Current opinion in critical care
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Curr Opin Crit Care · Oct 2015
ReviewArterial blood pressure and heart rate regulation in shock state.
Circulatory shock is a complicated problem that carries a high risk of complications and mortality for critically ill patients. The heart rate and blood pressure targets to which a patient in shock should be resuscitated remain a challenge to intensivists. ⋯ The ideal target blood pressure in the resuscitation of circulatory shock is variable and likely depends on prior blood pressure. Heart rate regulation with β-blockade appears to be safe in selected patients when accompanied by adequate resuscitation and monitoring.
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Curr Opin Crit Care · Oct 2015
ReviewDescribing and measuring recovery and rehabilitation after critical illness.
Rehabilitation is the cornerstone of management of postcritical illness morbidity. Selection of appropriate tools to measure response to rehabilitation therapy is vital to accurately document trajectory of change across the recovery continuum. In the context of physical-based strategies to redress critical illness associated muscle wasting and dysfunction, this review will discuss a framework to guide assessment of physical recovery in the critical illness population, clinimetric measurement properties for instruments and evidence for their implementation, and recent interventional trial data. ⋯ Determining the future design, conduct and impact of physical therapy interventions for critically ill patients will rely on further development of clinimetrically robust metrics to capture individual patient response spanning the recovery pathway. This approach should be similarly applied to rehabilitation interventions addressing other postintensive care syndrome domains.
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Curr Opin Crit Care · Oct 2015
ReviewMonitoring: from cardiac output monitoring to echocardiography.
Hemodynamic exploration is mandatory in patients with shock to identify the type of shock, to select the best therapeutic strategy, and to assess the efficacy of the selected therapy. In this review, we summarize the characteristics of the main available hemodynamic monitoring systems and emphasize on how to select the most appropriate ones in patients with circulatory shock. ⋯ The use of echocardiography should be encouraged at the initial period of shock to identify main involved mechanisms and to select the appropriate therapy. The use of more invasive monitoring systems should be discussed on an individualized basis.
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This review appraises recent evidence and provides clinical guidance on optimal perioperative fluid therapy. ⋯ Balanced crystalloids are the fluid of choice for perioperative resuscitation and optimization in patients not requiring blood products. Avoidance of a grossly positive sodium and water balance during the maintenance phase is likely to be important, but has not been assessed in randomized trials.