Current opinion in critical care
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Curr Opin Crit Care · Jun 2014
ReviewShould we perform a coronary angiography in all cardiac arrest survivors?
Percutaneous coronary revascularization is the cornerstone treatment of acute coronary syndromes. Out-of-hospital cardiac arrest (OHCA) is in most cases related to a culprit coronary occlusion and should be treated as soon as possible. ⋯ Systematic percutaneous coronary intervention after no obvious noncardiac cause of OHCA appears to be the most secure and the best adapted in these patients.
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Despite decades of advances in prehospital and in-hospital medical care, patients with out-of-hospital cardiac arrest continue to have poor neurologic and cardiac function following otherwise successful resuscitation. This review examines the mechanisms and therapeutic strategies currently under development to activate the post-conditioning pathways and thereby improve survival and function. ⋯ Detailed knowledge of the RISK and SAFE pathways can be used for further drug development. Human studies are now underway to test some of these strategies, but further clinical trials are necessary to translate these therapies to clinical practice.
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Curr Opin Crit Care · Jun 2014
ReviewCurrent tools for assessing heart function and perfusion adequacy.
Many devices are currently available for measuring cardiac output and function. Understanding the utility of these devices requires an understanding of the determinants of cardiac output and cardiac function, and the use of these parameters in the management of critically ill patients. This review stresses the meaning of the physiological measures that are obtained with these devices and how these values can be used. ⋯ Evaluation of cardiac function is useful when first dealing with an unstable patient, but for ongoing management measurement of cardiac output itself is key and even more so the trend in relationship to the patient's overall condition. This evaluation would be greatly benefited by the addition of objective measures of tissue perfusion.
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To discuss the role of measuring functional residual capacity (FRC) during mechanical ventilation to improve patient ventilator settings in order to prevent ventilator-induced lung injury. ⋯ In conclusion, measuring FRC could be extremely valuable during mechanical ventilation, but clinical studies are needed to prove whether this technique will improve outcome.
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Lung ultrasound, which allows a bedside visualization of the lungs, is increasingly used in critical care. This review aims at highlighting a simple approach to this new discipline. ⋯ http://links.lww.com/COCC/A8.