Current opinion in critical care
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Curr Opin Crit Care · Jun 2013
Review Observational StudyAirway management in cardiopulmonary resuscitation.
The optimal method for airway management during cardiac arrest is unknown. This review summarizes recent evidence comparing the use of basic and advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation], including the role of capnography during cardiac arrest. ⋯ Most of the evidence about airway management during cardiac arrest comes from observational studies. The best airway option is likely to be different for different rescuers, and at different time points of the resuscitation process. Properly designed, prospective, randomized trials are needed to help determine the optimal airway strategy. In our view, there is currently sufficient clinical equipoise to support such trials.
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Curr Opin Crit Care · Jun 2013
ReviewFrom speckle tracking echocardiography to torsion: research tool today, clinical practice tomorrow.
Speckle tracking is the latest available technology in echocardiography. However, the technology is still mainly used as a research tool. The potential applications of speckle tracking are many, including cardiac synchronization, regional wall motion analysis, and in the areas of cardiac mechanic studies. This review presents the background theory of speckle tracking echocardiography (STE) and how this technology can be extended to velocity vector analysis, strain, and torsion measurements. The interpretations of these measurements are covered. We also present some potential applications in the critical care setting. ⋯ Speckle tracking can be used to measure instantaneous myocardial contractility, strain, and left ventricular torsion. It is still a research tool at present, but shows the promise of being a clinical tool in the future.
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Curr Opin Crit Care · Jun 2013
ReviewIs there a role for adrenaline during cardiopulmonary resuscitation?
To critically evaluate the recent data on the influence adrenaline has on outcome from cardiopulmonary resuscitation. ⋯ Appropriately powered prospective, placebo-controlled trials of adrenaline in cardiac arrest are essential if the role of this drug is to be defined reliably.
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Sepsis elicits profound changes in the concentrations of plasma proteins synthesized by liver parenchymal cells referred to as acute-phase proteins. Mechanisms controlling this orchestrated response include release of cytokines that induce acute-phase proteins, while other 'house-keeping' genes are downregulated. ⋯ Sepsis induces reprogramming of the hepatic transcriptome. This includes induction of adaptive acute-phase proteins but also repression of phase I, II metabolism and transport with important implications for monitoring and pharmacotherapy.