Current opinion in critical care
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Postresuscitation myocardial dysfunction (PRMD) is a frequent complication, which worsens the hemodynamic status and can be lethal. Early identification and treatment of this cardiac complication is one of the key therapeutic goals during hospitalization of these patients. ⋯ Reversibility of PRMD justifies an aggressive management strategy, including detection of myocardial ischemia, inotropic support, and in the most severe cases, mechanical circulatory assistance. Hemodynamic dysfunction should not influence the decision to continue treatment because it is often reversible - the neurological status is much more likely to determine the ultimate outcome.
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Curr Opin Crit Care · Jun 2013
ReviewVentilation parameters used to guide cardiopulmonary function during mechanical ventilation.
To describe the newly introduced ventilation parameters that are used at the bedside to estimate cardiopulmonary function during positive pressure ventilation (PPV). ⋯ The utility of lung ultrasound is expanding. Although the clinical implications of FRC measurement and lung monitoring with imaging tools such as EIT are starting to be realized, their efficacy in severe hypoxic respiratory failure should be evaluated further in well designed clinical trials. To improve the preemptive management of impending respiratory failure, an alarm index that integrates noninvasive cardiopulmonary function parameters should be developed.
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Curr Opin Crit Care · Jun 2013
ReviewRegistries to measure and improve outcomes after cardiac arrest.
Cardiac arrest registries are used to measure and improve the process and outcome of resuscitation care, and can give insight into risk factors, prognosis, and the effectiveness of interventions to mitigate its impact. This review provides an overview of current out-of-hospital (OHCA) and in-hospital cardiac arrest (IHCA) registries, with attention to key recent findings and future directions. ⋯ OHCA and IHCA registries are invaluable in advancing our understanding of resuscitation care, as well as variations in international practice. Investigations that compare and contrast outcomes from established and evolving registries will help advance resuscitation science further.
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Left-ventricular diastolic dysfunction is associated with various conditions frequently encountered in ICU patients. Due to prolonged relaxation and increased left-ventricular stiffness, patients with diastolic dysfunction are at high risk of developing abrupt pulmonary venous congestion. The present review describes the clinical spectrum of left-ventricular diastolic abnormalities in ICU patients. ⋯ Left-ventricular diastolic dysfunction accounts for a growing proportion of cardiogenic pulmonary edema and weaning failure in ICU patients. It may be reversible when induced by sepsis or myocardial ischemia. Its prognostic value in the ICU settings remains to be further investigated.
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Curr Opin Crit Care · Jun 2013
ReviewBlood content analysis for evaluating cardiopulmonary function.
To review the role of blood analysis in cardiac and pulmonary evaluation. ⋯ The ongoing research on blood contents has not resulted in any new outstanding markers to the critical care physician to use in evaluating cardiopulmonary function, with the exception of high-sensitive cTn. Yet, many recent studies assist the clinician by providing a better understanding of how to use routine tools, like arterial and venous blood gas analysis, more effectively and offer guidance in optimizing Hb and lactate blood levels.