Current opinion in critical care
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Curr Opin Crit Care · Oct 2015
ReviewOxygen extraction and perfusion markers in severe sepsis and septic shock: diagnostic, therapeutic and outcome implications.
The purpose of this study is to review the recent literature examining the clinical utility of markers of systemic oxygen extraction and perfusion in the diagnosis, treatment and prognosis of severe sepsis and septic shock. ⋯ The phenotypic haemodynamic characterization of patients using perfusion markers has diagnostic, therapeutic and outcome implications in severe sepsis and septic shock. However, irrespective of haemodynamic phenotype, the outcome reflects the quality of care provided at the point of presentation. Utilizing these principles may allow more objective interpretation of resuscitation trials and translate these findings into current practice.
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Curr Opin Crit Care · Oct 2015
ReviewFluid bolus therapy: monitoring and predicting fluid responsiveness.
When a condition of hypoperfusion has been identified, clinicians must decide whether fluids may increase blood flow or whether other therapeutic approaches are needed. For this purpose, several tests and parameters have been introduced in clinical practice to predict fluid responsiveness and guide therapy. ⋯ Nowadays, several parameters are available to assess fluid responsiveness. Clinicians need to know all of them, with their limitations, without forgetting that the final aim of all therapies is to improve the microcirculation.
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Appropriate selection and definition of outcome measures are essential for clinical trials to be maximally informative. Core outcome sets (an agreed, standardized collection of outcomes measured and reported in all trials for a specific clinical area) were developed due to established inconsistencies in trial outcome selection. This review discusses the rationale for, and methods of, core outcome set development, as well as current initiatives in critical care. ⋯ Development and utilization of core outcome sets for studies relevant to the critically ill is in its infancy compared to other specialties. Notwithstanding, core outcome set development frameworks and guidelines are available, several sets are in various stages of development, and there is strong support from international investigator-led collaborations including the International Forum for Acute Care Trialists.
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Over recent years the digitalization, collection and storage of vast quantities of data, in combination with advances in data science, has opened up a new era of big data. In this review, we define big data, identify examples of critical care research using big data, discuss the limitations and ethical concerns of using these large datasets and finally consider scope for future research. ⋯ Big data have the potential to improve medical care and reduce costs, both by individualizing medicine, and bringing together multiple sources of data about individual patients. As big data become increasingly mainstream, it will be important to maintain public confidence by safeguarding data security, governance and confidentiality.
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Critical care physicians frequently try to manipulate the preload of the heart to optimize cardiac function. There is, however, still debate as to what actually indicates the preload of the heart. ⋯ When properly measured CVP can be a useful guide to the filling status of the right ventricle. CVP is especially useful when followed over time and combined with a measurement of cardiac output. Importantly, preload is only one of the factors determining cardiac output and it must be integrated into a comprehensive approach that takes into account changes in cardiac function and the return of blood to the heart. Finally, the specific value of preload does not indicate volume responsiveness.