Current opinion in critical care
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Curr Opin Crit Care · Jun 2008
ReviewPrediction of volume responsiveness in critically ill patients with spontaneous breathing activity.
Predicting volume responsiveness in patients with spontaneous breathing activity is a difficult challenge in the emergency room as well as in the intensive care unit because heart-lung interactions indices cannot be reliably used as they can be in mechanically ventilated patients fully adapted to their ventilator. The aim of this review is to summarize the different tools that have been proposed to predict the hemodynamic response to fluid infusion in the presence of spontaneous breathing activity. ⋯ The passive leg-raising test is the only method that has been repeatedly shown to be reliable for predicting volume responsiveness in patients who experience spontaneous breathing. The appropriate utilization of this test requires a real-time assessment of its effects on systemic blood flow.
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Curr Opin Crit Care · Jun 2008
ReviewCardiac arrest resuscitation: neurologic prognostication and brain death.
Persistent coma after cardiac arrest is a source of great emotional and financial cost to grieving family members in particular and the healthcare system in general. Neurologic prognostication helps guide appropriate discussions between family members and healthcare providers. Recent advances in therapeutic care increase the challenges, both medical and financial, on local practitioners. ⋯ Evidence-based tests of prognostication for neurologic outcome after cardiac arrest are presented. A review of the practice of withdrawal of life-sustaining therapies and the diagnosis of brain death is also provided. The reader is cautioned that most prognostic studies do not include possible amelioration with the use of therapeutic hypothermia.
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The measurement of cardiac output in the critically ill constitutes a vital part in the management of these patients. Minimally invasive techniques are gaining popularity as they allow continuous cardiac output monitoring while avoiding the risks associated with pulmonary artery catheterization. This article focuses on some of the commonly used minimally invasive devices that rely on pulse contour waveform analysis. ⋯ The minimally invasive cardiac output monitoring devices available differ in their methodology and application. Currently there is conflicting evidence as to the accuracy of some of these systems and further investigation into their clinical application is required.
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To evaluate the recent literature on the utility of the pulse oximetry plethysmographic curve to assess macrocirculation and microcirculation monitoring in intensive care patients. ⋯ A growing number of recent clinical studies demonstrated that plethysmographic dynamic indices are useful methods to assess fluid responsiveness. Any alternating signal processing of the raw data curves, however, may be detrimental for this purpose, as significant clinically relevant information could be lost after perpetual adjustment of filtering. Hence, time will tell if the pulse oximetry plethysmographic curve will succeed other methods as a noninvasive approach to monitor haemodynamics of critically ill patients.