Current opinion in critical care
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Curr Opin Crit Care · Jun 2008
ReviewPrevention and therapy of postresuscitation neurologic dysfunction.
The majority of cardiac arrest patients die after successful resuscitation. Despite disappointing survival rates, cardiac arrest research mainly focuses on new therapies applied during cardiac arrest in the out-of-hospital setting, but only little attention is given to therapies mitigating the so-called postresuscitation syndrome. Optimized postresuscitation hospital care might have the potential to substantially improve survival rate in patients after cardiac arrest. ⋯ Therapeutic mild hypothermia (32-34 degrees C) is currently the most advanced medical concept to prevent or mitigate the postresuscitation syndrome. Large prospective randomized clinical trials are needed to investigate normoventilation with blood gases within physiologic range, moderately elevated blood glucose levels, a mean arterial pressure above 80 mmHg, and early reperfusion therapy in all cardiac arrest patients.
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Curr Opin Crit Care · Jun 2008
ReviewMonitoring of endothelial dysfunction in critically ill patients: the role of endothelial progenitor cells.
This review provides an overview of sepsis as a prototypical critical illness and discusses the role of the endothelium in the pathophysiology of sepsis and sepsis-related organ dysfunction, the characterization and functions of endothelial progenitor cells, and investigates these cells both as a prognostic and therapeutic strategy in critically ill patients. ⋯ Circulating endothelial progenitor cells may be an important mechanism of vascular repair, and thus shows significant promise for prognostic and therapeutic strategies in critical illness, namely sepsis and sepsis-related organ dysfunction.
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To review the current status of the use of automated external defibrillators by lay persons, a concept known as public access defibrillation. ⋯ Public access defibrillation can save lives but further studies are required to define the optimal placement and use of automated external defibrillators in communities and the training of the personnel who use them.
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Curr Opin Crit Care · Jun 2008
ReviewUrgent invasive coronary strategy in patients with sudden cardiac arrest.
To review the evidence on urgent coronary angiography and percutaneous coronary intervention after resuscitated cardiac arrest and during ongoing cardiocerebral resuscitation. ⋯ Urgent coronary angiography and percutaneous coronary intervention should be attempted in conscious patients after reestablishment of spontaneous circulation similarly as in patients with acute coronary syndromes without preceding cardiac arrest. In comatose survivors, urgent coronary strategy is reasonable if acute ischemic cause is suspected and if there is realistic hope for neurological recovery that should be facilitated with mild induced hypothermia. Urgent coronary invasive strategy may be successful also during ongoing resuscitation in selected patients without advanced heart diseases and significant comorbidities.