Current opinion in critical care
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Curr Opin Crit Care · Jun 2007
ReviewTranspulmonary dilution-derived extravascular lung water as a measure of lung edema.
This review highlights current insights concerning the (measurement of) extravascular lung water as an index of pulmonary edema, by transpulmonary dilution techniques. The focus is on the applicability of the technique at the bedside in monitoring critically ill patients. ⋯ The thermodilution-derived extravascular lung water is a useful adjunct to assess lung vascular injury, cardiogenic edema and overhydration and to guide treatment in critically ill patients. The effects on morbidity and mortality of this approach need to be studied further.
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Several less invasive cardiac output monitoring techniques are now commercially available and have the potential to replace the pulmonary artery catheter under certain clinical circumstances. The aim of this review is to give a synopsis of the currently available cardiac output measurement methods. This information should help in selecting the appropriate technique in a particular clinical setting. ⋯ Less invasive cardiac output monitoring techniques may replace the pulmonary artery catheter in different clinical settings considering the specific properties of these techniques. The pulmonary artery catheter, however, may still be recommended for cardiac output measurement in specific clinical situations when monitoring of pulmonary artery pressures is desirable.
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Curr Opin Crit Care · Jun 2007
ReviewThe impedance threshold valve for adult cardiopulmonary resuscitation: a review of the literature.
Heart-lung interaction is an important parameter in the understanding of blood-flow induction during cardiopulmonary resuscitation. The impedance threshold valve is a device which has been created to increase venous return by occluding the airway during the decompression phase of cardiopulmonary resuscitation. This review analyzes the available literature focusing on the rationale of this device. ⋯ It seems clear, from both animal and human data, that enhancement of preload by a decrease in the intrathoracic pressures in the decompression phase improves overall cardiopulmonary resuscitation efficacy. By this means, the impedance threshold valve may be beneficial in patients in asystole or shock-refractory ventricular fibrillation. The potential long-term benefits of this new valve remain under investigation.
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To update the situation over the past few years on the clinical application of volumetric measures of preload in critically ill patients. ⋯ Volumetric measures of preload are good preload indexes. These data are to be interpreted together with the clinical patient's condition, conventional hemodynamic data and the course of illness in critically ill patients. In order to evaluate whether the application of a predefined therapy algorithm based on volumetric monitoring can improve patients' outcome, more studies are needed.