Journal of intensive care medicine
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J Intensive Care Med · Sep 2009
ReviewConfirmation of endotracheal tube position: a narrative review.
Endotracheal tube (ETT) insertion is the primary method of definitive airway protection and control in critically ill patients. Detection of ETT malposition in a timely fashion is crucial in both elective and emergent intubation. In this review, we describe classic tests and highlight several new technologies that may assist the practitioner in determining ETT position within the esophago-tracheal complex, namely ultrasonographic and impedance-based methods. ⋯ New methods such as ultrasonic location of the ETT show promise but require further study. The clinician performing ETT insertion should have multiple confirmation methods that allow the practitioner to adapt to a variety of clinical situations, depending on local costs and availability. Finally, when the clinician still has uncertainty, or multiple tests give conflicting results, the availability of bronchoscopy at the bedside to visualize the carina through the ETT is useful.
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J Intensive Care Med · Sep 2009
ReviewSympathetic overstimulation during critical illness: adverse effects of adrenergic stress.
The term ''adrenergic'' originates from ''adrenaline'' and describes hormones or drugs whose effects are similar to those of epinephrine. Adrenergic stress is mediated by stimulation of adrenergic receptors and activation of post-receptor pathways. Critical illness is a potent stimulus of the sympathetic nervous system. ⋯ Detrimental effects include impaired diastolic function, tachycardia and tachyarrhythmia, myocardial ischemia, stunning, apoptosis and necrosis. Adverse catecholamine effects have been observed in other organs such as the lungs (pulmonary edema, elevated pulmonary arterial pressures), the coagulation (hypercoagulability, thrombus formation), gastrointestinal (hypoperfusion, inhibition of peristalsis), endocrinologic (decreased prolactin, thyroid and growth hormone secretion) and immune systems (immunomodulation, stimulation of bacterial growth), and metabolism (increase in cell energy expenditure, hyperglycemia, catabolism, lipolysis, hyperlactatemia, electrolyte changes), bone marrow (anemia), and skeletal muscles (apoptosis). Potential therapeutic options to reduce excessive adrenergic stress comprise temperature and heart rate control, adequate use of sedative/analgesic drugs, and aiming for reasonable cardiovascular targets, adequate fluid therapy, use of levosimendan, hydrocortisone or supplementary arginine vasopressin.
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J Intensive Care Med · Sep 2009
ReviewTechniques for assessment of intravascular volume in critically ill patients.
Fluid replacement is considered the cornerstone of resuscitation in the ICU. However, only about 50% of critically ill hemodynamically unstable patients are fluid responsive; furthermore, both under-resuscitation and overzealous fluid administration adversely affect outcome Consequently, the resuscitation of critically ill patients requires an accurate assessment of the patients' intravascular volume status and their volume responsiveness. This paper reviews the evolution and accuracy of methods for assessing fluid responsiveness in critically ill patients.
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J Intensive Care Med · Sep 2009
Fever during pediatric intensive care unit admission is independently associated with increased morbidity.
To investigate the occurrence and etiology of fever at anytime during pediatric intensive care unit (PICU) admission, and to study its possible effects on clinical outcome in a heterogeneous population of critically ill children. ⋯ Fever in critically ill children occurs frequently during PICU stay. Fever after 48 hours of admission or new episodes of fever after 48 nonfebrile hours were mainly caused by nosocomial infections and was independently associated with prolonged length of ventilatory support and PICU stay.
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J Intensive Care Med · Sep 2009
Children with respiratory distress treated with high-flow nasal cannula.
High-flow nasal cannula (HFNC) therapy is a treatment for respiratory distress in neonates and children. In the present study, we assessed its effectiveness, comfort, and possible mechanism of action. ⋯ Our study indicates that high-flow nasal cannula improves the respiratory scale score, the oxygen saturation, and the patient's COMFORT scale. Its mechanism of action is application of mild positive airway pressure and lung volume recruitment.