Critical care clinics
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Critical care ultrasonography is a bedside technique performed by the frontline clinician at the point of care. Point-of-care ultrasonography is conceptually related to physical examination. ⋯ Ultrasonography adds to traditional physical examination by allowing the intensivist to visualize the anatomy and function of the body in real time. Initial, repeated, and goal-directed ultrasonography is an extension of the physical examination that allows the intensivist to establish a diagnosis and monitor the condition of the patient on a regular basis.
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Functional hemodynamic monitoring is the assessment of the dynamic interactions of hemodynamic variables in response to a defined perturbation. Recent interest in functional hemodynamic monitoring for the bedside assessment of cardiovascular insufficiency has heightened with the documentation of its accuracy in predicting volume responsiveness using a wide variety of monitoring devices, both invasive and noninvasive, and across multiple patient groups and clinical conditions. However, volume responsiveness, though important, reflects only part of the overall spectrum of functional physiologic variables that can be measured to define the physiologic state and monitor response to therapy.
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Critical care clinics · Jan 2015
ReviewUsing What You Get: Dynamic Physiologic Signatures of Critical Illness.
The development and resolution of cardiopulmonary instability take time to become clinically apparent, and the treatments provided take time to have an impact. The characterization of dynamic changes in hemodynamic and metabolic variables is implicit in physiologic signatures. ⋯ The creation of physiologic signatures requires no new information; additional knowledge is extracted from data that already exist. It is possible to create physiologic signatures for each stage in the process of clinical decompensation and recovery to improve outcomes.
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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.