Abstract：
:The role of the fiberscope in the management of difficult and failed intubations has been well established and the importance of learning this valuable skill has been emphasized. Nonetheless, the fiberscope is underutilized in anesthesia and critical care practices because of a high rate of intubation failure. The main cause of failure is lack of expertise in maneuvering the fiberscope. Other technical causes of failure include fogging or clouding of the fiberscope's lens, drifting off the midline, and inability to advance the endotracheal tube or withdraw the fiberscope after completing intubation. Proper selection of the size of the fiberscope in relation to the size of the endotracheal tube, adequate lubrication, and careful passage of the fiberscope through the distal opening of the tracheal tube (not the Murphy eye) prevent difficulties encountered during advancement of the tube or upon withdrawal of the bronchoscope. Patient-related causes include inadequate topical anesthesia, which leads to abrupt movement of the larynx, laryngeal spasm, coughing, and copious secretions; a large floppy epiglottis; and tumor and edema of the upper airway, which also interfere with exposure of the larynx. Various approaches for learning and applying fiberoptic endoscopy have been instituted. The key to increased success involves initial training and practice with an intubation model and tracheobronchial tree. These models enable the learner to develop the eye-hand coordination skills needed to use the fiberscope properly. The fiberscope is best used in patients after learning to perform three simultaneous movements--advancing the fiberscope, coordinated rotation of the insertion cord, and bending the tip of the fiberscope while traversing the airway. After the technical skills of the fiberscope become second nature, the endoscopist can give more attention to patient-related factors to improve the success rate of tracheal intubation. Expert use of the fiberscope can be a life-saving measure through alleviating major airway complications and unnecessary tracheostomies.
journal_name
Crit Care Clinjournal_title
Critical care clinicsauthors
Ovassapian A,Randel GIsubject
Has Abstractpub_date
1995-01-01 00:00:00pages
29-51issue
1eissn
0749-0704issn
1557-8232journal_volume
11pub_type
杂志文章,评审abstract：:Contrast-associated acute kidney injury (CAAKI) is a common iatrogenic condition. The principal risk factors for CAAKI are underlying renal impairment; diabetes in the setting of kidney disease; and intravascular volume depletion, effective or absolute. CAAKI is associated with serious adverse short-term and long-term...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2015.06.008
更新日期：2015-10-01 00:00:00
abstract：:For well over a decade, intensive care unit (ICU) telemedicine programs have been providing care to patients and families and an invaluable service to many receiving sites that are otherwise outside the traditional reach of high-quality critical care. It will be important that during this growth, outcomes regarding th...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2019.02.006
更新日期：2019-07-01 00:00:00
abstract：:This article summarizes the biomechanical relationship of the spinal column to load stresses with respect to column failure, and the resulting associated central nervous system injury. In addition, it presents pertinent animal research, which has focused onto the development standardized animal spinal cord injury mode...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-07-01 00:00:00
abstract：:The proliferation of methicillin-resistant Staphylococcus aureus (MRSA) and the severity of nosocomial critical care infections necessitate the development of viable alternative therapies. An increase in the tolerance of MRSA to the activity of vancomycin and to the associated suboptimal therapeutic measures is of par...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2007.12.010
更新日期：2008-04-01 00:00:00
abstract：:Electronic medical records can be used to mine clinical data (big data), providing automated analysis during patient care. This article describes the source and potential impact of big data analysis on risk stratification and early detection of deterioration. It compares use of big data analysis with existing methods ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2017.12.007
更新日期：2018-04-01 00:00:00
abstract：:The known metabolic abnormalities and nutritional requirements of the brain injury, spinal cord injury, and acute stroke patient have been presented. Further investigations are required in all these conditions to identify specific nutritional requirements and metabolic abnormalities. The specific role of nutritional s...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-01-01 00:00:00
abstract：:Positive-pressure ventilation may improve gas exchange, decrease the work-cost of breathing, and rest respiratory muscles, but it also will alter cardiac output and may modify blood flow distribution. Ventilation may induce these hemodynamic changes by altering systemic venous return to the RV (RV preload), pulmonary ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1990-07-01 00:00:00
abstract：:Approximately 12,000 Americans suffer traumatic spinal cord injuries each year. This article discusses the management of their neurologic, respiratory, cardiovascular, gastroenterologic, and genitourinary complications in the critical care setting. ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1986-10-01 00:00:00
abstract：:The thyrotoxic patient offers a considerable challenge to the critical care physician because the "obvious" diagnosis often will be a cardiac (or other nonthyroidal) problem, but the "correct" diagnosis will be an endocrinologic one. The importance of considering the diagnosis of thyrotoxicosis in any patient with tac...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1991-01-01 00:00:00
abstract：:In this review, the various interactions between heart and lung that occur during positive-pressure ventilation are contrasted with spontaneous ventilation. Based on this analysis, appropriate ventilator management directed at optimizing oxygen delivery to the tissues can be employed in the treatment of the critically...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1985-11-01 00:00:00
abstract：:Vesicants (or blister agents) are cytotoxic alkylating compounds, which are chemical agents sometimes collectively known as mustard gas or simply as mustard. Other blister agents are nitrogen mustard; sulfur mustard; lewisite, a vesicant that contains arsenic; and phosgene oxime, a halogenated oxime that possesses dif...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2005.06.005
更新日期：2005-10-01 00:00:00
abstract：:Supraventricular and ventricular arrhythmias remain relatively commonplace in the ICU. Proper pharmacologic treatment requires that the clinician recognize accompanying disease states that may alter the pharmacokinetics and pharmacodynamics of antiarrhythmic drugs. In addition, knowledge of cardiovascular toxicity, no...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1991-07-01 00:00:00
abstract：:Both limb muscle weakness and respiratory muscle weakness are exceedingly common in critically ill patients. Respiratory muscle weakness prolongs ventilator dependence, predisposing to nosocomial complications and death. Limb muscle weakness persists for months after discharge from intensive care and results in poor l...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2018.03.005
更新日期：2018-07-01 00:00:00
abstract：:Sedative drugs commonly are titrated to effect in critically ill patients. Subjective clinical assessment tools are used to determine the patient's level of sedation, and there clearly is a need for improved quantitative methods of monitoring sedation. This article describes the current methods for assessing the level...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1995-10-01 00:00:00
abstract：:The burned child requires a management that is different from that employed in the burned adult because of physiologic and psychological dissimilarities, although basic principles of management are the same. Particular problems and treatment of the burned child are highlighted. ...
journal_title：Critical care clinics
pub_type： 杂志文章
doi：
更新日期：1985-03-01 00:00:00
abstract：:The recent development of valid and reliable assessment tools to monitor agitation, sedation, analgesia, and delirium in the ICU represents an essential first step in the provision of patient comfort and the development of preferred treatment strategies. To make the ICU a more humane healing environment, these assessm...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70189-5
更新日期：2001-10-01 00:00:00
abstract：:Dyspnea is a subjective experience that can be reported by the patient. Respiratory distress is an observable corollary, and represents the physical or emotional suffering that results from the experience of dyspnea. Recognizing and understanding this subjective phenomenon poses a challenge to intensive care unit (ICU...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2004.03.015
更新日期：2004-07-01 00:00:00
abstract：:An estimated 14 million patients survive sepsis hospitalization each year. However, survivors commonly experience new functional disability, cognitive impairment, and a high rate of further medical setbacks, including hospital readmission and late death. One in 5 older survivors has a potentially preventable hospital ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2018.06.002
更新日期：2018-10-01 00:00:00
abstract：:Transplant patients face challenging medical journeys, with many detours to the intensive care unit. Before and after transplantation, they have significant psychological and cognitive comorbidities, which decrease their quality of life and potentially compromise their medical outcomes. Critical care staff are essenti...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2017.03.009
更新日期：2017-07-01 00:00:00
abstract：:Venous thromboembolic disease is a very common complication in the ICU. This article reviews incidence, prevention, and therapy related to venous thromboembolism, including both deep venous thrombosis and pulmonary embolism. Special diagnostic and treatment considerations in the ICU setting are highlighted. The increa...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2005.05.004
更新日期：2005-07-01 00:00:00
abstract：:Access to critical care is rapidly growing in areas of the world where it was previously nonexistent and where infectious diseases often comprise the largest disease burden. Additionally, with crowding, mass migrations, and air travel, infectious diseases previously geographically confined are quickly spread across th...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2013.03.005
更新日期：2013-07-01 00:00:00
abstract：:Nutritional support of the burn patient is essential to optimize host immune defenses and to promote prompt wound healing. The interdependent relationship between metabolism, nutrition, and infection is discussed, followed by an extensive description of the various means of determining the appropriate type, form, and ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1995-07-01 00:00:00
abstract：:This article provides a background so that the intensivist can appreciate the social and cultural context in which the AIDS epidemic developed. The upheaval that AIDS has caused in the gay community is described along with some of the economic effects AIDS has had on that population and on the practice of medicine, bo...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1993-01-01 00:00:00
abstract：:Carbon monoxide (CO) poisoning is common and frequently unrecognized since the signs and symptoms are relatively nonspecific. CO poisoning causes tissue hypoxia. Additionally, various animal studies have demonstrated that CO interferes with myoglobin, P450, and other enzyme function; causes lipid peroxidation through ...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70056-7
更新日期：1999-04-01 00:00:00
abstract：:N-6 and n-3 PUFAs from the diet are absorbed and reach the cell where they interact with fatty acid binding proteins within cell membranes and cytoplasm. They are processed in the endoplasmic reticulum (desaturation-elongation reactions, lipid synthesis, eicosanoid and epoxide production) and in peroxisomes (beta-oxid...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/s0749-0704(05)70160-3
更新日期：2001-01-01 00:00:00
abstract：:This article reviews principles in the rational use of antibiotics in sepsis and septic shock and presents evidence-based recommendations for optimal antibiotic therapy. Every patient with sepsis and septic shock must be evaluated at presentation before the initiation of antibiotic therapy. However, in most situations...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2009.08.004
更新日期：2009-10-01 00:00:00
abstract：:Given the broad treatment options, risk stratification of pulmonary embolism is a highly desirable component of management. The ideal tool identifies patients at risk of death from the original or recurrent pulmonary embolism. Using all-cause death in the first 30-days after pulmonary embolism diagnosis as a surrogate...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2020.02.002
更新日期：2020-07-01 00:00:00
abstract：:Obesity has been recognized as an increasing problem not only in North America but globally. With a significant rise in the prevalence of obesity amongst children and adolescents over the past 20 years, the comorbidities associated with obesity are also now emerging at an earlier age. These comorbidities cause specifi...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2010.06.009
更新日期：2010-10-01 00:00:00
abstract：:Management of the cardiac transplant recipient includes careful titration of inotropes and vasopressors. Recipient pulmonary hypertension and ventilatory status must be optimized to prevent allograft right ventricular failure. Vasoplegia, coagulopathy, arrhythmias, and renal dysfunction also require careful management...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：10.1016/j.ccc.2018.08.008
更新日期：2019-01-01 00:00:00
abstract：:Metabolic acid-base disturbances commonly and predictably complicate the course of many intensive care unit patients and plague the intensivists, surgeons, and anesthesiologists beset with the task of caring for them. In this article, we offer a systematic approach to the patient with the metabolic acid-base disorders...
journal_title：Critical care clinics
pub_type： 杂志文章,评审
doi：
更新日期：1987-10-01 00:00:00
