Articles: critical-illness.
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The impact of specialized training in critical care producing a heightened index of suspicion for the diagnosis of pneumothorax in intensive care unit (ICU) patients was prospectively examined. During a 12-month period, 28 ICU patients were found to have a pneumothorax. ⋯ Six of these nine initially misdiagnosed pneumothoraces (67%) were correctly diagnosed by a physician with specialized training and experience in critical care medicine prior to any clinical deterioration in the condition of the patients. This study suggests that specialized training and experience in the management of critically ill patients can significantly improve upon the diagnosis of pneumothorax in these patients and limit the occurrence of tension pneumothorax in the same patient population.
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Anaesth Intensive Care · Nov 1992
Fibreoptic bronchoscopy in the critically ill: a prospective study of its diagnostic and therapeutic value.
A prospective study was undertaken to assess the diagnostic value and therapeutic usefulness of fibreoptic bronchoscopy in the critically ill. ⋯ The use of fibreoptic bronchoscopy in the Intensive Care Unit, in combination with the technique of broncho-alveolar lavage, results in a clinically useful outcome in the majority of cases. Fibreoptic bronchoscopy is an effective and safe diagnostic and therapeutic tool in critically ill patients.
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Anaesth Intensive Care · Nov 1992
Comparative StudyDerived oxygen saturations are not clinically useful for the calculation of oxygen consumption.
In critically ill patients, oxygen consumption (VO2) and delivery (DO2) are used to determine optimal haemodynamic management and to grade severity of illness. VO2 may be measured by indirect calorimetry with metabolic gas monitoring systems or derived using the reverse Fick principle. Oxygen saturation (SaO2) may be measured directly by co-oximetry or derived by equations for incorporation into reverse Fick equations. ⋯ When SaO2 was calculated from three logarithmic equations and incorporated into the reverse Fick equations, calculated VO2's were significantly greater (P < 0.001) than those measured by indirect calorimetry. Correlation was poor and wide limits of agreement (-118 to +350 ml/min) were demonstrated. VO2 should ideally be measured by indirect calorimetry in the critically ill, or if reverse Fick is used, SaO2 should be measured by co-oximetry as the use of equations for clinical measurement of SaO2 is clinically suspect.
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Critical care clinics · Oct 1992
ReviewCentral venous catheterization in the critically ill patient.
Central venous catheter placement for access and monitoring purposes is one of the most commonly performed procedures in the intensive care unit. This article details the indications, techniques, and advantages and disadvantages associated with various approaches to central line insertion; complications associated with central venous line insertion are also reviewed briefly.
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AJR Am J Roentgenol · Oct 1992
Diagnostic and therapeutic use of chest sonography: value in critically ill patients.
Portable chest radiography, used for critically ill patients, often fails to depict thoracic disease clearly. Chest sonography allows good characterization of pleural diseases, mediastinal lesions, and pulmonary consolidations, and provides accurate and safe guidance for interventional procedures. Accordingly, we evaluated its usefulness in the diagnosis and management of critically ill patients. ⋯ Chest sonography is a useful diagnostic tool for critically ill patients with chest diseases. This technique can be particularly helpful when CT is not available or when critically ill patients cannot be moved.