scholarly journals Management of acute upper airway obstruction in an intensive care unit in a district general hospital.

1990 ◽  
Vol 65 (2) ◽  
pp. 241-245 ◽  
Author(s):  
G H Lear ◽  
S A McKenzie ◽  
H Boralessa
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Airway Obstruction ◽  
General Hospital ◽  
Upper Airway ◽  
District General Hospital ◽  
Upper Airway Obstruction

scholarly journals Surgical Versus Nonsurgical Interventions to Relieve upper Airway Obstruction in Children with Pierre Robin Sequence

2015 ◽  
Vol 22 (3) ◽  
pp. 171-175 ◽  
Author(s):  
Karen Kam ◽  
Meghan McKay ◽  
Joanna MacLean ◽  
Manisha B Witmans ◽  
Sheldon Spier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Birth Weight ◽  
Airway Obstruction ◽  
Airway Pressure ◽  
Positive Airway Pressure ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Pierre Robin Sequence ◽  
Pierre Robin

BACKGROUND: Newborns with Pierre Robin sequence (PRS) often experience chronic intermittent hypoxemia/hypoventilation associated with airway obstruction. The heterogeneity of the severity of upper airway obstruction makes management a challenge; the optimal intervention in individual cases is not clear.OBJECTIVE: To investigate the prevalence of surgical/nonsurgical interventions for PRS at two children’s hospitals. Patient characteristics and outcomes were examined.METHODS: The present retrospective chart review identified 139 patients with PRS born between 2000 and 2010. Demographic information, mode of airway management, associated anomalies and syndromes, polysomnography results, length of intensive care unit and hospital stay, complications and deaths were extracted.RESULTS: Interventions included prone positioning (alone [61%]), tongue-lip adhesion (45%), nasopharyngeal intubation (28%), continuous positive airway pressure (20%), tracheostomy (19%) and mandibular distraction osteogenesis (5%). Tracheostomies were more prevalent in syndromic patients (P=0.03). Patients who underwent tracheostomy had a lower birth weight (P=0.03) compared with newborns with other interventions. Patients who underwent surgical interventions had longer intensive care unit stays (P<0.001). No intervention was associated with a statistically significant likelihood of requiring a subsequent intervention. Thirty percent of patients underwent polysomnography, with a higher proportion of these using continuous positive airway pressure (n=15) (P<0.01).CONCLUSIONS: In the present descriptive study, patients with syndromic PRS or low birth weight underwent early intervention, which included a tracheostomy. Objective measures of airway obstruction were underutilized. Decision making regarding evaluation and management of upper airway obstruction in this population remains clinician and resource dependent. Reporting data obtained from a large cohort of PRS patients is important to compare experiences and motivate future studies investigating this complex condition.

scholarly journals Risk factors associated with symptoms of post-extubation upper airway obstruction in the emergency setting

2020 ◽  
Vol 48 (5) ◽  
pp. 030006052092636 ◽  
Author(s):  
Mafumi Shinohara ◽  
Masayuki Iwashita ◽  
Takeru Abe ◽  
Ichiro Takeuchi
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Confidence Interval ◽  
Airway Obstruction ◽  
Odds Ratio ◽  
Upper Airway ◽  
Upper Airway Obstruction ◽  
Laryngeal Edema ◽  
Female Sex

Objective Post-extubation stridor and hoarseness are important clinical manifestations that indicate laryngeal edema due to intubation. In previous studies the incidence of post-extubation stridor and hoarseness ranged from 1.5% to 26.3% in postoperative patients and patients in the intensive care unit. Female sex and prolonged intubation are reportedly risk factors for post-extubation stridor. However, the risk factors for post-extubation stridor and the appropriate endotracheal tube size in emergency settings remain unknown. This study was performed to identify the risk factors for post-extubation laryngeal edema after emergency intubation. Methods A prospective observational study was conducted in a tertiary emergency medical center/trauma center. The primary outcome was post-extubation stridor and hoarseness. Results During the study period, 482 emergency intubations and 227 extubations were performed in adult patients. In total, 29% of the patients presented symptoms of stridor and/or hoarseness. Female sex (odds ratio, 2.65; 95% confidence interval, 1.21–5.81) and the duration of intubation (odds ratio, 1.18; 95% confidence interval, 1.05–1.32) were associated with stridor and/or hoarseness. Conclusions Patients who undergo emergency intubation have a higher risk of post-extubation upper airway obstruction symptoms than postoperative patients and patients in the intensive care unit, and female sex is associated with these symptoms.

scholarly journals Etomidate in the management of severe Cushing’s disease and MRSA bacteraemia in a district general hospital in the United Kingdom

2019 ◽  
Vol 2019 ◽  
Author(s):  
Stephanie Wei Ping Wong ◽  
Yew Wen Yap ◽  
Ram Prakash Narayanan ◽  
Mohammad Al-Jubouri ◽  
Ashley Grossman ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Cushing’S Disease ◽  
District General Hospital ◽  
Serum Cortisol ◽  
Cushing's Disease ◽  
High Morbidity ◽  
List Type ◽  
Cortisol Levels

Summary We report our experience on managing a case of florid Cushing’s disease with Methicillin-resistant Staphylococcus aureus (MRSA) sepsis using intravenous etomidate in the intensive care unit of a UK district general hospital. Learning points: Severe Cushing’s syndrome is associated with high morbidity and mortality. Etomidate is a safe and effective medical therapy to rapidly lower cortisol levels even in the context of severe sepsis and immunosuppression. Etomidate should ideally be administered in an intensive care unit but is still feasible in a district general hospital. During treatment with etomidate, accumulation of serum 11β-deoxycortisol (11DOC) levels can cross-react with laboratory cortisol measurement leading to falsely elevated serum cortisol levels. For this reason, serum cortisol measurement using a mass spectrometry assay should ideally be used to guide etomidate prescription.

Psychiatric intensive care after two years

1989 ◽  
Vol 13 (8) ◽  
pp. 421-422 ◽  
Author(s):  
J. M. O'Dwyer ◽  
B. S. Mann
Keyword(s):  
Mental Health ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
General Hospital ◽  
Mentally Ill ◽  
Psychiatric Patients ◽  
District General Hospital ◽  
Descriptive Study ◽  
Psychiatric Unit ◽  
Health Authorities

The following is a descriptive study of Willoughby Ward, a psychiatric intensive care unit, opened in Parkside Hospital, Macclesfield, in July 1986. It provides a moderately secure facility for the treatment of psychiatric patients within both Crewe and Macclesfield Health Authorities. The unit has 15 beds, of which two are funded and used by Crewe area, where, unlike Macclesfield, the psychiatric unit is located in the district general hospital. Managed as a locked ward, the patients are admitted under the provisions of the Mental Health Act 1983. As well as being mentally ill as defined in the Act, the patients were disturbed to a degree as to be unmanageable in open conditions.

Sign in / Sign up

Export Citation Format

Share Document