Current opinion in critical care
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In this review, we discuss the latest updates on perioperative acute kidney injury (AKI) and the specific considerations that are relevant to different surgeries and patient populations. ⋯ Perioperative AKI is prevalent and associated with significant morbidity and mortality. Considering the lack of effective preventive or therapeutic interventions, this review focuses on perioperative AKI: measures for early diagnosis, defining risks and possible mechanisms, and summarizing current knowledge for intraoperative fluid and hemodynamic management to reduce risk of AKI.
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Curr Opin Crit Care · Jun 2016
ReviewAssessment of the effects of inspiratory load on right ventricular function.
The right ventricle (RV) plays a pivotal role during respiratory failure because of its high sensitivity to small loading changes during inspiration. Both RVs, preload and afterload, are altered during inspiration, either in spontaneous breathing or during mechanical ventilation. Some clinical situations especially affect RV load during inspiration, for example acute asthma and acute respiratory distress syndrome. The aim of this review is to explain and to summarize the different mechanisms leading to RV failure in these situations. ⋯ RV is very sensitive to abnormal inspiration, which is always responsible for an increase in its afterload. Pulse pressure variations, central venous pressure and especially echocardiography may monitor RV function in abnormal clinical situations. The pulmonary artery catheter was also proposed although now less used.
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Curr Opin Crit Care · Jun 2016
ReviewIs hypothermia indicated during cardiopulmonary resuscitation and after restoration of spontaneous circulation?
Targeted temperature management (TTM) after cardiac arrest has become a standard therapy in postresuscitation care. However, many questions addressing the optimum treatment protocol remain unanswered. ⋯ To maximize its beneficial potential, TTM should be customized to resuscitation covariates. Despite open questions on the optimum treatment protocol, active cooling should be started as soon as possible and hyperthermic conditions should be prevented in any case. To answer the question if intra-arrest cooling or prehospital cooling induction is indicated, additional studies are needed.
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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.