Intensive care units intubated patients

At ihe present time, there is no specific treatment or "cure" tor hantavirus infection. However, we do know that if the infected individuals are recognized early and are taken to an intensive care unit, some patients may do better. In intensive care, patients are intubated and given oxygen therapy to help them through the period of severe respiratory distress. 

Propofol (Diprivan) is used for induction and maintenance of anesthesia. It also may be used for sedation during diagnostic procedures and procedures that use a local anestiietic. This drug also is used for continuous sedation of intubated or respiratory-controlled patients in intensive care units. 

Myxedema coma is a medical emergency. The patient should be treated in the intensive care unit, since tracheal intubation... 

In a survey of intensive care units in the UK, more than two-thirds of the respondents would have chosen suxamethonium in a clinical scenario requiring re-intubation in a patient with abdominal sepsis and weaning failure after 20 days of ICU stay (198). The authors concluded that there is a lack of appreciation of the dangers of suxamethonium in critically ill patients in intensive care units. 

A prospective, observational study of 131 critically ill patients intubated with succinylcholine in an intensive care unit (ICU) showed that significant increase in potassium concentration (>=6.5 mmol/L) was related to the length of ICU stay (p<0.001) and the presence of acute cerebral pathology (p=0.047) [S -J.The threshold of 16days was found to be highly predictive of acute hyperkalaemia> 6.5 mmol/L with 37% (95% confidence interval 19-58%). 

A 92-year-old African-American woman suffered from smoke inhalation during a house fire. The patient was transferred from a cross-town hospital to receive hyperbaric oxygen (HBO) therapy for carbon monoxide intoxication. Before arrival she was sedated, intubated, and administered with 5g hydroxocobalamin intravenously for suspected cyanide poisoning. In the emergency department (ED) a Foley s catheter was placed and, upon inspection, her urine was tinted a deep red colour. She received prompt HBO treatment and was transferred to the intensive care unit (ICU). Despite mechanical ventilation, HBO therapy and treatment for cyanide toxicity, the patient suffered cardiopulmonary arrest while in the ICU and died days later. 

Astrachan DI, Kirchner JC, Goodwin WJ Jr. Prolonged intubation versus tracheotomy complications, practical and psychological considerations. Laryngoscope 1988 98(11) 1165-1169. Heffner JE. Tracheotomy application and timing. Clin Chest Med 2003 24(3) 389-398. Nieszkowska A, Combes A, Luyt CE, et al. Impact of tracheotomy on sedative administration, sedation level, and comfort of mechanically ventilated intensive care unit patients. Crit Care Med 2005 33(ll) 2527-2533. 

Salata RA, Lederman MM, Shlaes DM, et al. Diagnosis of nosocomial pneumonia in intubated, intensive care unit patients. Am Rev Respir Dis 1987 135 426-432. 

Compared to most hospitalized patients, rates of nosocomial pneumonia are 10- to 20-fold higher in intensive care unit patients, and 7- to 21-fold higher in the intubated patients (4-6). Therefore, intubated patients in intensive care should be a major focus of surveillance for nosocomial pneumonia. Unit-... 

Intubation associated with mechanical ventilation is the single most important risk factor for the development of nosocomial pneumonia and tracheitis. Intubation should be used only when medically indicated. Extubation should be accomplished as quickly as it is clinically feasible. It may be appropriate for individual pediatric and neonatal intensive care units to develop criteria for intubation and continued mechanical ventilation. Auditing practice versus predetermined criteria might identify opportunities to reduce patient ventilator-days. 

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