Critical care medicine
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Critical care medicine · Dec 2013
Hemodynamic Directed Cardiopulmonary Resuscitation Improves Short-Term Survival From Ventricular Fibrillation Cardiac Arrest.
During cardiopulmonary resuscitation, adequate coronary perfusion pressure is essential for establishing return of spontaneous circulation. Current American Heart Association guidelines recommend standardized interval administration of epinephrine for patients in cardiac arrest. The objective of this study was to compare short-term survival using a hemodynamic directed resuscitation strategy versus chest compression depth-directed cardiopulmonary resuscitation in a porcine model of cardiac arrest. ⋯ Hemodynamic directed resuscitation targeting coronary perfusion pressures greater than 20 mm Hg during 10 minutes of cardiopulmonary resuscitation for ventricular fibrillation cardiac arrest improves short-term survival, when compared to resuscitation with depth of compressions guided to 33 mm or 51 mm and standard American Heart Association vasopressor dosing.
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Critical care medicine · Dec 2013
Prediction of Survival to Discharge Following Cardiopulmonary Resuscitation Using Classification and Regression Trees.
To predict the likelihood that an inpatient who experiences cardiopulmonary arrest and undergoes cardiopulmonary resuscitation survives to discharge with good neurologic function or with mild deficits (Cerebral Performance Category score = 1). ⋯ We have developed and validated Classification and Regression Tree models that predict survival to discharge with good neurologic function or with mild deficits following in-hospital cardiopulmonary arrest. Models like this can assist physicians and patients who are considering do-not-resuscitate orders.
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Critical care medicine · Dec 2013
Hypothermic Liquid Ventilation Prevents Early Hemodynamic Dysfunction and Cardiovascular Mortality After Coronary Artery Occlusion Complicated by Cardiac Arrest in Rabbits.
Ultrafast and whole-body cooling can be induced by total liquid ventilation with temperature-controlled perfluorocarbons. Our goal was to determine whether this can afford maximal cardio- and neuroprotections through cooling rapidity when coronary occlusion is complicated by cardiac arrest. ⋯ Achieving hypothermia rapidly is critical to improve the cardiovascular outcome after cardiac arrest with underlying myocardial infarction.
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Critical care medicine · Dec 2013
Repeated Derecruitments Accentuate Lung Injury During Mechanical Ventilation.
The aim of our study was to assess whether repeated derecruitments induced by the repetitive withdrawal of high positive end-expiratory pressure could induce lung injury in a swine model. ⋯ Repeated derecruitments exacerbated lung injury, particularly at the bronchiolar level in the dependent portion. Strategies to minimize this type of injury should be incorporated when designing optimal ventilator strategies in acute respiratory distress syndrome patients.