficits, may be unstable from cardiac or pulmonary instability, have to endure an invasive intervention of sometimes long duration, may suffer complications and require close postinterventional follow-up, they often demand intensive care measures...
December 2016: Seminars in Neurology
https://www.readbyqxmd.com/read/27904565/is-type-2-diabetes-mellitus-in-mechanically-ventilated-adult-trauma-patients-potentially-related-to-the-occurrence-of-ventilator-associated-pneumonia
#2
Hadi Darvishi-Khezri, Abbas Alipour, Amir Emami Zeydi, Abolfazl Firouzian, Ghahraman Mahmudi, Melody Omrani-Nava
BACKGROUND: Ventilator-associated pneumonia (VAP) is a type of lung infection that typically affects critically ill patients undergoing mechanical ventilation (MV) in the intensive care unit (ICU). Patients with type 2 diabetes mellitus (T2DM) are considered to be more susceptible to several types of infections including community-acquired pneumonia. However, it is not clear whether T2DM is a risk factor for the development of VAP. The purpose of this study was to determine the risk of VAP for diabetic and nondiabetic mechanically ventilated trauma patients...
2016: Journal of Research in Medical Sciences: the Official Journal of Isfahan University of Medical Sciences
https://www.readbyqxmd.com/read/27899469/emergency-surgical-airways-following-activation-of-a-difficult-airway-management-team-in-hospitalized-critically-ill-patients-a-case-series
#3
REVIEW
Joseph M Darby, Gregory Halenda, Courtney Chou, Joseph J Quinlan, Louis H Alarcon, Richard L Simmons
INTRODUCTION: An emergency surgical airway (ESA) is widely recommended for securing the airway in critically ill patients who cannot be intubated or ventilated. Little is known of the frequency, clinical circumstances, management methods, and outcomes of hospitalized critically ill patients in whom ESA is performed outside the emergency department or operating room environments. METHODS: We retrospectively reviewed all adult patients undergoing ESA in our intensive care units (ICUs) and other hospital units from 2008 to 2012 following activation of our difficult airway management team (DAMT)...
November 28, 2016: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/27894559/helicopter-transport-in-regionalized-burn-care-one-program-s-perspective
#4
Benjamin Nicholson, Harinder Dhindsa
BACKGROUND: The decision to use helicopter EMS (HEMS) for the transport of burn patients is a complex decision. This analysis sought to evaluate burn patients flown to burn centers who met predetermined criteria for patients who likely benefit from HEMS care. METHODS: A retrospective transport chart review of all burn transports covering the preceding nine and a half years was conducted to evaluate for HEMS appropriate criteria defined as patients requiring advanced airway management, ventilator support, facial burns, inhalation injury, circumferential burns, electrical or chemical burn, or major burns...
November 2016: Air Medical Journal
https://www.readbyqxmd.com/read/27894277/human-limb-skeletal-muscle-wasting-and-architectural-remodeling-during-five-to-ten-days-intubation-and-ventilation-in-critical-care-an-observational-study-using-ultrasound
#5
Peter Turton, Richard Hay, Jonathon Taylor, Jamie McPhee, Ingeborg Welters
BACKGROUND: Critically ill patients frequently suffer muscle weakness whilst in critical care. Ultrasound can reliably track loss of muscle size, but also quantifies the arrangement of the muscle fascicles, known as the muscle architecture. We sought to measure both pennation angle and fascicle length, as well as tracking changes in muscle thickness in a population of critically ill patients. METHODS: On days 1, 5 and 10 after admission to critical care, muscle thickness was measured in ventilated critically ill patients using bedside ultrasound...
November 29, 2016: BMC Anesthesiology
https://www.readbyqxmd.com/read/27875775/bronchoscopic-intubation-is-an-effective-airway-strategy-in-critically-ill-patients
#6
Kevin C Ma, Augustine Chung, Kerri I Aronson, Jamuna K Krishnan, Igor Z Barjaktarevic, David A Berlin, Edward J Schenck
PURPOSE: American Society of Anesthesiologists guidelines recommend the use of bronchoscopic intubation as a rescue technique in critically ill patients. We sought to assess the safety and efficacy of bronchoscopic intubation as an initial approach in critically ill patients. METHODS: We performed a retrospective cohort study of patients who underwent endotracheal intubation in the medical intensive care unit of a tertiary urban referral center over 1 academic year...
November 4, 2016: Journal of Critical Care
https://www.readbyqxmd.com/read/27873291/prediction-of-non-recovery-from-ventilator-demanding-acute-respiratory-failure-ards-and-death-using-lung-damage-biomarkers-data-from-a-1200-patient-critical-care-randomized-trial
#7
Jens-Ulrik S Jensen, Theis S Itenov, Katrin M Thormar, Lars Hein, Thomas T Mohr, Mads H Andersen, Jesper Løken, Hamid Tousi, Bettina Lundgren, Hans Christian Boesen, Maria E Johansen, Sisse R Ostrowski, Pär I Johansson, Jesper Grarup, Jørgen Vestbo, Jens D Lundgren
BACKGROUND: It is unclear whether biomarkers of alveolar damage (surfactant protein D, SPD) or conductive airway damage (club cell secretory protein 16, CC16) measured early after intensive care admittance are associated with one-month clinical respiratory prognosis. If patients who do not recover respiratory function within one month can be identified early, future experimental lung interventions can be aimed toward this high-risk group. We aimed to determine, in a heterogenous critically ill population, whether baseline profound alveolar damage or conductive airway damage has clinical respiratory impact one month after intensive care admittance...
December 2016: Annals of Intensive Care
https://www.readbyqxmd.com/read/27870576/airway-management-strategies-for-brain-injured-patients-meeting-standard-criteria-to-consider-extubation-a-prospective-cohort-study
#8
Victoria A McCredie, Niall D Ferguson, Ruxandra L Pinto, Neill Kj Adhikari, Robert A Fowler, Martin G Chapman, Althea Burrell, Andrew J Baker, Deborah J Cook, Maureen O Meade, Damon C Scales
RATIONALE: Patients with acute brain injury are frequently capable of breathing spontaneously with minimal ventilatory support despite persistent neurological impairment. OBJECTIVES: We sought to describe factors associated with extubation timing, success and primary tracheostomy in these patients. METHODS: We conducted a prospective multicenter observational cohort study in three academic hospitals in Toronto, Canada. Consecutive brain-injured adults receiving mechanical ventilation for at least 24 hours in 3 ICUs were screened by study personnel daily for extubation consideration criteria...
November 21, 2016: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/27853105/clinical-characteristics-of-patients-who-overdose-on-multiple-psychotropic-drugs-in-tokyo
#9
Satoshi Hori, Kosaku Kinoshita
OBJECTIVE: The purpose of this study was to identify the clinical aspects leading to overdose of multiple psychotropic drugs, in order to determine areas which need attention in the proper treatment of overdose patients. METHODS: Patients who were treated for overdose of psychotropic drugs at our emergency and critical center over two years were targeted. The clinical data was gathered from the medical records and database of all patients, including age, gender, vital signs, and laboratory data, drugs, and medical complications during hospital stay...
2016: Journal of Toxicological Sciences
https://www.readbyqxmd.com/read/27850573/935-tracheal-intubation-in-critical-care-transport-global-consensus-quality-metric-performance
#10
Michael Bigham, Hamilton Schwartz, Michael Gothard, Megan Gothard, Patrick Parrish
No abstract text is available yet for this article.
December 2016: Critical Care Medicine
https://www.readbyqxmd.com/read/27849480/validation-of-an-assessment-tool-for-field-endotracheal-intubation
#11
Danielle Hart, Joseph Clinton, Shilo Anders, Troy Reihsen, Mary Ann McNeil, Gregory Rule, Robert Sweet
OBJECTIVES: Endotracheal intubation (ETI) is an important skill for all emergency providers; our ability to train and assess our learners is integral to providing optimal patient care. The primary aim of this study was to assess the inter-rater reliability (IRR) and discriminant validity of a novel field ETI assessment tool using a checklist-derived performance score (PS) and critical failure (CF) rate. METHODS: Forty-three participants (18 paramedic students, 11 paramedics, and 14 emergency physicians [EPs]) performed ETI during a simulated trauma scenario on a pseudo-ventilated cadaver...
November 2016: Military Medicine
https://www.readbyqxmd.com/read/27846872/challenges-on-non-invasive-ventilation-to-treat-acute-respiratory-failure-in-the-elderly
#12
REVIEW
Raffaele Scala
Acute respiratory failure is a frequent complication in elderly patients especially if suffering from chronic cardio-pulmonary diseases. Non-invasive mechanical ventilation constitutes a successful therapeutic tool in the elderly as, like in younger patients, it is able to prevent endotracheal intubation in a wide range of acute conditions; moreover, this ventilator technique is largely applied in the elderly in whom invasive mechanical ventilation is considered not appropriated. Furthermore, the integration of new technological devices, ethical issues and environment of treatment are still largely debated in the treatment of acute respiratory failure in the elderly...
November 15, 2016: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/27843781/comparison-of-bispectral-index-monitoring-with-the-critical-care-pain-observation-tool-in-the-pain-assessment-of-intubated-adult-patients-after-cardiac-surgery
#13
Zahra Faritous, Arvin Barzanji, Rasoul Azarfarin, Behshid Ghadrdoost, Mohsen Ziyaeifard, Nahid Aghdaei, Mostafa Alavi
BACKGROUND: Detecting pain is crucial in sedated and mechanically ventilated patients, as they are unable to communicate verbally. OBJECTIVES: This study aimed to compare Bispectral index (BIS) monitoring with the Critical-care pain observation tool (CPOT) and vital signs for pain assessment during painful procedures in intubated adult patients after cardiac surgery. MATERIALS AND METHODS: Seventy consecutive patients who underwent cardiac surgery (coronary artery bypass graft or valvular surgery) were enrolled in the study...
August 2016: Anesthesiology and Pain Medicine
https://www.readbyqxmd.com/read/27843549/comparison-of-foam-swabs-and-toothbrushes-as-oral-hygiene-interventions-in-mechanically-ventilated-patients-a-randomised-split-mouth-study
#14
Paola J Marino, Ailish Hannigan, Sean Haywood, Jade M Cole, Nicki Palmer, Charlotte Emanuel, Tracey Kinsella, Michael A O Lewis, Matt P Wise, David W Williams
INTRODUCTION: During critical illness, dental plaque may serve as a reservoir of respiratory pathogens. This study compared the effectiveness of toothbrushing with a small-headed toothbrush or a foam-headed swab in mechanically ventilated patients. METHODS: This was a randomised, assessor-blinded, split-mouth trial, performed at a single critical care unit. Adult, orally intubated patients with >20 teeth, where >24 hours of mechanical ventilation was expected were included...
2016: BMJ Open Respiratory Research
https://www.readbyqxmd.com/read/27833679/endotracheal-tube-cuff-pressures-in-patients-intubated-prior-to-helicopter-ems-transport
#15
Joseph Tennyson, Tucker Ford-Webb, Stacy Weisberg, Donald LeBlanc
INTRODUCTION: Endotracheal intubation is a common intervention in critical care patients undergoing helicopter emergency medical services (HEMS) transportation. Measurement of endotracheal tube (ETT) cuff pressures is not common practice in patients referred to our service. Animal studies have demonstrated an association between the pressure of the ETT cuff on the tracheal mucosa and decreased blood flow leading to mucosal ischemia and scarring. Cuff pressures greater than 30 cmH2O impede mucosal capillary blood flow...
November 2016: Western Journal of Emergency Medicine
https://www.readbyqxmd.com/read/27832565/safety-of-nicotine-replacement-therapy-in-critically-ill-smokers-a-retrospective-cohort-study
#16
A Kerr, J T McVey, A M Wood, Fmp Van Haren
Nicotine replacement therapy (NRT) is a common first-line treatment to prevent nicotine withdrawal in smokers. However, available literature reports conflicting results regarding its efficacy and safety in critically ill patients. The objective of this study was to evaluate the relationship between NRT in smokers in the intensive care unit (ICU) and outcomes. This case-control study was conducted in a university-affiliated tertiary hospital ICU. Over a period of five years, 126 active smokers who received transdermal NRT were matched to 126 active smokers who did not receive NRT...
November 2016: Anaesthesia and Intensive Care
https://www.readbyqxmd.com/read/27818334/neuromuscular-blockade-in-the-21-st-century-management-of-the-critically-ill-patient
#17
REVIEW
Julian deBacker, Nicholas Hart, Eddy Fan
Neuromuscular blockings agents (NMBAs) have a controversial role in the ventilatory and medical management of critical illness. The clinical concern surrounding NMBA-induced complications stems from evidence presented in the 2002 clinical practice guidelines, but new evidence from subsequent randomized trials and studies provides a more optimistic outlook about the application of NMBAs in the intensive care unit (ICU). Furthermore, changes in the delivery of critical care such as protocolized care pathways, minimizing or interrupting sedation, increased monitoring techniques, and overall improvements in reducing immobility have created a modern, 21st century ICU environment whereby NMBAs may be administered safely...
November 3, 2016: Chest
https://www.readbyqxmd.com/read/27816155/respiratory-considerations-including-airway-and-ventilation-issues-in-critical-care-obstetric-patients
#18
REVIEW
Holly Ende, Dirk Varelmann
Critical care management of the obstetric patient can present unique challenges. Parturients who present with respiratory distress can suffer from a multitude of etiologies, and each diagnosis must be pursued as appropriate to the clinical picture. Normal physiologic changes of pregnancy may obscure the presentation and diagnosis, and irrelevant of the cause, pregnancy may complicate the management of hypoxic and hypercarbic respiratory failure in this patient population. In addition to these concerns, both anticipated and unanticipated difficult airway management, including difficulty ventilating and intubating, are more common during pregnancy and may be encountered during endotracheal tube placement...
December 2016: Obstetrics and Gynecology Clinics of North America
https://www.readbyqxmd.com/read/27811586/verbal-communication-during-airway-management-and-emergent-endotracheal-intubation-observations-of-team-behavior-among-multi-institutional-pediatric-intensive-care-unit-in-situ-simulations
#19
Ranna A Rozenfeld, Anna P Nannicelli, Alexandra R Brown, Walter J Eppich, Donna M Woods, Steven O Lestrud, Zehava L Noah, Jane L Holl
OBJECTIVE: To assess health-care teams' verbal communication, an observable teamwork behavior, during simulations involving pediatric emergency airway management and intubation. METHODS: We conducted video-recorded, risk-informed in situ simulations at 5 hospitals with pediatric intensive care units in the Chicago, Illinois, area. Clinicians participated in their clinical roles (eg, attending physician, bedside nurse) and had access to hospital operational systems (eg, electronic health record, medical imaging, laboratory services)...
November 2, 2016: Journal of Patient Safety
https://www.readbyqxmd.com/read/27804108/tracheal-extubation-of-the-adult-intensive-care-patient-with-a-predicted-difficult-airway-a-narrative-review
#20
REVIEW
D J Sturgess, K B Greenland, S Senthuran, F A Ajvadi, A van Zundert, M G Irwin
Management of the difficult airway is an important, but as yet poorly-studied, component of intensive care management. Although there has been a strong emphasis on prediction and intubation of the difficult airway, safe extubation of the patient with a potentially difficult airway has not received the same attention. Extubation is a particularly vulnerable time for the critically ill patient and, because of the risks involved and the consequences of failure, it warrants specific consideration. The Royal College of Anaesthetists 4th National Audit Project highlighted differences in the incidence and consequences of major complications during airway management between the operating room and the critical care environment...
November 2, 2016: Anaesthesia
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