Abstract:
OBJECTIVE:To determine the abnormalities present in endotracheal tubes removed from mechanically ventilated patients for "massive airleak." "Massive airleak" was defined as a leak that the attending physician felt was indicative of endotracheal tube defect such that extubation (and reintubation, if needed) would be indicated. DESIGN:Prospective, observational study. SETTING:Mixed medical-surgical intensive care unit at a community teaching hospital. PATIENTS:Seventeen patients among 1,082 patients who were undergoing mechanical ventilation during the study period. INTERVENTIONS:Authors were not involved in the evaluation of most airleak situations and most participating physicians were unaware of the study. All physicians involved were board certified in pulmonary, critical care, emergency medicine, or anesthesiology. Removed endotracheal tubes were grossly inspected and subjected to pneumatic stress to determine the sites of the leakage. MEASUREMENTS AND MAIN RESULTS:Eighteen endotracheal tubes were examined over a 2-yr period. Of these tubes, 11 (61%) had no evidence of mechanical fault. Five (28%) tubes had defects in the tracheal cuff and two (11%) tubes had abnormalities of the pilot valve apparatus. Condensation within the pilot valve cuff was present in 14 of 18 tubes and was present in ten of 11 intact tubes. Although the study population had an equal number of orally and nasally placed endotracheal tubes, intact tubes were disproportionately oral (8/11) and tubes wtih cuff leaks were predominantly nasal (4/5) (p = .038). CONCLUSIONS:A large number of endotracheal tubes removed for presumed defect are flawless. The authors speculate that tube malposition is the most likely explantation for this phenomenon. Our findings suggest that patient care might improve with more meticulous daily attention to the airway, as well as a more analytical rather than action-oriented approach to the leaking endotracheal tube.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Kearl RA,Hooper RGsubject
Has Abstractpub_date
1993-04-01 00:00:00pages
518-21issue
4eissn
0090-3493issn
1530-0293journal_volume
21pub_type
杂志文章abstract:OBJECTIVE:Keratinocyte growth factor (KGF) is expressed primarily by fibroblasts, is important for alveolar epithelial proliferation/function, and protects against lung injury in multiple animal models. We wished to determine whether acute lung injury/acute respiratory distress syndrome (ALI/ARDS) alveolar fluid induce...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e31819fc81a
更新日期:2009-05-01 00:00:00
abstract:OBJECTIVE:To determine whether low-dose dopamine administration reduces the incidence or severity of acute renal failure, need for dialysis, or mortality in patients with critical illness. DATA SOURCES AND STUDY SELECTION:We performed a MEDLINE search of literature published from 1966 to 2000 for studies addressing th...
journal_title:Critical care medicine
pub_type: 杂志文章,meta分析
doi:10.1097/00003246-200108000-00005
更新日期:2001-08-01 00:00:00
abstract::We developed a method to measure accurately pressures at the airway opening (Pao) and in the trachea (Ptr) in neonates during high frequency oscillatory ventilation (HFOV) from 15-30 Hz. All component parts of the pressure-measuring system were tested as a unit against a reference transducer in a closed chamber in whi...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198401000-00011
更新日期:1984-01-01 00:00:00
abstract:OBJECTIVE:To evaluate the prognostic value of short-latency median nerve somatosensory evoked potentials and brainstem auditory evoked potentials in outcome prediction for comatose cardiac arrest patients treated with hypothermia. DESIGN:Prospective, randomized, controlled trial of mild hypothermia after out-of-hospit...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/01.ccm.0000171536.63641.d9
更新日期:2005-08-01 00:00:00
abstract:OBJECTIVES:Measurement of blood lactate concentration in the early management of sepsis is an important step in severity assessment. High blood lactate levels in the early phase of sepsis have classically been thought to be related to tissue hypoxia, but other factors could intervene. We hypothesized that the activatio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001308
更新日期:2015-12-01 00:00:00
abstract:OBJECTIVES:Myocardial ischemia plays a central role in the development of right ventricular failure after acute pulmonary embolism. This study investigates whether pulmonary mediators act specifically on coronary tone and cardiac contractile function in acute pulmonary microembolization and whether such effects are alt...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199803000-00024
更新日期:1998-03-01 00:00:00
abstract::Percutaneous cholecystostomy was employed successfully as an alternative to cholecystectomy for the treatment of acute cholecystitis with perforation in an elderly woman. The procedure, performed portably in the cardiac care unit, was selected because progressive cardiac and renal decompensation made the patient an ex...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198508000-00017
更新日期:1985-08-01 00:00:00
abstract:OBJECTIVES:Anxiety results from the anticipation of a threat and might be associated with poor outcome in the critically ill. This study aims at showing that anxiety at admission in critically ill patients is associated with new organ failure over the first 7 days of ICU hospitalization independently of baseline organ ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004495
更新日期:2020-10-01 00:00:00
abstract:OBJECTIVES:To understand when the use of high-frequency ventilation would be advantageous, we formulated the problem of achieving adequate alveolar ventilation at minimal pressure cost by dividing it into two simpler problems: a) the pressure cost per unit of convective oscillatory flow; and b) the convective flow cost...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-199422091-00004
更新日期:1994-09-01 00:00:00
abstract:OBJECTIVE:The aim of this study was to evaluate the relationship of patient care variables to survival and functional outcome in the pediatric population with traumatic brain injury. DESIGN:Retrospective chart review. SETTING:A 16-bed pediatric critical care unit in an academic community children's hospital. PATIENT...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200207000-00038
更新日期:2002-07-01 00:00:00
abstract:OBJECTIVES:Milrinone is a phosphodiesterase F-III inhibitor with positive inotropic and vasodilating activities. We investigated the hemodynamic response and pharmacokinetics of intravenous milrinone in patients with acute heart failure. DESIGN:Double-blind studies: a prospective, multicenter, double-blind, dose-findi...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/00003246-199609000-00010
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVE:To study whether noninvasive pressure support ventilation (NIPSV) with helium/oxygen (He/oxygen), which can reduce dyspnea, PaCO2, and work of breathing more than NIPSV with air/oxygen in decompensated chronic obstructive pulmonary disease, could have beneficial consequences on outcome and hospitalization cos...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/01.CCM.0000055369.37620.EE
更新日期:2003-03-01 00:00:00
abstract::Changes in pulmonary function and the development of atelectasis in the postoperative period have been well documented in the adult population. The use of incentive spirometry has been shown to be effective in the prevention of these postoperative complications. At the Hospital of Sick Children, we studied 17 children...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198208000-00009
更新日期:1982-08-01 00:00:00
abstract:OBJECTIVE:Inflammation and immobility are comorbid etiological factors inducing muscle weakness in critically ill patients. This study establishes a rat model to examine the effect of inflammation and immobilization alone and in combination on muscle contraction, histology, and acetylcholine receptor regulation. DESIG...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0B013E3181659669
更新日期:2008-03-01 00:00:00
abstract::During a consecutive 17 month period, 15 trauma patients were diagnosed as having a myocardial contusion on the basis of abnormal ECG in 14 patients, elevated creatinine phosphokinase (CPK) in 13 patients, and elevated CPK-Muscle Brain (CPK-MB) isoenzyme determination in 11 patients. Using these screening modalities, ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198201000-00005
更新日期:1982-01-01 00:00:00
abstract::End tidal CO2 tension (PetCO2) and transcutaneous CO2 tension (PtcCO2) were compared with arterial CO2 (PaCO2) before and after withdrawal of mechanical ventilation in 20 patients predisposed to hypercarbia. With stable PaCO2 during mechanical ventilation, the correlation coefficient (r) between PaCO2 and PetCO2 was ....
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198708000-00011
更新日期:1987-08-01 00:00:00
abstract:OBJECTIVE:To compare the effectiveness and safety of the hemoglobin-based nitric oxide scavenger, pyridoxalated hemoglobin polyoxyethylene, against placebo in patients with vasopressor-dependent distributive shock. DESIGN:Multicenter, randomized, placebo-controlled, open-label study. SETTING:Sixty-one participating I...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/CCM.0000000000000554
更新日期:2015-01-01 00:00:00
abstract:OBJECTIVE:To derive a target range of optimal sedation for the COMFORT Scale and to prospectively test that target range against intensivist assessment of adequacy of sedation. DESIGN:Serial prospective agreement cohort studies. SETTING:Twelve-bed pediatric intensive care unit in an urban academic teaching hospital. ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199401000-00029
更新日期:1994-01-01 00:00:00
abstract:OBJECTIVE:To determine if autopsies performed on patients who die in the medical intensive care unit (ICU) provide clinically important new information. DESIGN:Retrospective review. SETTING:A 16-bed medical-coronary ICU. PATIENTS:Patients who underwent autopsy during a 1-yr period. INTERVENTIONS:Pre mortem diagnose...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199808000-00015
更新日期:1998-08-01 00:00:00
abstract:OBJECTIVE:This pilot study was designed to identify which contextual factors facilitate/hinder the implementation of the awakening, breathing, coordination, delirium, and early mobility (ABCDE) bundle for guidance in future studies. DESIGN:The sources of data for this study included document review, planned site visit...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182a2c2b1
更新日期:2013-09-01 00:00:00
abstract:OBJECTIVES:Previous studies in adults suggest that various types of physiologic stress appear to decrease phagocytic cell function. Adherence and chemotaxis of, and phagocytosis and bacterial killing by, neonatal neutrophils are altered compared with adult neutrophil function. Stresses encountered by the fetus and neon...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199312000-00022
更新日期:1993-12-01 00:00:00
abstract:OBJECTIVE:Leucine-rich repeat and immunoglobulin domain-containing protein (LINGO)-1 is expressed in neural stem cells, and its neutralization results in sustained neuronal immaturity. Thus, targeted inhibition of LINGO-1 via RNA interference may enhance transplanted neural stem cell survival and neuronal differentiati...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000001351
更新日期:2016-03-01 00:00:00
abstract:OBJECTIVE:Addressing the quality gap in ICU-based palliative care is limited by uncertainty about acceptable models of collaborative specialist and generalist care. Therefore, we characterized the attitudes of physicians and nurses about palliative care delivery in an ICU environment. DESIGN:Mixed-methods study. SETT...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000002099
更新日期:2017-04-01 00:00:00
abstract:OBJECTIVE:To determine the relationship between sublingual and intestinal mucosal microcirculatory perfusion. DESIGN:Observational, experimental study. SETTING:University-affiliated large animal laboratory. SUBJECTS:Ten fasted, anesthetized, mechanically ventilated, male pigs randomized to a sham group (n = 3) or to...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181b029c1
更新日期:2009-11-01 00:00:00
abstract:OBJECTIVES:Although discussing a prognosis is a duty of physicians caring for critically ill patients, little is known about surrogate decision-makers' beliefs about physicians' ability to prognosticate. We sought to determine: 1) surrogates' beliefs about whether physicians can accurately prognosticate for critically ...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0b013e318180ddf9
更新日期:2008-08-01 00:00:00
abstract:OBJECTIVE:Delirium is common in mechanically ventilated patients in the ICU and associated with short- and long-term morbidity and mortality. The use of systemic corticosteroids is also common in the ICU. Outside the ICU setting, corticosteroids are a recognized risk factor for delirium, but their relationship with del...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,多中心研究
doi:10.1097/CCM.0000000000000247
更新日期:2014-06-01 00:00:00
abstract:OBJECTIVE:Phenylephrine is often used for management of cerebral perfusion pressure after traumatic brain injury, but can have undesirable actions. Few studies have evaluated alternatives. The hypothesis was that arginine vasopressin was as effective as phenylephrine for maintaining tissue oxygenation during cerebral p...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181847af3
更新日期:2008-09-01 00:00:00
abstract::Trauma is the leading cause of both morbidity and mortality in the pediatric population, and traumatic injury causes > 50% of all childhood deaths. Significant mortality rates have been reported for children with traumatic brain injury. Although children have better survival rates as compared with adults with traumati...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/00003246-200211001-00003
更新日期:2002-11-01 00:00:00
abstract:OBJECTIVE:To develop a pharmacokinetic-pharmacogenomic population model of morphine in critically ill children with acute respiratory failure. DESIGN:Prospective pharmacokinetic-pharmacogenomic observational study. SETTING:Thirteen PICUs across the United States. PATIENTS:Pediatric subjects (n = 66) mechanically ven...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003741
更新日期:2019-06-01 00:00:00
abstract::Patient awareness of intermittent positive-pressure ventilation (IPPV) treatment in the ICU was studied in 304 patients. These ICU patients were divided into three groups: those treated for internal medical diseases (IMD; n = 129), patients admitted after major surgical procedures (MSP; n = 126), and patients treated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198901000-00006
更新日期:1989-01-01 00:00:00