Current opinion in critical care
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Curr Opin Crit Care · Jun 2015
ReviewContinuous noninvasive hemoglobin monitoring: ready for prime time?
Determination of hemoglobin (Hb) concentration is essential for the detection of anemia and hemorrhage and is widely used to evaluate a patient for a possible blood transfusion. Although commonly accepted as intrinsic to the process, traditional laboratory measurements of Hb are invasive, intermittent, and time-consuming. Noninvasive Hb (NIHb)-monitoring devices have recently become available and promise the potential for detecting sudden changes in a patient's Hb level. In addition to reduced delays in clinical intervention, these devices also allow for a reduction in patient discomfort, infection risk, required personnel, and long-term costs. Unfortunately, it has been shown that many clinical factors can influence their accuracy. ⋯ NIHb measurements may currently be considered to be a supplemental tool for monitoring trends in Hb concentration, but are not currently developed enough to replace an invasive approach. Moreover, further studies are still required before implementing NIHb in the clinical decision-making process. Specifically, no studies have demonstrated that this technology improves clinical outcomes or patient safety.
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Curr Opin Crit Care · Jun 2015
ReviewLung volume assessment in acute respiratory distress syndrome.
Measurements of lung volumes allow evaluating the pathophysiogical severity of acute respiratory distress syndrome (ARDS) in terms of the degree of reduction in aerated lung volume, calculating strain, quantifying recruitment and/or hyperinflation, and gas volume distribution. We summarize the current techniques for lung volume assessment selected according to their possible usage in the ICU and discuss the recent findings obtained with implementation of these techniques in patients with ARDS. ⋯ Although lung volume measurements are still limited to research area of ARDS, recent progress in technology provides clinicians more opportunities to evaluate lung volumes noninvasively at the bedside and may facilitate individualization of ventilator settings based on the specific physiological understandings of a given patient.
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Curr Opin Crit Care · Jun 2015
'Kids save lives': why schoolchildren should train in cardiopulmonary resuscitation.
Quick initiation of basic life support (BLS) by laypersons is one of the most successful strategies in the fight against sudden cardiac death. In developed countries, cardiac arrest is still a major contributor to avoidable death, and despite the fact that more than 50% of all cardiac arrests are witnessed, layperson BLS is performed in less than 20%. To improve this situation, BLS training in schools has been established. ⋯ Resuscitation training in schools can help to increase the amount of BLS-trained population. Social skills of pupils can be improved and training can be successfully implemented independently of the pupils' age and physique.
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Most of our blood volume is contained in the venous compartment. The so-called 'compliant veins' are an adjustable blood reservoir, which is playing a paramount role in maintaining haemodynamic stability. The purpose of this study is to review what is known about this blood reservoir and how we can use this information to assess the cardiovascular state of critically ill patients. ⋯ The Pmsf along with other haemodynamic variables can provide valuable information to correctly understand the cardiovascular status of critically ill patients and better manage the fluid therapy and cardiovascular support. Future studies using the Pmsf will show its usefulness for fluid administration.
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This article evaluates the latest scientific evidence regarding airway management during in-hospital and out-of-hospital cardiopulmonary resuscitation (CPR). ⋯ Recent studies of airway management during CPR rely mostly on registry and observational designs. Prospective randomized trials are needed to determine the optimal approach to airway management during cardiac arrest, but have not yet been completed.