Current opinion in critical care
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Curr Opin Crit Care · Jun 2019
ReviewEchocardiographic assessment of left ventricular diastolic pressure.
Knowledge of the left ventricular pressures throughout the cardiac cycle is of considerable assistance in managing a haemodynamically unstable patient. Invasive pressure measurement is the only accurate way to analyze ventricular diastolic pressures but this is not feasible outside the catheterization laboratory, whereas the use of a pulmonary artery catheter or Doppler echocardiography, using surrogate measurements, is available at the bedside. The ever-increasing trend toward noninvasive monitoring puts echocardiography at the forefront and considerable effort has been made to define its role in this setting. ⋯ The recent literature on the clinical application of echocardiography on the accuracy in determining left ventricular noninvasively demonstrates that although far from perfect, it can be a very useful tool.
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Curr Opin Crit Care · Jun 2019
ReviewTranspulmonary thermodilution techniques in the haemodynamically unstable patient.
Transpulmonary thermodilution (TPTD) devices invasively measure not only cardiac output but also several other haemodynamic variables estimating cardiac preload, cardiac preload, systolic function, the lung oedema and systolic function, the lung oedema and the pulmonary permeability. In light of the recent literature, we describe how different indices are measured, emphasize their clinical interest and list potential limits and side-effects of the technique. ⋯ TPTD provides several indices that may help in making decisions during the therapeutic management of haemodynamically unstable patients. It should be used for the most critically ill patients, whose management requires a reliable, precise and holistic view of the cardiopulmonary condition.
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Curr Opin Crit Care · Jun 2019
ReviewIs microcirculatory assessment ready for regular use in clinical practice?
The present review discusses the current role of microcirculatory assessment in the hemodynamic monitoring of critically ill patients. ⋯ Clinical and biological surrogates of microcirculatory assessment can be used at bedside. The role of microvideoscopic techniques is still hampered by the lack of clearly defined targets as well as interventions specifically targeting the microcirculation.
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Curr Opin Crit Care · Jun 2019
ReviewAssessing brain injury after cardiac arrest, towards a quantitative approach.
Withdrawal of life-sustaining therapy due to a presumed poor neurological prognosis precedes most deaths in patients who have been resuscitated after an out-of-hospital cardiac arrest and are being treated in an ICU. Guidelines to support these critical decisions recommend a multimodal strategy based on advanced diagnostic methods. This review will discuss clinical experience with the 2015 guidelines and recent developments towards more accurate quantification of posthypoxic brain injury. ⋯ The current guidelines for neuroprognostication include a step-by-step multimodal algorithm but many patients will still be left with an uncertain prognosis 4-5 days after cardiac arrest. Novel quantitative methods are a necessary step to a more nuanced prediction of outcome for this group of patients.
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Curr Opin Crit Care · Jun 2019
Cardiac arrest: prediction models in the early phase of hospitalization.
There is a need for an early assessment of outcome in patients with return of spontaneous circulation after cardiac arrest. During the last decade, several models were developed in order to identify predictive factors that may facilitate prognostication and stratification of outcome. ⋯ In addition to the development of artificial intelligence, the prediction approach based on adequate scores will further increase the knowledge in prognostication after cardiac arrest. This strategy may help to develop treatment strategies according to the predicted severity of the outcome.