Journal of intensive care medicine
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J Intensive Care Med · Jul 2003
Editorial Comment ReviewNosocomial pneumonia: the gorilla in the ICU.
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Despite its therapeutic efficacy in various clinical scenarios in the intensive care unit setting, there are limited reports regarding the intraoperative applications of nitric oxide (NO). The authors present 2 pediatric patients to whom inhaled NO was administered intraoperatively. ⋯ In the second patient, NO was used to alleviate pulmonary hypertension and cardiovascular dysfunction with pulmonary artery cross-clamping for placement of a modified Blalock-Taussig shunt. The potential intraoperative applications and techniques for the intraoperative delivery of NO are presented.
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The management of critically ill patients requires a fundamental understanding of cardiopulmonary interactions associated with mechanical ventilation. The hemodynamic changes due to ventilation are a result of changes in lung volume and intrathoracic pressure (ITP) and can occur during spontaneous or positive pressure ventilation despite constant tidal volumes. ⋯ The authors will consider the mechanisms of the effects of ITP on the pulmonary arterial and venous branches. These effects will aid in understanding the complex interactions between ventilation and right and left ventricular pressures and volumes, as well as the influence of lung inflation pressure on ventricular interdependence.
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J Intensive Care Med · Jan 2003
ReviewPneumothorax in patients with acute respiratory distress syndrome: pathophysiology, detection, and treatment.
Pneumothorax is a frequent and potentially fatal complication of mechanical ventilation in patients with acute respiratory distress syndrome (ARDS). Prompt recognition and treatment of pneumothoraces is necessary to minimize morbidity and mortality. The radiologic and clinical signs of pneumothoraces in ARDS patients may have unusual and subtle features. ⋯ Sparse clinical literature exists on when or how to treat pneumothoraces once they develop in patients with ARDS. In this article, the authors review the pathogenesis, radiologic signs, clinical significance, and treatment of pneumothoraces in ARDS patients. Treatment options include traditional tube thoracostomy, open thoracotomy, and image-guided percutaneous catheters.
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Disorders of sodium and water metabolism are frequently encountered in hospitalized patients. Hyponatremia in critically ill patients can cause significant morbidity and mortality. Inappropriate treatment of hyponatremia can add to the problem. ⋯ The increasing knowledge about aquaporins and the role of vasopressin in water metabolism has enhanced our understanding of these disorders. The authors have outlined the general approach to the diagnosis and management of hyponatremia. A systematic approach by clinicians, using a detailed history, physical examination, and relevant diagnostic tests, will assist in efficient management of salt and water problems.