Current opinion in critical care
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Tissue hypoperfusion is a common pathophysiologic process leading to multiple-organ dysfunction and death. An important goal of hemodynamic monitoring is the early detection of inadequate tissue perfusion and oxygenation. The use of simple, noninvasive monitoring techniques has the advantage of facilitating earlier initiation of therapy. Near-infrared spectroscopy has emerged in recent years as a tool for monitoring peripheral oxygenation (StO2) in various tissues, including muscle. Here, we review our current knowledge about the applicability, usefulness, and limitations of near-infrared spectroscopy as a technique to evaluate muscle oxygenation in acutely ill patients. ⋯ Near-infrared spectroscopy provides a noninvasive measure of muscle oxygen metabolism and microvascular dysfunction in critically ill patients. It may be useful to guide the management of critically ill patients.
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Curr Opin Crit Care · Jun 2008
ReviewImproving cardiopulmonary resuscitation quality to ensure survival.
There is correlation between quality of bystander cardiopulmonary resuscitation and patient survival. Recent developments in defibrillator technology enable recording of cardiopulmonary resuscitation quality, and have shown quality of professional cardiopulmonary resuscitation far from guidelines' levels for factors such as chest compression depth and rate, ventilation rate, and pauses in chest compressions. The effects of cardiopulmonary resuscitation quality factors on patient survival are presently under scrutiny. ⋯ Cardiopulmonary resuscitation quality affects survival after cardiac arrest. Reporting cardiopulmonary resuscitation quality data should be standard in all studies of cardiac arrest as effects of studied interventions can depend on or influence cardiopulmonary resuscitation quality. These data are also valuable in quality improvement processes both in-hospital and out-of-hospital.
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To summarize current opinion and advances in pediatric cardiopulmonary resuscitation, including etiology, pathophysiology, rationale for interventions, and postresuscitation management. ⋯ Recent advances in our understanding of the etiology, pathophysiology, and therapies tied to the timing, phase, and duration of cardiac arrest can improve outcomes for children. New epidemiological data and multicenter studies are ushering in the era of evidence-based pediatric resuscitation therapeutics.
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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
ReviewDeveloping alternative strategies for the treatment of traumatic haemorrhagic shock.
The optimal strategy of stabilizing haemodynamic function in uncontrolled traumatic haemorrhagic shock states is unclear. Although fluid replacement is established in controlled haemorrhagic shock, its use in uncontrolled haemorrhagic shock is controversial, because it may worsen bleeding. ⋯ A multicenter, randomized, controlled, international clinical trial is being initiated to assess the effects of arginine vasopressin (10 IU) vs. saline placebo in prehospital traumatic haemorrhagic shock patients, not responding to standard shock treatment, being managed by helicopter emergency medical services [vasopressin in traumatic haemorrhagic shock (VITRIS.at) study].