A multidisciplinary care model significantly expedited the decannulation process and reduced the overall time that a tracheostomy was in situ. The intervention was associated with a reduction in clinical incidents and shorter intensive care unit admissions, which can be associated with significant monetary savings.

Since its introduction nearly 30 yr ago, the pulmonary artery catheter (PAC) has become part of everyday management in cardiology, anaesthesia and intensive care but remains controversial. 12 37 78 136 164 The apparent failure to demonstrate improvements in patient outcome 28 66 68 192 and the risks associated with its use 15 153 have long been criticized. 139 Failure to explore its full use and redundancy of the catheter after initial placement are additional concerns. More worrying is the incorrect interpretation of data 64 82 97 and consequent misdirection of therapy. Others are disturbed by a reliance on measurements rather than on clinical signs. 140 However, many argue that the PAC enhances bedside understanding of cardiorespiratory interactions, complements the interpretation of clinical signs and benefits management of haemodynamic disorders. 47 53 62 65 77 136 157 170 The first part of this article reviews the history, technical aspects and practical uses of pulmonary artery catheterization. The second part evaluates the clinical impact of the PAC on anaesthesia and intensive care medicine.

Many critically ill patients have increased extracellular fluid which might affect ceftazidime pharmacokinetics. We investigated the pharmacokinetics of ceftazidime in 15 adult intensive care patients receiving 2 g of ceftazidime intravenously three times a day. The ceftazidime mean (standard deviation) apparent volume of distribution and terminal-phase half-life were 56.91 (25.93) liters and 4.75 (1.85) h, respectively, significantly greater than values reported previously for healthy controls (P < 0.001). The mean ceftazidime clearance and area under the curve at steady state were not significantly different from those previously reported for controls. We conclude that ceftazidime pharmacokinetics in critically ill patients were altered by an increased volume of drug distribution and elevated elimination half-life.

No abstract

No abstract