Current opinion in critical care
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The fluid challenge is used in the fluid management of many sick patients. The principle behind the fluid challenge technique is that by giving a small amount of fluid in a short period of time, the clinician can assess whether the patient has a preload reserve that can be used to increase the stroke volume with further fluids. The key components of a fluid challenge are described. ⋯ A fluid challenge identifies and simultaneously treats volume depletion, whilst avoiding deleterious consequences of fluid overload through its small volume and targeted administration.
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Summary estimates indicate that bystander cardiopulmonary resuscitation (CPR) can improve the chances of out-of-hospital cardiac arrest survival two-fold to three-fold. And yet, only a minority of arrest victims receive bystander CPR. This summary will review the challenges and approaches to achieve early and effective bystander CPR. ⋯ Recent developments in bystander CPR have simplified arrest recognition and improved CPR training, while retaining CPR effectiveness. The goal of these developments is to increase and improve bystander CPR and in turn improve resuscitation.
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Curr Opin Crit Care · Jun 2011
ReviewTherapeutic hypothermia after cardiac arrest: where are we now?
Therapeutic hypothermia is widely recommended after cardiac arrest. In this review, we present publications reflecting the current discussion and opinions related to use of therapeutic hypothermia in comatose adult cardiac arrest survivors. ⋯ Although only proven beneficial for patients with ventricular fibrillation, the majority of centres today use therapeutic hypothermia also for comatose survivors with other initial rhythms. Some controversies still exist; the optimal target temperature, timing and duration of cooling have not yet been defined, and some researchers still think that the concept of therapeutic hypothermia is not satisfactorily proven scientifically. A new randomized study comparing temperature management to 36°C with 33°C is therefore underway.
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Curr Opin Crit Care · Jun 2011
ReviewDelivering high-quality cardiopulmonary resuscitation in-hospital.
This review discusses recent data relating to delivering high-quality cardiopulmonary resuscitation (CPR) to patients with in-hospital cardiac arrest. ⋯ Delivering high-quality CPR in-hospital requires a multifaceted approach. Collecting data during arrests and feeding back in real time and postevent during debriefings can be used to improve delivery of high-quality CPR. There are few studies that show improvement in actual patient outcomes (e.g., survival to hospital discharge) with improvements in delivery of high-quality CPR. Recognizing the importance of both technical and nontechnical skills (human factors) to deliver high-quality CPR is essential.
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Therapeutic hypothermia and aggressive management of postresuscitation disease considerably improved outcome after adult cardiac arrest over the past decade. However, therapeutic hypothermia alters prognostic accuracy. Parameters for outcome prediction, validated by the American Academy of Neurology before the introduction of therapeutic hypothermia, need further update. ⋯ Awakening from postanoxic coma is increasingly observed, despite early absence of motor signs and frank elevation of serum markers of brain injury. A new multimodal approach to prognostication is therefore required, which may particularly improve early prediction of favorable clinical evolution after cardiac arrest.