Current opinion in critical care
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To summarize recent advances in pediatric cardiopulmonary arrest prevention, resuscitation and postresuscitation management. ⋯ Pediatric cardiac arrest is not a futile condition; many children are successfully resuscitated each year. The implementation of new prearrest, intraarrest and postresuscitative therapies has the potential to further improve survival rates following pediatric cardiac arrest.
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The present review discusses the evolution of the microcirculation from a theoretical idea to a clinical concept, as a result of the introduction of direct in-vivo observation techniques. ⋯ Direct in-vivo observation of the microcirculation has enabled the construction of microcirculatory failure as a clinical concept in the critically ill. Aiming for promicrocirculatory recruitment strategies in order to improve outcome will be the challenge for the near future.
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Echocardiography has become more widely available to noncardiologists because of the technological advances in smaller, multipurpose ultrasound units with basic cardiac capabilities. In this review, we discuss the type of clinical information a trained intensivist can hope to obtain from bedside echocardiography and suggest the ways in which this complements traditional hemodynamic monitoring. ⋯ Intensivists can safely and accurately perform goal-oriented echocardiography. Although not yet proven to influence clinical outcome, we suggest that the major utility of echocardiography is for those with distributive or mixed shock in whom target central venous pressure has been achieved without evidence of adequate tissue perfusion. In this subset of patients, echocardiography can aid in selecting those most likely to benefit from further fluid or inotropic support.
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Conventional cardiopulmonary resuscitation (CPR) by bystanders with chest compressions and mouth-to-mouth ventilation has been documented to save life. Nevertheless, despite four decades of promulgation, it is a serious problem that the majority of bystanders are unwilling or unable to perform conventional CPR. I review the efficacy of chest compression-only cardiocerebral resuscitation (CCR) for all adult patients with out-of-hospital cardiac arrest. ⋯ To save more lives, I hope that compression-only CCR by citizen is generally, known, recommended, and taught to the public, because chest compression-only CCR by citizen is the preferable approach to basic life support for adult victims with out-of-hospital cardiac arrest.
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Curr Opin Crit Care · Jun 2009
ReviewVentilation during resuscitation efforts for out-of-hospital primary cardiac arrest.
To discuss recent findings surrounding the role of ventilation during cardiopulmonary resuscitation for individuals with out-of-hospital primary cardiac arrest. ⋯ Assisted ventilation during the initial provision of cardiopulmonary resuscitation is less important than previously believed. It is hypothesized that, by training prehospital medical providers to utilize passive oxygen insufflation for individuals with primary cardiac arrest, critical organ perfusion will increase and, therefore, survival after out-of-hospital cardiac arrest will improve.