Current opinion in critical care
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Curr Opin Crit Care · Jun 2018
ReviewExtravascular lung water measurements in acute respiratory distress syndrome: why, how, and when?
Increase in pulmonary vascular permeability accompanied with accumulation of excess extravascular lung water (EVLW) is the hallmark of acute respiratory distress syndrome (ARDS). Currently, EVLW and pulmonary vascular permeability index (PVPI) can be quantitatively measured using the transpulmonary thermodilution (TPTD) technique. We will clarify why, how, and when EVLW and PVPI measurements should be performed. ⋯ EVLW and PVPI measurement will open the door to future ARDS clinical practice and research, and have potential to be included in the future ARDS definition.
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Curr Opin Crit Care · Jun 2018
ReviewPredicting adverse hemodynamic events in critically ill patients.
The art of predicting future hemodynamic instability in the critically ill has rapidly become a science with the advent of advanced analytical processed based on computer-driven machine learning techniques. How these methods have progressed beyond severity scoring systems to interface with decision-support is summarized. ⋯ Using advanced analytic tools to glean knowledge from clinical data streams is rapidly becoming a reality whose clinical impact potential is great.
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Curr Opin Crit Care · Jun 2018
Review Comparative StudyNeuroprognostication postcardiac arrest: translating probabilities to individuals.
Predicting neurological recovery in patients who are comatose after cardiac arrest is an important activity during postarrest care, and this prediction can affect survival. As no early test or clinical finding perfectly predicts potential for recovery, guidelines recommend using data from multiple examinations or tests to estimate patient prognosis. ⋯ Absence of cortical functional recovery over time is detected using multiple testing modalities and remains strongly associated with poor outcome. Early recovery of cortical function increases the probability of good outcome. Concordant assessments from multiple tests increase confidence in prognostication.
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The present review discusses the current role of the pulmonary artery catheter (PAC) in the hemodynamic monitoring of critically ill patients. ⋯ The PAC still has an important role in the cardiopulmonary monitoring of critically ill patients.
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Curr Opin Crit Care · Jun 2018
ReviewAntiarrhythmic drug therapy during cardiopulmonary resuscitation: should we use it?
The optimal antiarrhythmic drug therapy (amiodarone or lidocaine) in the treatment of ventricular fibrillation/pulseless ventricular tachycardia (VF/pVT) cardiac arrest that is refractory to defibrillation is uncertain. This article reviews the evidence for and against these drugs, alternatives treatments for refractory VF/pVT and aims to define the role of antiarrhythmic drugs during cardiopulmonary resuscitation (CPR). ⋯ The benefit of antiarrhythmic drugs appears to be for those patients in whom initial early CPR and defibrillation attempts fail and the antiarrhythmic drug is given early. There does not appear to be any clear survival benefit for any one particular drug and other factors such as availability and cost should be considered when deciding which drug to use. Furthermore, other interventions (e.g. percutaneous coronary intervention and extra-corporeal CPR) may provide additional survival benefit when defibrillation attempts and antiarrhythmic drugs are not effective.