Current opinion in critical care
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Curr Opin Crit Care · Jun 2008
ReviewIntraabdominal pressure monitoring during fluid resuscitation.
Elevated intraabdominal pressure is commonly encountered in the critically ill, has detrimental effects on all organ systems, and is associated with significant morbidity and mortality. Serial intraabdominal pressure measurements are essential to the diagnosis, management, and fluid resuscitation of patients who develop intraabdominal hypertension and/or abdominal compartment syndrome. ⋯ Serial intraabdominal pressure measurements are essential for the diagnosis and management of intraabdominal hypertension/abdominal compartment syndrome. Intraabdominal pressure must be measured accurately and utilized in a goal-directed fashion to guide fluid and end-organ resuscitation. As a result of its ability to predict survival among the critically ill, intraabdominal pressure should be routinely monitored in the patient who demonstrates risk factors for intraabdominal hypertension/abdominal compartment syndrome.
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To briefly review recent advances in the noninvasive assessment of arterial pressure (indirect methods) in the field of critical care. ⋯ Intraarterial blood pressure must be preferred over noninvasive blood pressure recordings when critical decisions are required. In hemodynamically stable patients, valuable information may be obtained by using noninvasive techniques, amongst which arterial tonometry seems especially promising.
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Curr Opin Crit Care · Jun 2008
ReviewDetection of acute heart failure in chronic obstructive pulmonary disease patients: role of B-type natriuretic peptide.
Unrecognized chronic heart failure is present in 21-30% of chronic obstructive pulmonary disease patients. It may be a precipitating factor for acute exacerbation of chronic obstructive pulmonary disease or may hinder weaning from mechanical ventilation. The aim of the review is to emphasize recent studies that validated measurements of plasma B-type natriuretic peptide in the diagnosis of heart dysfunction in chronic obstructive pulmonary disease patients. ⋯ Recent evidence suggests that natriuretic peptide measurements are accurate in the diagnosis of coexisting left heart failure in chronic obstructive pulmonary disease patients, either in stable condition or during severe cardiopulmonary interactions occurring during acute exacerbation of chronic obstructive pulmonary disease, or evoking weaning difficulties related to left heart dysfunction.
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Curr Opin Crit Care · Jun 2008
ReviewThrombolysis and other drugs during cardiopulmonary resuscitation.
No specific drug therapy has been shown to improve long-term survival after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This study reviews recent studies on drugs during cardiopulmonary resuscitation. ⋯ Epinephrine is the vasopressor of first choice for routine use during cardiopulmonary resuscitation. Arginine vasopressin may be considered in patients presenting with asystole or who are unresponsive to initial treatment with epinephrine. Amiodarone should be used in shock-refractory ventricular fibrillation. Although not recommended for routine use, thrombolytic therapy during cardiopulmonary resuscitation may be considered in patients with suspected pulmonary embolism or after unsuccessful conventional cardiopulmonary resuscitation in patients with a presumably thrombotic cause of cardiac arrest.
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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.