Mangala Narasimhan

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STUDY OBJECTIVES The use of highly active antiretroviral therapy (HAART) has dramatically improved morbidity and mortality in patients with HIV infection. The types of critical illness and their outcomes in HIV-infected patients in recent years is unknown. DESIGN We reviewed the medical records of all patients admitted to the Medical ICU of Beth Israel(More)
OBJECTIVE To evaluate the effect of a standardized worksheet on physicians' and nurses' perceptions of their understanding of goals of care and on patients' length of stay in an intensive care unit. METHODS A worksheet was completed daily during multidisciplinary rounds and was posted at each bedside in the medical intensive care unit at Beth Israel(More)
We analyzed 385 consecutive central venous catheter (CVC) attempts over a 6-month period. All critically ill patients 18 years of age or older requiring a CVC were included. The rate of mechanical complications not including failure to place was 14%. Complications included failure to place the CVC (n = 86), arterial puncture (n = 18), improper position (n =(More)
OBJECTIVE To describe critical illnesses that occur commonly in patients with human immunodeficiency virus (HIV) infection. METHODS We reviewed and summarized the literature on critical illness in HIV infection using a computerized MEDLINE search. SUMMARY In the last 10 yrs, our perception of HIV infection and acquired immune deficiency syndrome (AIDS)(More)
Thoracic ultrasonography is a noninvasive and readily available imaging modality that has important applications in pulmonary medicine outside of the ICU. It allows the clinician to diagnose a variety of thoracic disorders at the point of care. Ultrasonography is useful in imaging lung consolidation, pleural-based masses and effusions, pneumothorax, and(More)
BACKGROUND To compare the complication rates of urgent endotracheal intubation (UEI) performed by pulmonary critical care medicine (PCCM) fellows and attending intensivists using a direct laryngoscope (DL) versus a video laryngoscope (VL) in a medical intensive care unit (MICU). METHODS We studied all UEIs performed from November 2008 through July 2012 in(More)
PURPOSE Propofol is known to provide excellent intubation conditions without the use of neuromuscular blocking agents. However, propofol has adverse effects that may limit its use in the critically ill patients, particularly in the hemodynamically unstable patient. We report on the safety and efficacy of propofol for use as an agent for urgent endotracheal(More)
We examined risk factors associated with failure of arterial catheterization in the medical intensive care unit of a large urban teaching hospital. We analyzed 92 consecutive arterial catheterizations by internal medicine house staff and critical care fellows. Of the 92 attempts, 26.1% were done on femoral arteries, and 73.9% were done on radial arteries.(More)
BACKGROUND Point-of-care ultrasonography performed by frontline intensivists offers the possibility of reducing the use of traditional imaging in the medical ICU (MICU). We compared the use of traditional radiographic studies between two MICUs: one where point-of-care ultrasonography is used as a primary imaging modality, the other where it is used only for(More)
Sir: Arterial catheterization is a common intensive care unit (ICU) procedure. We have previously found that women are more likely to fail catheter attempts [1]. Few prior studies have investigated gender differences in arterial size. Men have larger left main and left anterior descending (LAD) coronary arteries, independently of body surface area (BSA)(More)