Journal of critical care
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Journal of critical care · Feb 2016
A modified technique for percutaneous dilatational tracheostomy: A retrospective review of 60 cases.
We describe a modified technique for percutaneous dilatational tracheostomy (PDT) using intermittent bronchoscopy and ultrasound (US). This method requires 1 single physician operator and no special airway adjuncts. Our aim is to reduce the complications associated with the current popular PDT technique, that is, accidental intraprocedural airway loss, intraprocedural bleeding, and hypoventilation associated with use of continuous bronchoscopy. ⋯ Our modified technique demonstrates a potential to reduce accidental intraprocedural airway loss and intraoperative bleeding associated with PDT while possibly improving gas exchange and saving procedural costs. This technique needs to be comparatively studied with current popular PDT technique in a prospective trial to firmly establish associated risks and benefits.
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Journal of critical care · Feb 2016
Criteria for initiation of invasive ventilation in septic shock: An international survey.
The objective of this study is to record intensivists' beliefs on indications and modalities of ventilatory support in critically ill patients with septic shock. ⋯ This survey highlights the general belief that invasive mechanical ventilation may worsen hemodynamic status in patients with septic shock. There was general agreement with the mandatory need to initiate mechanical ventilation in patients with respiratory failure and coma, but with little respect to hemodynamic criteria.
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Journal of critical care · Feb 2016
ReviewThoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review.
The use of diagnostic ultrasound by physiotherapists is not a new concept; it is frequently performed in musculoskeletal physiotherapy. Physiotherapists currently lack accurate, reliable, sensitive, and valid measurements for the assessment of the indications and effectiveness of chest physiotherapy. Thoracic ultrasound may be a promising tool for the physiotherapist and could be routinely performed at patients' bedsides to provide real-time and accurate information on the status of pleura, lungs, and diaphragm; this would allow for assessment of lung aeration from interstitial syndrome to lung consolidation with much better accuracy than chest x-rays or auscultation. ⋯ This narrative review refers to lung and diaphragm ultrasound semiology and describes how physiotherapists could use this tool in their clinical decision-making processes in various cases of respiratory disorders. The use of thoracic ultrasound semiology alongside typical examinations may allow for the guiding, monitoring, and evaluating of chest physiotherapy treatments. Thoracic ultrasound is a potential new tool for physiotherapists.