Current opinion in critical care
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The aim of this review is to update and discuss the use of mechanical chest compression devices in treatment of cardiac arrest. ⋯ Mechanical chest compression devices have been developed to better deliver uninterrupted chest compressions of good quality. Prospective large randomized studies have not been able to prove a better outcome compared to manual chest compressions; however, latest guidelines support their use when high-quality manual chest compressions cannot be delivered. Mechanical chest compressions can also be preferred during transportation, in the cath-lab and as a bridge to more invasive support like extracorporeal membrane oxygenation.
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Curr Opin Crit Care · Jun 2016
ReviewNear-infrared spectroscopy during cardiopulmonary resuscitation and after restoration of spontaneous circulation: a valid technology?
This article explores the status of using near-infrared spectroscopy and reporting cerebral oximetry (rSO2) for cardiac arrest patients. ⋯ Near-infrared spectroscopy and rSO2 have been used as a monitor during CPR, detection of ROSC, after ROSC, and during post-resuscitation care. Prospective, controlled, randomized clinical studies are needed to document their wide use.
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This article summarizes current knowledge of the causes and consequences of interruption of chest compressions during cardiopulmonary resuscitation. ⋯ It is important to avoid any unnecessary pause in chest compressions before and after a defibrillation shock. Pauses should be kept to an absolute minimum, preferably to less than 10 s.
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Curr Opin Crit Care · Jun 2016
ReviewFlow-directed vs. goal-directed strategy for management of hemodynamics.
For the past 15 years, there has been a strong push to use goal-directed protocols for resuscitating critically ill patients and to manage perioperative patients. However, recent large clinical trials have failed to find evidence of improved outcome with this approach. ⋯ A clinical approach that uses monitored values such as cardiac output as a feedback tool to evaluate the response to therapeutic interventions in individual patients may be better than protocols that set fixed targets for all study participants.
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This article describes and discusses the importance of monitoring patient-ventilator asynchrony, and the advantages and limitations of the specific techniques available at the bedside to evaluate it. ⋯ The prevalence and consequences of asynchronies may be largely underestimated because of a frequent lack of monitoring. Dedicated software solutions that continuously and automatically detect asynchronies may allow both clinical research and clinical applications aimed at determining the effects of asynchronies and minimizing their incidence among critically ill patients.