Search PubMed⌕ Search

Biomedical subjects

Charles G Durbin

Publications and source records attributed to Charles G Durbin.

At least 19 recordsLinked to original sources
PubMed2007

Tracheostomy in the critically ill: indications, timing and techniques.

PURPOSE OF REVIEW: Tracheostomy is one of the most common procedures performed in the intensive care unit. Indications, risks, benefits, timing and technique of the procedure, however, remain controversial. The decision of when and how to perform a tracheostomy is often subjective, but must be individualized to the patient. The following review gives an update on recent literature related to tracheostomy in the critically ill. RECENT FINDINGS: Surprisingly, few data are available on the current practice of tracheostomy in the intensive care unit setting. Very few trials address this issue in a prospective, randomized fashion (randomized controlled trial). Most reports include small numbers representing a heterogeneous population, describing contrary results and precluding any definite conclusions. Evidence seems to suggest that early tracheostomy, however, might be preferable in selected patients. SUMMARY: Due to increased experience and advanced techniques, percutaneous tracheostomy has become a popular, relatively safe procedure in the intensive care unit. The question of appropriate timing, however, has not been definitely answered with a randomized controlled trial. Instead, a number of retrospective studies and a single prospective study have shed some light on this issue. Most reports favor the performance of tracheostomy within 10 days of respiratory failure.

Critical Care↗
PubMed2006

Team model: advocating for the optimal method of care delivery in the intensive care unit.

OBJECTIVE: To review published data on the team model of intensive care unit (ICU) care delivery. DESIGN: Nonexhaustive, selective literature search. SETTING: Review of literature published in the English language. PATIENTS/SUBJECTS: Humans cared for in ICUs. INTERVENTIONS: None. RESULTS: The team model for delivery of ICU care reduces mortality, ICU length of stay, hospital length of stay, and cost of care. Convincing data suggest that merely having daily rounds led by an intensivist enhances patient care significantly. Further improvements can be obtained by maintaining a nurse-to-patient ratio of no greater than 1:2, adding critical care pharmacists, and providing dedicated respiratory therapists to the ICU team. CONCLUSION: Current and looming shortages of all ICU healthcare providers is a barrier to universal implementation of the team model. Advocating for the ICU team model for critical care delivery requires local, regional, national, and international activities for success.

Critical Care↗
PubMed2005

Using ventilator and cardiovascular graphics in the patient who is hemodynamically unstable.

The interaction of a mechanical ventilator and the human cardiovascular system is complex. One of the most important effects of positive-pressure ventilation (PPV) is that it can decrease venous return. PPV also alters right- and left-ventricular ejection. Increased lung volume increases right-ventricular size by increasing pulmonary vascular resistance, causing intraventricular cardiac-septum shift, and decreasing left-ventricular filling. Increased intrathoracic pressure reduces afterload on the LV and increases ejection of blood from the LV. Understanding and managing these complex and often opposing interactions in critically ill patients is facilitated by analysis of hemodynamic and ventilator waveforms at the bedside. The relationship of PPV to changes in the arterial pressure waveform gives important information regarding appropriate fluid and vasopressor treatment. This article focuses on effects of respiratory pressures on hemodynamics and considers how cardiac pressures can be transmitted to the airway and cause ventilator malfunction.

Blood Pressure↗
PubMed2005

Applied respiratory physiology: use of ventilator waveforms and mechanics in the management of critically ill patients.

Graphical waveforms have become ubiquitous in clinical care. Using and understanding pictures and symbols is a daily activity. Humans are neurologically equipped to understand symbolic information and have done so for millennia. Cave drawings are examples of using images to convey information. The same approach used in understanding "art" is needed to use ventilator waveforms effectively. Didactic study, frequent viewing, and understanding of the background of the artist (artistic context) are needed to fully appreciate art. Using waveforms to care for patients requires understanding of the clinical context under which they are obtained, factors that affect their creation, and artifacts that interfere with interpretation. This article summarizes the presentation and discussions at this Journal Conference on ventilator waveforms in relation to lung and chest wall compliance, resistance, carbon dioxide kinetics, hemodynamics, specific modes of ventilation, specific lung diseases, and ventilator-weaning.

Airway Resistance↗
PubMed2005

Indications for and timing of tracheostomy.

Tracheostomy is one of the most common intensive care unit procedures performed. The advantages include patient comfort, safety, ability to communicate, and better oral and airway care. Patients may have shorter intensive care unit stays, days of mechanical ventilation, and hospital stays. There are risks, long-term and acute, and the timing of when to do a tracheostomy must be individualized. As soon as the need for prolonged airway access is identified, the tracheostomy should be considered. Generally, this decision can be made within 7-10 days. Bedside techniques allow rapid tracheostomy with low morbidity.

Humans↗
PubMed2005

Techniques for performing tracheostomy.

One of the most commonly performed procedures in the critically ill, tracheostomy has been described and used for lifesaving treatment of upper-airway obstruction for at least 3,500 years. The procedure can be performed surgically in the operating room or at the bedside in the intensive care unit. Recently, percutaneous techniques performed by a variety of specialists have become popular alternatives to open surgical tracheostomy. Various devices have been developed to minimize identified risk and improve the simplicity of the procedure. These techniques and devices are described in this paper.

Bronchoscopy↗
PubMed2005

Early complications of tracheostomy.

Complications from surgical procedures are common and must be taken into account when assessing the risks and benefits of a particular treatment approach. Common acute risks of tracheostomy include bleeding, airway loss, damage to adjacent structures, and failure of the chosen technique to achieve successful airway placement. The frequency and severity of these occurrences depends on several factors. These include the specific approach to tracheostomy, the skill and experience of the operator, and patient anatomic and physiologic factors. The incidence of undesired outcomes during tracheostomy cannot be exactly predicted because of the interaction of the above issues. This paper will consider some of the common and less common acute complications of several of the usual techniques for temporary tracheostomy placement in critically ill patient.

Equipment Failure↗
PubMed2004

Guidelines for critical care medicine training and continuing medical education.

OBJECTIVE: Critical care medicine trainees and faculty must acquire and maintain the skills necessary to provide state-of-the art clinical care to critically ill patients, to improve patient outcomes, optimize intensive care unit utilization, and continue to advance the theory and practice of critical care medicine. This should be accomplished in an environment dedicated to compassionate and ethical care. PARTICIPANTS: A multidisciplinary panel of professionals with expertise in critical care education and the practice of critical care medicine under the direction of the American College of Critical Care Medicine. SCOPE: Physician education in critical care medicine in the United States should encompass all disciplines that provide care in the intensive care unit and all levels of training: from medical students through all levels of postgraduate training and continuing medical education for all providers of clinical critical care. The scope of this guideline includes physician education in the United States from residency through ongoing practice after subspecialization. DATA SOURCES AND SYNTHESIS: Relevant literature was accessed via a systematic Medline search as well as by requesting references from all panel members. Subsequently, the bibliographies of obtained literature were reviewed for additional references. In addition, a search of organization-based published material was conducted via the Internet. This included but was not limited to material published by the American College of Critical Care Medicine, Accreditation Council for Graduate Medical Education, Accreditation Council for Continuing Medical Education, and other primary and specialty organizations. Collaboratively and iteratively, the task force met, by conference call and in person, to construct the tenets and ultimately the substance of this guideline. CONCLUSIONS: Guidelines for the continuum of education in critical care medicine from residency through specialty training and ongoing throughout practice will facilitate standardization of physician education in critical care medicine.

Clinical Competence↗
PubMed2004

The spectrum of respiratory care research: prospective clinical research.

Prospective clinical research is given the greatest weight in evidence-based clinical practice recommendations, and therefore has the greatest potential to change care and help the largest number of patients. This article briefly describes the history of government regulation of prospective clinical research, how a prospective clinical research project is developed, and how the researcher seeks project approval from the institutional review board. We also evaluate 2 published studies with regard to ethical and regulatory matters that influenced the studies.

Biomedical Research↗
PubMed2004

How to come up with a good research question: framing the hypothesis.

Having a questioning attitude is the fist step in the research process. Research begins with a question, which leads to a hypothesis. Questions abound in our daily clinical lives. Most quality research consists of comparisons. By carefully selecting a comparison group or condition, the quality of the research project can be improved. By including in the hypothesis the comparison group, the experiment can be focused and the analysis simplified. The best questions come from the investigator's subject of interest. When starting a research project, start small and choose an experienced mentor.

Biomedical Research↗
PubMed2004

Effective use of tables and figures in abstracts, presentations, and papers.

In some situations, tables, graphs, and figures can present certain types of information (including complicated relationships and sequences of events) more clearly and in less space than the same information would require in sentence form. However, do not use tables, graphs, and figures for small amounts of data that could be conveyed clearly and succinctly in a sentence. Also, do not reiterate in sentences the data that are shown in a table, graph, or figure: the point of creating a table or graph or figure is to eliminate that type of sentence from your manuscript. In building a data table you must balance the necessity that the table be complete with the equally important necessity that it not be too complex. Sometimes it is helpful to break a large table into several smaller ones to allow the reader to identify important information easily, but, conversely, it is a common mistake of novice authors to split up into several tables data that belong in one table. In almost all cases, only one table or graph or figure should be included in an abstract, and then only if it can convey essential information in less space and in a more easily interpretable way than the sentence form. For a poster, in almost all instances you should use only one typeface and one font in a table, graph, or figure. In general, do not use bold, italics, or color unless you are presenting a great deal of data and you need to highlight certain data values and you are certain that using bold, italics, or color will improve readability, which is rare. Do not include identical information in a table and a graph/figure. In reporting a clinical trial you will need to include a patient flow chart that identifies the number of patients initially screened for the study, the number of patients who were excluded (and why) after initial screening or in the final analysis, and how many patients entered, exited early, and completed each arm of the study. A treatment protocol should also be described with a flow chart. In preparing a graph the most common error is to include a line that suggests an unsubstantiated extrapolation between or beyond the data points. In selecting the graph's axes, avoid truncating, enlarging, or compressing the axes in ways that might make the graph confusing or misleading. To prepare clear, accurate, easily interpretable tables, graphs, and figures, rely on the rules described in authoritative guides such as the Council of Science Editors' Scientific Style and Format and the American Medical Association's Manual of Style.

Abstracting and Indexing↗
PubMed2002

More reliable oximetry reduces the frequency of arterial blood gas analyses and hastens oxygen weaning after cardiac surgery: a prospective, randomized trial of the clinical impact of a new technology.

OBJECTIVE: Evaluation of the impact on clinical care of improved, innovative oximetry technology. DESIGN: Randomized, prospective trial. SETTING: Postcardiac surgery intensive care unit in a major teaching hospital. PATIENTS: A total of 86 patients after undergoing coronary artery bypass surgery. INTERVENTIONS: All patients were monitored with two oximeters, one employing conventional oximetry (conventional pulse oximeter, CPO) and one using an improved innovative technology (innovative pulse oximeter, IPO), on different fingers of the same hand. The outputs from both devices were collected continuously by computer, but only one device was randomly selected and displayed for clinicians. MEASUREMENTS AND MAIN RESULTS: The amount and percentage of nonfunctional monitoring time was collected and found to be much greater for the CPO than the IPO (8.7% +/- 16.4% for CPO vs. 1.2% +/- 3.3% for IPO, p =.000256). Time to extubation was not different between the two groups (634 +/- 328 mins for IPO vs. 706 +/- 459 mins for CPO). Clinicians managing patients with the more reliable IPO weaned patients faster to an FIO2 of 0.40 (176 +/- 111 mins for IPO vs. 348 +/- 425 mins for CPO, p =.0125), obtained fewer arterial blood gas measurements (2.7 +/- 1.2 for IPO vs. 4.1 +/- 1.6 for CPO, p =.000015), and made the same number of ventilator changes during this weaning process (2.9 +/- 1.2 for IPO vs. 2.9 +/- 1.7 for CPO). CONCLUSIONS: Provision of more reliable oximetry allows caregivers to act in a more efficient and cost-effective manner in regard to oxygen weaning and use of arterial blood gas measurements. Investigating the effect of a monitor on the process of care, rather than simply its accuracy and precision, is a useful, relevant paradigm for evaluating the value and impact of a new technology.

Adult↗