Current opinion in critical care
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Computed tomography (CT) in patients with acute respiratory distress syndrome has shown that intrapulmonary gas is not homogeneously distributed. Although regional ventilation can be studied by isotope and magnetic resonance techniques while aeration of the lungs can be imaged using CT, these techniques are not available at the bedside. Recently, electrical impedance tomography has been introduced as a true bedside technique which provides information on regional ventilation distribution. ⋯ In view of recently published data, it can be concluded that, in critically ill patients, electrical impedance tomography determines reliable regional ventilation. Therefore, this technique has the potential to become a valuable bedside tool.
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Curr Opin Crit Care · Jun 2007
ReviewLayperson training for cardiopulmonary resuscitation: when less is better.
Basic cardiopulmonary resuscitation, including use of automated external defibrillators, unequivocally saves lives. However, even when motivated, those wishing to acquire training traditionally have faced a myriad of barriers including the typical time commitment (3-4 h) and the number of certified instructors and equipment caches required. ⋯ Simpler to set-up and implement, the half-hour video-based self-instruction makes it easier for employers, churches, civic groups, school systems and at-risk persons at home to implement such training and it will likely facilitate more frequent re-training. It is now hoped that the ultimate benefit will be more lives saved in communities worldwide.
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Curr Opin Crit Care · Jun 2007
ReviewCompression-only cardiopulmonary resuscitation for bystanders and first responders.
The current resuscitation guidelines consider ventilation and chest compression essential components of resuscitation and therefore only one methodology, standard cardiopulmonary resuscitation, is explicitly recommended for the treatment of both respiratory and cardiac arrests. Pathophysiological and experimental observations argue that this generalization results in suboptimal treatment for victims of cardiac arrest. ⋯ The current resuscitation guidelines regarding the prehospital treatment of victims of adult cardiac arrest should be modified to explicitly permit the use of continuous-chest-compression cardiopulmonary resuscitation.
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Curr Opin Crit Care · Jun 2007
ReviewHow to monitor lung recruitment in patients with acute lung injury.
Bedside assessment of lung recruitment is critical for setting mechanical ventilation during acute respiratory distress syndrome. We review recent findings on this topic and attempt to provide a clinical approach to estimating lung recruitment. ⋯ Two approaches should be considered to estimate lung recruitment: the use of computed-tomography scanning and indices combining different respiratory variables. Future studies, especially on lung-perfusion distribution, are warranted to improve our knowledge of the pathophysiology of lung recruitment.