Critical care : the official journal of the Critical Care Forum
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The current gold standard for the diagnosis of elevated intracranial pressure (ICP) remains invasive monitoring. Given that invasive monitoring is not always available or clinically feasible, there is growing interest in non-invasive methods of assessing ICP using diagnostic modalities such as ultrasound or magnetic resonance imaging (MRI). ⋯ They report a positive correlation between measurements of the ONSD on MRI and invasive ICP measurements. If the findings of this study can be replicated in larger populations, this technique may be a useful non-invasive screening test for elevated ICP in select populations.
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Editorial Comment
Maintenance of tracheal tube cuff pressure: where are the limits?
Continuous control of tracheal tube cuff inflation using a pneumatic device resulted in severe tracheal wall damage in ventilated piglets. This damage was similar in piglets managed with manual control of cuff inflation. The periodic hyperinflation of the tube cuff used in both groups of this study may explain these results. This manoeuvre should be avoided in clinical practice.
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Wireless communication and data transmission are playing an increasing role in the critical care environment. Early anecdotal reports of electromagnetic interference (EMI) with intensive care unit (ICU) equipment resulted in many institutions banning these devices. ⋯ Restrictions to the use of mobile devices are being lifted, and it has been suggested that the benefits of improved communication may outweigh the small risks. However, increased use of cellular phones and ever changing communication technologies require ongoing vigilance by healthcare device manufacturers, hospitals and device users, to prevent potentially hazardous events due to EMI.
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Editorial Comment
Selenium supplementation in critically ill patients: can too much of a good thing be a bad thing?
A recent study by Forceville and colleagues evaluated the effect of high-dose selenium administration as a treatment for septic shock. The study was negative and conflicts with existing clinical data regarding selenium administration in critically ill patients. Perhaps the key to understanding the differences between these discrepant observations lies in considering the dose and timing of selenium administration.
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Editorial Comment
Corticosteroids to prevent postextubation upper airway obstruction: the evidence mounts.
Intubation of the airway can lead to laryngotracheal injury, resulting in extubation failure from upper airway obstruction (UAO). A number of factors can help to identify patients who are at greatest risk for postextubation UAO. Three randomized controlled trials demonstrate that prophylactic corticosteroids decrease the risk for postextubation UAO and probably the need for re-intubation.