Critical care clinics
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Critical care clinics · Jan 2015
ReviewDefining Goals of Resuscitation in the Critically Ill Patient.
There is still no "universal" consensus on an optimal endpoint for goal directed therapy (GDT) in the critically ill patient. As in other areas of medicine, this should help providers to focus on a more "individualized approach" rather than a protocolized approach to ensure proper patient care. ⋯ It is essential to also monitor flow variables (cardiac output/stroke volume) and dynamic parameters of fluid responsiveness whenever available. This article will provide a review of current and trending approaches of the goals of resuscitation in the critically ill patient.
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Although invasive hemodynamic monitoring requires considerable skill, studies have shown a striking lack of knowledge of the measurements obtained with the pulmonary artery catheter (PAC). This article reviews monitoring using a PAC. Issues addressed include basic physiology that determines cardiac output and blood pressure; methodology in the measurement of data obtained from a PAC; use of the PAC in making a diagnosis and for patient management, with emphasis on a responsive approach to management; and uses of the PAC that are not indications by themselves for placing the catheter, but can provide useful information when a PAC is in place.
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Critical care clinics · Jan 2015
ReviewOrganizational Approaches to Improving Resuscitation Effectiveness.
Hemodynamic instability and shock are important causes of mortality worldwide. Improving outcomes for these patients through effective resuscitation is a key priority for the health system. ⋯ The discussion is rooted in a conceptual model of effective resuscitation based on three domains: monitoring systems, response teams, and feedback mechanisms. Targeting each of these domains in a unified approach helps clinicians effectively treat deteriorating patients, ultimately improving outcomes for this high-risk patient group.