Textbook of Critical Care

Flexible bronchoscopy

Specialty and category within specialty Intensive care medicine: Diseases of the respiratory system Airway management CPT codes Bronchoscopy ICD-9 codes 33.2 Diagnostic procedures on lung and bronchus 33.22 Fiber-optic bronchoscopy 33.24 Closed [endoscopic] biopsy of bronchus 33.27 Closed endoscopic biopsy…

Chest tube placement, care, and removal

Before the procedure Indications Most commonly undertaken to treat one of the following conditions: Pneumothorax Pleural fluid collection Hemothorax Simple effusion Empyema Can be both a diagnostic and a therapeutic maneuver Contraindications In an emergent situation (i.e., tension pneumothorax), there…

Thoracentesis

Before the procedure Indications Pleural effusion is not explained by the clinical presentation Massive pleural effusion with impending respiratory failure Suspected pleural space infection Suspected complication of pneumonia (empyema) Suspected hemothorax Contraindications Absolute Lack of expertise Severe uncorrectable coagulopathy (platelet…

Paracentesis and diagnostic peritoneal lavage

Paracentesis: Before the procedure Indications Paracentesis is the insertion of a needle or catheter into the peritoneal cavity for the purpose of aspirating peritoneal fluid. It is most often indicated for diagnostic or therapeutic evacuation of ascites. Diagnostic indications New-onset…

Pericardiocentesis

Preprocedure Indications Pericardial tamponade Pericardiocentesis is the first treatment option in patients with overt tamponade because only the removal of fluid allows normal ventricular filling and restores adequate cardiac output. If the patient is hemodynamically stable, the procedure should be…

Ventricular assist device implantation

Before the procedure Indications Postcardiotomy failure (left ventricular assist device [LVAD]) Elevated left atrial pressure (LAP) and cardiogenic shock despite inotropic support and intraaortic balloon pump (IABP) LAP >25 mm Hg Cardiac index (CI) <2 L/min/m 2 Severe left ventricular…

Transvenous and transcutaneous cardiac pacing

Before the procedure Indications Treatment of symptomatic bradycardia Sinus bradycardia Second-degree or third-degree atrioventricular block Prophylaxis Bradycardia-induced ventricular tachyarrhythmias (e.g., torsades de pointes) Increased risk of advanced atrioventricular block (e.g., acute myocardial infarction, infective endocarditis, surgery in patients with underlying…

Cardioversion and defibrillation

Before the procedure Indications Emergency re-establishment of an organized electrical rhythm Hemodynamically unstable polymorphic ventricular tachycardia Ventricular fibrillation Pulseless ventricular tachycardia Narrow or wide QRS complex tachycardia (ventricular rate >150) associated with hemodynamic instability, chest pain, or pulmonary edema Elective…

Bedside pulmonary artery catheterization

Before the procedure Indications Need for continuous monitoring of pulmonary artery (PA) and right atrial (RA) pressures, cardiac output, and mixed venous oxygen saturation (SvO 2 ), providing that: The data collected will help in the management of the patient…