Current opinion in critical care
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Curr Opin Crit Care · Jun 2007
ReviewBedside evaluation of pressure-volume curves in patients with acute respiratory distress syndrome.
To describe the physiologic and diagnostic utility of static pressure-volume curves of the respiratory system at the bedside in patients with acute lung injury or acute respiratory distress syndrome. ⋯ Measurement of pressure-volume curves at the bedside in critically ill patients with acute lung injury or acute respiratory distress syndrome should be considered a useful respiratory monitoring tool to assess physiologic lung status and to adjust ventilator settings, when appropriate, to minimize superimposed lung injury associated with mechanical ventilators.
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Numerous recent reports have described limitations in the quality of cardiopulmonary resuscitation. Thus, there has been increasing interest in the techniques available to monitor quality. This review focuses on the major publications since the review published by the International Liaison Committee on Resuscitation in 2005. Some key articles published prior to this time period have also been included. ⋯ Many options are available to monitor the quality of cardiopulmonary resuscitation. Some have significant limitations, and others are only readily available in hospital. The use of the information from this more intensive monitoring promises to improve outcomes of cardiopulmonary resuscitation.
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The most current practice guidelines for cardiopulmonary resuscitation published by the American Heart Association and European Resuscitation Council have placed the highest priority on achieving the most optimal circulation possible following sudden cardiac arrest through the delivery of early, consistent, high-quality and infrequently interrupted chest compressions during resuscitative efforts. The purpose of this review is to analyze the most recent trials involving adjunct mechanical devices designed to optimize blood flow to vital organs during cardiopulmonary resuscitation conditions. ⋯ Markedly enhanced circulation during cardiopulmonary resuscitation efforts has been found to be a critical element for effecting successful resuscitation. Preliminary studies of adjunct mechanical cardiopulmonary resuscitation devices have revealed significant increases in improved hemodynamics in both animal models and human studies, as well as improvements in short-term human survival in the clinical setting. Several of these devices are currently undergoing definitive clinical trials that hopefully will establish irrefutable efficacy and improved long-term neurological outcomes.