Current opinion in critical care
-
Curr Opin Crit Care · Jun 2012
ReviewDispatch-assisted cardiopulmonary resuscitation: the anchor link in the chain of survival.
Early bystander cardiopulmonary resuscitation (CPR) provides a vital bridge after collapse from cardiac arrest until defibrillation can be performed. However, due to multiple barriers and despite large-scale public CPR training, this life-saving therapy is still not rendered in a majority of cardiac arrest events. As a result, cardiac arrest survival remains very low in most communities. ⋯ This review focuses on the rationale and evolving science behind dispatch CPR instructions, as well as some best practices for implementing and measuring dispatch-assisted CPR with the goal of maximizing its potential to save lives from sudden cardiac arrest.
-
The role of cardiac arrest centers, more recently termed Cardiac Receiving Centers, in improving outcomes after successful resuscitation is becoming more and more convincing. But which of all the treatments provided by Cardiac Receiving Centers are most beneficial is less certain. This review examines the role of early coronary angiography and percutaneous coronary intervention in this regard. ⋯ Emergent coronary angiography and percutaneous coronary intervention are the most important Cardiac Receiving Center treatments beyond hypothermia. Providing both of these essential postresuscitation therapies is the very purpose of such centers.
-
An early quantitative resuscitation strategy improves outcome in critically ill patients. The hemodynamic endpoints of such a strategy have been a topic of debate in the literature. This review focuses on the use of lactate as a marker for risk stratification, lactate clearance as a hemodynamic endpoint, and its use compared to mixed venous oxygenation as a resuscitation goal. ⋯ Resuscitation of the critically ill patient should be aimed at the reversal of tissue hypoxia. The use of lactate as a hemodynamic marker and resuscitation endpoint makes physiologic sense, and is supported by the recent data. The use of lactate clearance versus other traditional endpoints of resuscitation, such as mixed venous oxygen saturation, should be based on the clinical characteristics and response of the individual patient.
-
Curr Opin Crit Care · Jun 2012
ReviewProtocol C: a nonguidelines-compliant approach to improve survival of patients with out-of-hospital cardiac arrest.
To describe a resuscitation protocol for out-of-hospital cardiac arrest designed for healthcare professionals that demands more from rescuers than does conventional cardiopulmonary resuscitation. It was introduced with the aim of improving survival that has remained disappointingly poor worldwide. ⋯ Uniform resuscitation protocols for lay and for professional use may not be appropriate. Only randomized trials can indicate the potential value of this challenge to conventional wisdom.
-
Curr Opin Crit Care · Jun 2012
ReviewLung monitoring at the bedside in mechanically ventilated patients.
It has become clear that mechanical ventilation itself can cause damage to the lung in critically ill patients, also known as ventilator-induced lung injury (VILI). Insight into the mechanisms of VILI has learned that a compromise must be found between positive end-expiratory pressure (PEEP) induced alveolar recruitment and prevention of hyperinflation. Therefore, there is a need for clinicians to optimize the PEEP settings for the individual patient at the bedside. In this review, we will discuss several lung-monitoring techniques to improve patient ventilator settings. ⋯ In conclusion, both FRC and EIT are promising clinical monitoring systems but clinical studies are needed to prove whether these monitors help the clinician toward effective and better ventilator management.