Current opinion in critical care
-
Drug therapy continues to be recommended as part of cardiac arrest management. There has been increasing transparency about the lack of evidence to support such drug therapy, and the gaps identified in our knowledge have stimulated ongoing research. This review aims to highlight recently published articles that relate to the use of drugs during cardiopulmonary resuscitation (CPR). ⋯ The use of some drugs (e.g. epinephrine) can be recommended in cardiac arrest, but only on the basis of short-term benefits. These short-term benefits need to be converted into long-term outcomes by optimizing management in the postarrest period. Potential drug strategies need to be evaluated in settings in which the drug is administered in a timely fashion, good CPR is provided, and postresuscitation care has been optimized.
-
Curr Opin Crit Care · Jun 2011
ReviewOptimal oxygenation during and after cardiopulmonary resuscitation.
Reversal of tissue hypoxia, particularly in the heart and brain, is a fundamental goal of cardiopulmonary resuscitation. However, a growing body of evidence suggests that hyperoxia, especially after return of spontaneous circulation (ROSC), may worsen outcomes. The purpose of this review is to describe the current evidence supporting the concept of controlled oxygenation during and after cardiac arrest. ⋯ The benefit of supplemental oxygen during cardiopulmonary resuscitation remains uncertain. However, in patients who achieve ROSC after cardiac arrest, available evidence supports adjusting inspired oxygen content to avoid arterial hyperoxemia while providing adequate arterial oxyhemoglobin saturation. This strategy is likely to be most effective when initiated as soon as possible after ROSC and appears to be most important during the first hour. Definitive clinical trials are needed to determine the ultimate impact on outcome.
-
Electrical impedance tomography (EIT) is an attractive method of monitoring patients during mechanical ventilation because it can provide a noninvasive continuous image of pulmonary impedance, which indicates the distribution of ventilation. This article will discuss ongoing research on EIT, with a focus on methodological aspects and limitations and novel approaches in terms of pathophysiology, diagnosis and therapeutic advancements. ⋯ There is growing evidence that supports EIT usage as a bedside measure to individually optimize ventilator settings in critically ill patients in order to prevent ventilator-induced lung injury. A standardization of current approaches to analyse and interpret EIT data is required in order to facilitate the clinical implementation.
-
Hemodynamic monitoring has gained widespread acceptance in intensive care units. Despite ongoing debate regarding its safety and efficacy, monitoring with the pulmonary artery catheter (PAC) remains used for the management of severe heart failure and shock. ⋯ Despite competition with less invasive hemodynamic monitoring devices or ultrasonic methods, the PAC remains a useful monitoring device in situations in which the knowledge of pulmonary artery pressure, pulmonary artery occlusion pressure and oxygenation parameters are needed. The proper use of PAC requires, however, a perfect knowledge of the numerous pitfalls and difficulties in interpretation of its measurements.
-
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.