Current opinion in critical care
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Curr Opin Crit Care · Jun 2015
ReviewThe accuracy of noninvasive cardiac output and pressure measurements with finger cuff: a concise review.
The present review aims to summarize literature on the accuracy of the finger cuff method to measure cardiac output (CO) and blood pressure, its ability to track hemodynamic changes, and to predict fluid responsiveness. ⋯ The finger cuff method provides a reasonable estimate of CO and blood pressure, which does not meet the criteria for clinical interchangeability with the currently used invasive devices.
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Curr Opin Crit Care · Jun 2015
ReviewMechanical devices for chest compression: to use or not to use?
The delivery of high-quality manual chest compressions is rarely achieved in practice. Mechanical chest compression devices can consistently deliver high-quality chest compressions. The recent publication of large prehospital trials of these devices provides important new information about the role of these devices. ⋯ Mechanical cardiopulmonary resuscitation (CPR) results in similar survival rates to manual CPR in out of hospital cardiac arrest. There are insufficient data to support or refute the routine use of mechanical CPR devices during in-hospital cardiac arrest. Observational studies demonstrate the feasibility of using mechanical CPR when manual CPR is difficult or impossible, and as a bridge to advanced therapies.
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Microcirculatory shock is a condition defined by the presence of tissue hypoperfusion despite the normalization of systemic and regional blood flow. In this article, we discuss the characteristics of the microcirculation in septic shock, the main form of microcirculatory shock, along with its interaction with systemic hemodynamics, and the response to different therapies. ⋯ The optimal treatment of microcirculatory shock might require monitoring and therapeutic goals targeted on the microcirculation, more than in systemic variables. The clinical benefits of this approach should be demonstrated in clinical trials.
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Monitoring of the peripheral circulation can be done noninvasively in contrast to the more traditional invasive systemic haemodynamic monitoring in the intensive care unit. Physical examination of peripheral circulation based on clinical assessment has been well emphasized for its convenience, accessibility, and relation to the prognosis of patients with circulatory shock. The purpose of this article is to highlight the main findings according to recent literature into the clinical applications of the peripheral perfusion assessment in patient management. ⋯ The feasibility and reproducibility of the clinical assessment of peripheral circulation are substantial, and reliance on capillary refill time, skin temperature, and mottling score must be emphasized and exploited. Incorporating therapeutic strategies into resuscitation protocols that aim at normalizing these peripheral circulation parameters are being developed to investigate the impact of peripheral perfusion-targeted resuscitation in the survival of critically ill patients.
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Curr Opin Crit Care · Jun 2015
ReviewContinuous noninvasive hemoglobin monitoring: ready for prime time?
Determination of hemoglobin (Hb) concentration is essential for the detection of anemia and hemorrhage and is widely used to evaluate a patient for a possible blood transfusion. Although commonly accepted as intrinsic to the process, traditional laboratory measurements of Hb are invasive, intermittent, and time-consuming. Noninvasive Hb (NIHb)-monitoring devices have recently become available and promise the potential for detecting sudden changes in a patient's Hb level. In addition to reduced delays in clinical intervention, these devices also allow for a reduction in patient discomfort, infection risk, required personnel, and long-term costs. Unfortunately, it has been shown that many clinical factors can influence their accuracy. ⋯ NIHb measurements may currently be considered to be a supplemental tool for monitoring trends in Hb concentration, but are not currently developed enough to replace an invasive approach. Moreover, further studies are still required before implementing NIHb in the clinical decision-making process. Specifically, no studies have demonstrated that this technology improves clinical outcomes or patient safety.