Current opinion in critical care
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To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified. ⋯ Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.
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To reiterate the necessity of integrating echocardiography in the management of shocked patients and to propose a step-by-step functional evaluation of hemodynamics proven to optimize hemodynamic monitoring and to adapt the treatment. ⋯ Echocardiography has become a hemodynamic monitoring technique used worldwide. It allows to make a quick and simple diagnosis of typical hemodynamic situations, by means of basic CCE, and also to achieve real functional hemodynamic monitoring, through advanced CCE.
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Postresuscitation myocardial dysfunction (PRMD) is a frequent complication, which worsens the hemodynamic status and can be lethal. Early identification and treatment of this cardiac complication is one of the key therapeutic goals during hospitalization of these patients. ⋯ Reversibility of PRMD justifies an aggressive management strategy, including detection of myocardial ischemia, inotropic support, and in the most severe cases, mechanical circulatory assistance. Hemodynamic dysfunction should not influence the decision to continue treatment because it is often reversible - the neurological status is much more likely to determine the ultimate outcome.
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Curr Opin Crit Care · Jun 2013
ReviewVentilation parameters used to guide cardiopulmonary function during mechanical ventilation.
To describe the newly introduced ventilation parameters that are used at the bedside to estimate cardiopulmonary function during positive pressure ventilation (PPV). ⋯ The utility of lung ultrasound is expanding. Although the clinical implications of FRC measurement and lung monitoring with imaging tools such as EIT are starting to be realized, their efficacy in severe hypoxic respiratory failure should be evaluated further in well designed clinical trials. To improve the preemptive management of impending respiratory failure, an alarm index that integrates noninvasive cardiopulmonary function parameters should be developed.
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Curr Opin Crit Care · Jun 2013
ReviewRegistries to measure and improve outcomes after cardiac arrest.
Cardiac arrest registries are used to measure and improve the process and outcome of resuscitation care, and can give insight into risk factors, prognosis, and the effectiveness of interventions to mitigate its impact. This review provides an overview of current out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) registries, with attention to key recent findings and future directions. ⋯ OHCA and IHCA registries are invaluable in advancing our understanding of resuscitation care, as well as variations in international practice. Investigations that compare and contrast outcomes from established and evolving registries will help advance resuscitation science further.