Critical care clinics
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This article focuses on static methods for determining preload, specifically pressure and volumetric indices measured at the bedside. The underlying ventricular function will determine where the patient is located on Frank-Starling ventricular function curve and the patient's response to a fluid challenge. The proper interpretation and use of such measures, coupled with an understanding of their limitations and knowledge of alternative methods, is necessary to guide properly volume resuscitation in the critically ill.
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Critical care clinics · Apr 2010
Techniques for determining cardiac output in the intensive care unit.
To achieve the goals of resuscitation in critically ill patients, a thorough understanding of the techniques available to measure cardiac output is important. Recently the pulmonary artery catheter has fallen out of favor because of concerns of safety and a lack of efficacy. ⋯ But is important to remember that the ability of these techniques to improve outcome has yet to be demonstrated, and one should apply caution in how they are used until their use in algorithmic treatment approaches have been shown to improve outcome. This article discusses the invasive and noninvasive techniques to assess cardiac output.
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Critical care clinics · Apr 2010
Mean arterial pressure: therapeutic goals and pharmacologic support.
The Surviving Sepsis Campaign targets central venous pressure, mean arterial pressure, and central venous oxygen saturation as guides for resuscitation. Fluid resuscitation and the use of vasopressors are paramount to the success of the campaign's end points. Although the achievement of supranormal physiologic parameters has been associated with higher mortality in some studies, these slightly higher blood pressures may enable better oxygen delivery, in some observations. This article focuses on the mean arterial pressure goals during sepsis, the measurement of the mean arterial pressure, and the manipulation of this target with volume resuscitation and pharmacologic interventions.
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Critical care clinics · Jan 2010
ReviewAdmission criteria and prognostication in patients with cancer admitted to the intensive care unit.
Critical care for patients with cancer was once considered inappropriate because of a perceived poor prognosis for their long-term survival. Three decades of research has yielded evidence to support the use of critical care resources for many patients with cancer. ⋯ This article reviews the studies that have attempted to apply mortality prediction scales or scoring systems to these patients. Clinical judgment with incorporation of consensus opinions from the literature should be used to develop admission or restriction criteria for intensive care of patients with cancer.
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Critical care clinics · Jan 2010
ReviewAcute respiratory failure in the patient with cancer: diagnostic and management strategies.
Acute respiratory failure (ARF) remains the major reason for admission to the intensive care unit (ICU) in patients with cancer and is often associated with high mortality, especially in those who require mechanical ventilation. The diagnosis and management of ARF in patients who have cancer pose unique challenges to the intensivist. ⋯ Timely diagnosis and treatment of reversible causes of respiratory failure, including earlier use of noninvasive ventilation and judicious ventilator and fluid management in patients with acute lung injury, are essential to achieve an optimal outcome. Close collaboration between oncologists and intensivists helps ensure that clear goals, including direction of treatment and quality of life, are established for every patient with cancer who requires mechanical ventilation for ARF.