Current opinion in critical care
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To emphasize the importance and clinical implications of right ventricular function assessment in many situations encountered by intensivists and to explain in practical terms how to perform such an assessment at the bedside. ⋯ Assessment of right ventricular function in the ICU is crucial in many situations because right ventricular failure may be responsible for, or participate in, shock in pulmonary embolism, acute respiratory distress syndrome and septic shock. The best method is echocardiography, which is noninvasive and accurate.
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The pulmonary artery catheter is one of the most scrutinized monitors used in intensive care today. Pulmonary artery catheter use is declining due to limited demonstrated beneficial outcomes and the advancement of less invasive monitoring. This study discusses the current use of the pulmonary artery catheter and problems associated with its use including inaccuracy of measurements and data interpretation, inappropriately applied therapeutic interventions, inappropriate delays in applying interventions, and inappropriate patient selection. ⋯ In summary, the pulmonary artery catheter monitor continues to be used for intensive care patients. To date, no single monitor is associated with an abundance of clear outcome benefits. There are some clinical data showing that the pulmonary artery catheter may still be useful when applied to the right patient population using appropriately timed therapies.
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To describe the principles underlying oesophageal Doppler monitoring of cardiac output, and how invaluable information relating to left ventricular contractility, preload and afterload can be simply derived from the shape of the flow velocity waveform. ⋯ A clear role is emerging for minimally invasive monitoring of blood flow and haemodynamics using oesophageal Doppler. As with any monitoring modality, it has to be incorporated into an appropriate and rational management stratagem. Its safety record, rapid learning curve, reliability and ease of use encourage further application.
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To discuss recent data that may influence defibrillation in clinical practice and improve outcome after cardiac arrest from a shockable rhythm. ⋯ A defibrillation strategy that enables rhythm analysis to recognize ventricular fibrillation, defibrillator charging and optimally timed shock delivery with minimal or no interruptions to chest compressions should improve the chances of shock success. Performance debriefing of rescuers and recognizing that the risk to rescuers during defibrillation has been overstated should also help minimize interruptions to chest compressions for shock delivery.
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The purpose of this study is to review the prevalence and significance of gasping in patients experiencing cardiac arrest. ⋯ Gasping frequently occurs during cardiac arrest. Public and emergency medical dispatchers must be more aware of its presence and significance.