Current opinion in critical care
-
Curr Opin Crit Care · Jun 2005
ReviewMonitoring of pulmonary mechanics in acute respiratory distress syndrome to titrate therapy.
This paper reviews recent findings regarding the respiratory mechanics during acute respiratory distress syndrome as a tool for tailoring its ventilatory management. ⋯ The Venegas approach should be the standard analysis of pressure-volume curves. In any patient, the potential for recruitment should be assessed, as a basis for tailoring the most effective mechanical ventilation. Further studies are needed to clarify the potential use of the pressure-volume curve to guide a lung-protective ventilatory strategy.
-
Curr Opin Crit Care · Jun 2005
Randomized Controlled Trial Comparative Study Clinical TrialMechanical devices for cardiopulmonary resuscitation.
For over 40 years, manual chest compressions have been the foundation of cardiopulmonary resuscitation and recent studies have clearly reconfirmed the hemodynamic significance of delivering consistent, high-quality, infrequently-interrupted chest compressions. However, there remain multiple inadequacies in the actual delivery of manual chest compressions during cardiopulmonary resuscitation. One potential solution is use of adjunct mechanical devices. ⋯ High quality chest compressions during cardiopulmonary resuscitation are critical elements in effecting successful resuscitation following a cardiac arrest. Recent studies utilizing adjunct mechanical devices have not only revealed significant increases in the effectiveness of chest compressions, including improved hemodynamics in both animal models and human studies, but also improvements in short-term human survival in the clinical setting. It is hoped that these promising findings will eventually be corroborated in terms of improved neurologically intact, long-term patient survival. Clinical trials are currently underway to validate such efficacy.
-
Maintenance of adequate tissue oxygenation is an important task in intensive care units. In this context, venous oximetry by obtaining mixed venous oxygen saturation or central venous oxygen saturation has been discussed as useful monitoring parameters. This review discusses the physiology and clinical application of these parameters. ⋯ Early goal directed therapy should be implemented in the initial resuscitation of septic patients. Measurement of central venous oxygen saturation can easily be applied in intensive care unit patients and offers a useful indirect indicator for the adequacy of tissue oxygenation.
-
Curr Opin Crit Care · Jun 2005
ReviewHow monitoring of the microcirculation may help us at the bedside.
Recent technologic developments have allowed the direct visualization of the microcirculation at the bedside. The present review explores how the monitoring of microcirculation can help in clinical practice. ⋯ Microcirculation plays an important role in the pathogenesis of shock and organ dysfunction, especially in sepsis. Monitoring microcirculation at the bedside may be used to assess severity of the disease and to predict outcome, but in the absence of sufficient data regarding the effects of therapeutic interventions it cannot yet be used to guide therapy, even though this approach is promising.
-
Curr Opin Crit Care · Jun 2005
ReviewRegional carbon dioxide monitoring to assess the adequacy of tissue perfusion.
Tissue dysoxia is now widely regarded as the major factor leading to organ dysfunction in critically ill patients. Recent data suggests that early aggressive resuscitation of critically ill patients, which limits and/or reverses tissue dysoxia may prevent progression to organ dysfunction and improve outcome. The traditional clinical and laboratory markers used to assess tissue dysoxia are, however, insensitive and have numerous limitations. Regional carbon dioxide monitoring appears to be ideally suited to monitoring the adequacy of resuscitation. This review provides an update on this evolving technology. ⋯ Sublingual capnometry may be the ideal technology for guiding early goal directed therapy. This technology may be useful for monitoring tissue oxygenation, titrating therapeutic interventions, and as an end point for resuscitation in critically ill and injured patients.