Current opinion in critical care
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To discuss the role of echocardiography for the hemodynamic evaluation of critically ill patients. ⋯ Echocardiography has now become an important tool for hemodynamic evaluation of the critically ill patient. Echocardiography should be performed in most patients with circulatory and respiratory failure.
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Curr Opin Crit Care · Jun 2014
ReviewElectrical impedance tomography imaging of the cardiopulmonary system.
This review article summarizes the recent advances in electrical impedance tomography (EIT) related to cardiopulmonary imaging and monitoring on the background of the 30-year development of this technology. ⋯ EIT is not routinely used in a clinical setting, but the interest in EIT is evident. The major task for EIT research is to provide the clinicians with guidelines how to conduct, analyse and interpret EIT examinations and combine them with other medical techniques so as to meaningfully impact the clinical decision-making.
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Functional haemodynamic monitoring is the assessment of the dynamic interactions of haemodynamic variables in response to a defined perturbation. ⋯ Functional haemodynamic monitoring approaches are increasing in numbers, conditions in which they are useful and resuscitation protocol applications. This is a rapidly evolving field whose pluripotential is just now being realized.
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Curr Opin Crit Care · Jun 2014
ReviewTowards cardiopulmonary resuscitation without vasoactive drugs.
Whereas there is clear evidence for improved survival with cardiopulmonary resuscitation (CPR) and defibrillation during cardiac arrest management, there is today lacking evidence that any of the recommended and used drugs lead to any long-term benefit for the patients. In this review, we try to discuss our current view on why advanced life support (ALS) today can be performed without the use of drugs, and instead gain all focus on improving the tasks we know improve survival: CPR and defibrillation. ⋯ There is currently no evidence to support any specific drugs during cardiac arrest. Good-quality CPR, early defibrillation and goal-directed postresuscitation care is more important. Healthcare systems should not prioritize implementation of unproven drugs before good quality of care can be documented. More drug studies are indeed required, and future research needs to incorporate better diagnostic tools to test more specific and tailored therapies that account for underlying causes and individual responsiveness.
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The prognosis of patients with postanoxic coma (PAC) after cardiac arrest is a challenging task for clinicians. The need for early and accurate prognostic predictors is crucial. Treatment with therapeutic hypothermia and sedation alters the reliability of neurological examination. Considering the extensive literature existing on this topic, we aimed to provide a practical approach on how to predict outcome in patients with PAC, particularly in those treated with therapeutic hypothermia. ⋯ For reliable prediction of outcome in patients with PAC, various prognostic methods should be combined with the standard neurological examination in a multimodal approach.