scholarly journals Percutaneous Dilational Tracheostomy Technique and Experience

1989 ◽  
Vol 17 (4) ◽  
pp. 456-457 ◽  
Author(s):  
P. D. Cook ◽  
V. I. Callanan
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Tracheostomy Tube ◽  
Major Complication ◽  
Adult Patients ◽  
Safe Procedure ◽  
Percutaneous Dilational Tracheostomy ◽  
Elective Tracheostomy ◽  
Percutaneous Insertion

A technique for percutaneous insertion of an adult tracheostomy tube in the Intensive Care Unit is described. Experience with twenty-one insertions over an eight-month period is reviewed. No major complication was noted at insertion, during cannulation or after removal in any patient. We have found the percutaneous dilational technique to be an effective and safe procedure which can be used routinely for elective tracheostomy in intubated adult patients.

scholarly journals Percutaneous Dilational Tracheostomy - A Clinical Study Evaluating Two Systems

1996 ◽  
Vol 24 (1) ◽  
pp. 56-59 ◽  
Author(s):  
P. V. Van Heerden ◽  
S. A. R. Webb ◽  
B. M. Power ◽  
W. R. Thompson
Keyword(s):  
Intensive Care Unit ◽  
Critical Care ◽  
Intensive Care ◽  
Clinical Study ◽  
Tracheostomy Tube ◽  
Bleeding Diathesis ◽  
Percutaneous Dilational Tracheostomy ◽  
Early Complications ◽  
Airway Control ◽  
Premature Removal

Percutaneous dilational tracheostomy (PDT), first described in the 1950s, has become a common bedside technique in the Intensive Care Unit (ICU). This study compares the early complications associated with the use of the Ciaglia PDT (Cook Critical Care, Bloomington, USA) technique, with the newly available Portex PDT technique (Portex Ltd., UK). The Ciaglia technique was adopted in this ICU in July 1994 and twenty-nine patients had a tracheostomy using this set until January 1995. Complications during the procedure were collected prospectively. When the Portex PDT set became available in January 1995, it was decided to assess the complication rate of this technique and compare them to the previously-collected data using the Ciaglia PDT set. Twenty-five patients have had a tracheostomy using the Portex PDT set. There has been no mortality associated with either PDT set. Bleeding requiring intervention occurred in two patients in the Ciaglia group and three patients in the Portex Group. All these patients had a bleeding diathesis. Loss of airway control occurred on one occasion in the Ciaglia group due to premature removal of the endotracheal tube. The first routine tracheostomy tube change at day 7 was complicated in four cases in the Ciaglia group. One infected stoma was noted in the Ciaglia group at day 7. Both techniques result in rapid, safe placement of a tracheostomy tube in critically ill patients in the ICU, obviating the need for surgical referral and transport to the operating room.

Topical Lidocaine Patch for Postthoracotomy and Poststernotomy Pain in Cardiothoracic Intensive Care Unit Adult Patients

2019 ◽  
Vol 39 (5) ◽  
pp. 51-57 ◽  
Author(s):  
Michael Liu ◽  
Mabel Wai ◽  
James Nunez
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Standard Care ◽  
Academic Medical Center ◽  
Adult Patients ◽  
Control Group ◽  
Lidocaine Group ◽  
Lengths Of Stay ◽  
Topical Lidocaine

Background Transdermal lidocaine patches have few systemic toxicities and may be useful analgesics in cardiac surgery patients. However, few studies have evaluated their efficacy in the perioperative setting. Objective To compare the efficacy of topical lidocaine 5% patch plus standard care (opioid and nonopioid analgesics) with standard care alone for postthoracotomy or poststernotomy pain in adult patients in a cardiothoracic intensive care unit. Methods A single-center, retrospective cohort evaluation was conducted from January 2015 through December 2015 in the adult cardiothoracic intensive care unit at a tertiary academic medical center. Cardiac surgery patients with new sternotomies or thoracotomies were included. Patients in the lidocaine group received 1 to 3 topical lidocaine 5% patches near sternotomy and/or thoracotomy sites daily. Patches remained in place for 12 hours daily. Patients in the control group received standard care alone. Results The primary outcome was numeric pain rating for sternotomy/thoracotomy sites. Secondary outcomes were cardiothoracic intensive care unit and hospital lengths of stay and total doses of analgesics received. Forty-seven patients were included in the lidocaine group; 44 were included in the control group. Mean visual analogue scores for pain did not differ between groups (lidocaine, 2; control, 1.9; P = .58). Lengths of stay were similar for both groups (cardiothoracic intensive care unit: lidocaine, 3.06 days; control, 3.11 days; P = .86; hospital: lidocaine, 8.26 days; control, 7.61 days; P = .47). Conclusions Adjunctive lidocaine 5% patches did not reduce acute pain in postthoracotomy and post-sternotomy patients in the cardiothoracic intensive care unit.

scholarly journals Meningoencephalitis in intensive care unit: Do Japanese Encephalitis cases go unsuspected?

2017 ◽  
Vol 7 (1) ◽  
pp. 7-10
Author(s):  
Ashish Ghimire ◽  
Balkrishna Bhattarai ◽  
Basudha Khanal ◽  
Suchana Marhatta ◽  
Gopendra Prasad Deo
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Adult Patients ◽  
Medical Emergency ◽  
Real Problem ◽  
Cerebrospinal Fluid Analysis ◽  
Laboratory Findings ◽  
Fluid Analysis ◽  
Intensive Approach ◽  
Serology Testing

Background: Meningoencephalitis (ME) is a medical emergency. Acute infective encephalitis is usually viral. Nepal has the second highest prevalence of JE in South East Asia. About one third of the JE cases results in death. The records of the JE in the laboratory of B.P. Koirala Institute of Health Sciences (BPKIHS) showed 760 samples to have the evidence of JE infection out of 3352 tested during the period of 2001-2011 AD. The present study aimed to conduct an audit on meningoencephalitis cases admitted in the ICU of our hospital in an attempt to find its burden.Methods: Medical records of all the adult patients with the provisional diagnosis of Meningoencephalitis at BPKIHS over the period of 2009-2011 AD were examined. Laboratory findings of all the patients diagnosed with ME who were admitted to the eight bedded general intensive care unit (ICU) were also reviewed. The diagnosis was made based on the findings of medical history, clinical examination and cerebrospinal fluid analysis for biochemistry and cytology, results of anti JE IgM test performed on CSF and/or serum.Results: Altogether 127 samples of CSF were obtained from adult patients admitted in different inpatient department of BPKIHS with the clinical diagnosis of meningo encephalitis between 2009-2011 AD. Out of them, 25 (19.68%) were tested positive of JE. A total of 684 patients were admitted over the same period with different diagnoses in 8 bedded ICU of hospital. Fifteen (2.19%) were transferred to the ICU with the ME. In the ICU, 9(60%) were treated as viral encephalitis. Among them CSF of only 4 patients’ were sent for testing for JE and found positive in 2 cases. Seven (46.6%) patients expired while 4(26.6%) were taken home by the relatives against medical advice in critically ill conditions and remaining 4 (26.6%) improved and transferred to ward. Among the expired patients 5 (71.4%) had viral encephalitis.Conclusion: JE is a real problem but many cases are likely to have been gone undetected. Adoption of a more intensive approach with much liberal serology testing policy seems to be appropriate for better detecting JE cases in the setting.

scholarly journals EFEITOS DA MOBILIZAÇÃO PRECOCE EM PACIENTES ADULTOS INTERNADOS EM UNIDADE DE TERAPIA INTENSIVA: REVISÃO SISTEMÁTICA / EFFECTS OF EARLY MOBILIZATION IN ADULT PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT: SYSTEMATIC REVIEW

2021 ◽  
Vol 7 (3) ◽  
pp. 30427-30441
Author(s):  
Ranná Barros Souza ◽  
Leticia Maues Marques ◽  
Elana Dayane Chaves Gonçalves ◽  
Gabriel de Freitas Santos da Costa ◽  
Marcos Vinícius da Conceição Furtado ◽  
...  
Keyword(s):  
Systematic Review ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Early Mobilization ◽  
Adult Patients ◽  
Terapia Intensiva

scholarly journals Prediction of prolonged mechanical ventilation for intensive care unit patients: A cohort study

2013 ◽  
pp. 184-188 ◽  
Author(s):  
Alvaro Sanabria ◽  
Ximena Gomez ◽  
Valentin Vega ◽  
Luis Carlos Dominguez ◽  
Camilo Osorio
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Cohort Study ◽  
Intensive Care ◽  
Critically Ill ◽  
Medical Condition ◽  
Prolonged Mechanical Ventilation ◽  
Invasive Mechanical Ventilation ◽  
Adult Patients ◽  
Saps Ii Score

Introduction: There are no established guidelines for selecting patients for early tracheostomy. The aim was to determine the factors that could predict the possibility of intubation longer than 7 days in critically ill adult patients. Methods: This is cohort study made at a general intensive care unit. Patients who required at least 48 hours of mechanical ventilation were included. Data on the clinical and physiologic features were collected for every intubated patient on the third day. Uni- and multivariate statistical analyses were conducted to determine the variables associated with extubation. Results: 163 (62%) were male, and the median age was 59±17 years. Almost one-third (36%) of patients required mechanical ventilation longer than 7 days. The variables strongly associated with prolonged mechanical ventilation were: age (HR 0.97 (95% CI 0.96-0.99); diagnosis of surgical emergency in a patient with a medical condition (HR 3.68 (95% CI 1.62-8.35), diagnosis of surgical condition-non emergency (HR 8.17 (95% CI 2.12-31.3); diagnosis of non-surgical-medical condition (HR 5.26 (95% CI 1.85-14.9); APACHE II (HR 0.91 (95% CI 0.85-0.97) and SAPS II score (HR 1.04 (95% CI 1.00-1.09) The area under ROC curve used for prediction was 0.52. 16% of patients were extubated after day 8 of intubation. Conclusions: It was not possible to predict early extubation in critically ill adult patients with invasive mechanical ventilation with common clinical scales used at the ICU. However, the probability of successfully weaning patients from mechanical ventilation without a tracheostomy is low after the eighth day of intubation.

scholarly journals A multi-center cross-sectional study on blood purification among adult patients in intensive care unit in China

2019 ◽  
Vol 132 (10) ◽  
pp. 1208-1211 ◽  
Author(s):  
Yang Gao ◽  
Zhi-Dong Qi ◽  
Rui-Jin Liu ◽  
Hai-Tao Liu ◽  
Qiu-Yuan Han ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Cross Sectional Study ◽  
Blood Purification ◽  
Adult Patients ◽  
Sectional Study ◽  
Cross Sectional

scholarly journals Assessment of Pleural Effusion and Small Pleural Drain Insertion by Resident Doctors in an Intensive Care Unit: An Observational Study

2019 ◽  
Vol 13 ◽  
pp. 117954841987152 ◽  
Author(s):  
Luigi Vetrugno ◽  
Giovanni M Guadagnin ◽  
Federico Barbariol ◽  
Stefano D’Incà ◽  
Silvia Delrio ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Observational Study ◽  
Maximum Size ◽  
Safe Procedure ◽  
Ultrasound Guided ◽  
First Line Therapy ◽  
Mean Size ◽  
Chest X Ray ◽  
Failed Attempt

Small-bore pleural drainage device insertion has become a first-line therapy for the treatment of pleural effusions (PLEFF) in the intensive care unit; however, no data are available regarding the performance of resident doctors in the execution of this procedure. Our aim was to assess the prevalence of complications related to ultrasound-guided percutaneous small-bore pleural drain insertion by resident doctors. In this single-center observational study, the primary outcome was the occurrence of complications. Secondary outcomes studied were as follows: estimation of PLEFF size by ultrasound and postprocedure changes in PaO2/FiO2 ratio. In all, 87 pleural drains were inserted in 88 attempts. Of these, 16 were positioned by the senior intensivist following a failed attempt by the resident, giving a total of 71 successful placements performed by residents. In 13 cases (14.8%), difficulties were encountered in advancing the catheter over the guidewire. In 16 cases (18.4%), the drain was positioned by a senior intensivist after a failed attempt by a resident. In 8 cases (9.2%), the final chest X-ray revealed a kink in the catheter. A pneumothorax was identified in 21.8% of cases with a mean size (±SD) of just 10 mm (±6; maximum size: 20 mm). The mean size of PLEFF was 57.4 mm (±19.9), corresponding to 1148 mL (±430) according to Balik’s formula. Ultrasound-guided placement of a small-bore pleural drain by resident doctors is a safe procedure, although it is associated with a rather high incidence of irrelevant pneumothoraces.

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