Critical care clinics
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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
Optimizing hemodynamic support in septic shock using central and mixed venous oxygen saturation.
Global tissue hypoxia is one of the most important factors in the development of multisystem organ dysfunction. In hemodynamically unstable critically ill patients, central venous oxygen saturation (Scvo(2)) and mixed venous oxygen saturation (Svo(2)) monitoring has been shown to be a better indicator of global tissue hypoxia than vital signs and other clinical parameters alone. Svo(2) is probably more representative of global tissue oxygenation, whereas Scvo(2), is less invasive. Svo(2) and Scvo(2) monitoring can have diagnostic and therapeutic uses in understanding the efficacy of interventions in treating critically ill, hemodynamically unstable patients.
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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
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 · Apr 2010
ReviewNoninvasive monitoring cardiac output using partial CO(2) rebreathing.
This article reviews use of partial carbon dioxide rebreathing devices to determine cardiac output and their application for hemodynamic monitoring in the ICU and operating room. The primary focus is on the NICO monitoring device. Compared with conventional cardiac output methods, these techniques are noninvasive, easily automated, and provide real-time and continuous cardiac output monitoring. The advantages and limitations of each technique are different discussed.