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OBJECTIVE The timing of tracheotomy in patients requiring mechanical ventilation is unknown. The effects of early percutaneous dilational tracheotomy compared with delayed tracheotomy in critically ill medical patients needing prolonged mechanical ventilation were assessed. DESIGN Prospective, randomized study. SETTING Medical intensive care units. (More)
OBJECTIVE To compare percutaneous tracheostomy with conventional operative tracheostomy. DESIGN Randomized clinical trial. SETTING The medical and surgical critical care units of a large, tertiary-care, private hospital. PATIENTS Twenty-five male and 21 female translaryngeally intubated patients with respiratory failure, in whom tracheostomy was(More)
Over a 24-month period, tracheostomy was performed in 55 patients using a percutaneous, wire-guided, dilatational technique. All such procedures were undertaken at the patient's bedside in the intensive care unit, with the patient under local anesthesia and mechanically ventilated through an oral endotracheal tube. A variety of wire-guides, dilators, and(More)
OBJECTIVES Part 1: To describe the complication of posterior tracheal wall injury and perforation associated with the percutaneous dilational tracheostomy (PDT). Part 2: To determine the mechanism of posterior tracheal wall injury during PDT. DESIGN Prospective observational study. SUBJECTS Part 1: Medical-surgical ICU patients requiring tracheostomy.(More)
As practicing intensivists, we frequently diagnose pleural effusions in mechanically ventilated patients and routinely perform thoracentesis even when the patient is on positive end-expiratory pressure (PEEP). In light of a recent report, we have reviewed our experience. It is of interest that all thoracenteses were performed with patients in the lateral(More)
Despite widespread application of cardiac pacing to a wide variety of circumstances with minimal morbidity are remarkable success, the possible role of transvenous pacing in the acute setting of cardiac resuscitation has not been adequately evaluated. The authors report their experience with the use of transvenous pacemakers in 26 patients undergoing(More)
Despite the host of complications which may be associated with intravenous sodium bicarbonate infusion, the use of this agent is a frequent necessity in patients with metabolic acidosis. No satisfactory formula for calculating bicarbonate dose had previously been described, although such an approach might be expected to reduce the incidence of these(More)
We used metoprolol orally or iv in 25 patients with multifocal atrial tachycardia that was complicating severe cardiopulmonary illness, and we observed its effect on heart rate and rhythm, BP, and arterial blood gases. All patients showed a dramatic slowing of heart rate, averaging 54.0 +/- 4.0 beat/min (p less than .001), with only small and transient fall(More)