Current opinion in critical care
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Curr Opin Crit Care · Jun 2018
Review Comparative StudyIn-hospital cardiac arrest: are we overlooking a key distinction?
To review the epidemiology, peri-arrest management, and research priorities related to in-hospital cardiac arrest (IHCA) and explore key distinctions between IHCA and out-of-hospital cardiac arrest (OHCA) as they pertain to the clinician and resuscitation scientist. ⋯ IHCA is a unique disease entity with an epidemiology and natural history that are distinct from OHCA. In both research and clinical practice, physicians should recognize these distinctions so as to advance the care of IHCA victims.
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Cardiac arrest mortality remains high, and the impact on outcome of most advanced life support interventions is unclear. The optimal method for managing the airway during cardiac arrest remains unknown. This review will summarize and critique recently published evidence comparing basic airway management with the use of more advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation]. ⋯ Most of the available evidence about airway management during cardiac arrest comes from observational studies. The best option for airway management is likely to be different for different rescuers, and at different time points of the resuscitation process. Thus, it is common for a single patient to receive multiple 'stepwise' airway interventions. The only reliable way to determine the optimal airway management strategy is to undertake properly designed, prospective, randomized trials. One randomized clinical trial has been published recently and two others have completed enrollment but have yet to be published.
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The current review attempts to demonstrate the value of several forms of carbon dioxide (CO2) gaps in resuscitation of the critically ill patient as monitor for the adequacy of the circulation, as target for fluid resuscitation and also as predictor for outcome. ⋯ CO2 gap is a sensitive marker of tissue hypoperfusion, with added value over traditional markers of tissue hypoxia in situations in which an oxygen diffusion barrier exists such as in tissue oedema and impaired microcirculation. Venous-to-arterial cCO2 or partial pressure gaps can be used to evaluate whether attempts to increase CO should be made. Considering the potential of the several forms of CO2 measurements and its ease of use via point-of-care analysers, it is recommendable to implement CO2 gaps in standard clinical practice.
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Curr Opin Crit Care · Jun 2018
ReviewPhysiology-directed cardiopulmonary resuscitation: advances in precision monitoring during cardiac arrest.
We review the recent advances in physiologic monitoring during cardiac arrest and offer an evidence-based framework for prioritizing physiologic targets during cardiopulmonary resuscitation (CPR). ⋯ Physiologic monitoring can and should be used to deliver precision CPR whenever possible and may improve outcomes after cardiac arrest.
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Curr Opin Crit Care · Jun 2018
Review Comparative StudyCardiac output monitoring: how to choose the optimal method for the individual patient.
To review the different methods available for the assessment of cardiac output (CO) and describe their specific indications in intensive care and perioperative medicine. ⋯ Various invasive, minimally invasive, and noninvasive methods to assess CO are available. A profound understanding of the different CO monitoring methods is key to define indications for CO monitoring in the individual critically ill or surgical patient.