Current opinion in critical care
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To review recent evidence concerning the interactions between hemodynamic and perfusion parameters during septic shock resuscitation, and to propose some basic foundations for a more comprehensive perfusion assessment. ⋯ All individual perfusion parameters have extensive limitations to adequately reflect tissue perfusion during persistent sepsis-related circulatory dysfunction. A multimodal approach integrating macrohemodynamic, metabolic, peripheral and eventually microcirculatory perfusion parameters may overcome those limitations. This approach may also provide a thorough understanding on the predominant driving forces of hypoperfusion, and lead to physiologically oriented interventions.
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To survey the recent medical literature examining studies of the hemodynamic effects of mechanical ventilation. ⋯ PPV and SVV predict volume responsiveness, but like all monitoring approaches, need to be understood within the framework of their physiologic determinations.
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Artificial ventilation is one of the best known resuscitation procedures. It is generally accepted that there must be oxygen delivery to vital organs during cardiac arrest and resuscitation in order to prevent irreversible damage, but there is an increasing number of ventilation concepts for resuscitation. Traditional and alternative methods of ventilation are reviewed. ⋯ Positive-pressure ventilation with pure oxygen remains, in clinical practice, the gold standard in ALS. Further research should focus on the role of passive oxygenation during early ALS. The concentration of oxygen needed during resuscitation has to be defined and alternative ventilation patterns, regarding the impact of CPR, should be investigated.
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The 2010 Cardiopulmonary Resuscitation (CPR) Guidelines recommended therapeutic hypothermia for postcardiac arrest syndrome as a beneficial and effective treatment. However, the optimal temperature, method, onset, duration and rewarming rate, and therapeutic window remain unknown. ⋯ One of the most significant advances in CPR treatment in the past decade is therapeutic hypothermia. Although post-ROSC cooling has been shown to improve neurological outcome for patients with out-of-hospital cardiac arrest, intra-arrest cooling during CPR is likely to protect the myocardium from reperfusion injury and enhance neurological benefits.