Current opinion in critical care
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To discuss the role of measuring functional residual capacity (FRC) during mechanical ventilation to improve patient ventilator settings in order to prevent ventilator-induced lung injury. ⋯ In conclusion, measuring FRC could be extremely valuable during mechanical ventilation, but clinical studies are needed to prove whether this technique will improve outcome.
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Lung ultrasound, which allows a bedside visualization of the lungs, is increasingly used in critical care. This review aims at highlighting a simple approach to this new discipline. ⋯ http://links.lww.com/COCC/A8.
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Curr Opin Crit Care · Jun 2014
ReviewThe impact of oxygen and carbon dioxide management on outcome after cardiac arrest.
To describe the impact of oxygen and carbon dioxide management on patient outcomes following cardiac arrest. ⋯ Current data for oxygen and carbon dioxide management following resuscitation suggest that hyperoxia and hypocapnia may be injurious and should be avoided, and that mild hypercapnia may increase the likelihood of discharge home amongst survivors. Such data should be viewed as hypothesis generating. Randomized controlled trials have commenced to clarify the safety, feasibility and efficacy of targeting different oxygen and carbon dioxide tensions following cardiac arrest.
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The ultimate purpose of fluid administration in states of hypovolemia is to correct cardiac output to improve microcirculatory perfusion and tissue oxygenation. Observation of the microcirculation using handheld microscopes gives insight into the nature of convective and diffusive defect in hypovolemia. The purpose of this article is to introduce a new platform for hemodynamic-targeted fluid therapy based on the correction of tissue and microcirculatory perfusion assumed to be at risk during hypovolemia. ⋯ We hypothesized that the optimal amount of fluid needed for correction of hypovolemia is defined by a physiologically based functional microcirculatory hemodynamic platform where convection and diffusion need to be optimized. Future clinical trials using handheld microscopes able to automatically evaluate the microcirculation at the bedside will show whether such a platform will indeed optimize fluid therapy.
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To discuss the role of extracorporeal membrane oxygenation (ECMO) in patients with cardiac arrest. ⋯ This review highlights that ECPR is feasible for both IHCA and OHCA. In the recent series, the outcome of ECPR in IHCA is satisfactory, with survival rates good with neurologic outcome reaching the 40-50% range. All series converge in highlighting that time from cardiac arrest to ECMO flow is a critical determinant of outcome, with survival rates of 50% when initiated within 30 min of IHCA, 30% between 30 and 60 min, and 18% after 60 min. Results of ECPR in OHCA are more challenging. Recent series suggest that good outcome can be obtained in 15-20% of the patients, provided that time from arrest to ECMO is shorter than 60 min. Duration of cardiac arrest seems to be more important than location of cardiac arrest. ECPR thus seems to be a valuable option in selected cases.