Current opinion in critical care
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Curr Opin Crit Care · Jun 2010
ReviewUsing oxygen delivery targets to optimize resuscitation in critically ill patients.
The use of fluid and inotropic therapies to optimize global haemodynamic variables, in particular oxygen delivery, in critically ill patients has been a controversial area of research for more than 25 years. The aim of this review is to describe the current evidence base for this treatment and how concepts of haemodynamic optimization have evolved in recent years. ⋯ These advances in our understanding have now informed the design of large randomized trials in various patient groups. The true value of haemodynamic optimization is likely to be confirmed or refuted within the next 5 years.
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Curr Opin Crit Care · Jun 2010
ReviewRealistic expectations for public access defibrillation programs.
Public access defibrillation programs have increased dramatically over the past 15 years. This review will focus on their effectiveness and operational characteristics and discuss the characteristics of successful programs, which can improve outcomes. ⋯ Automated external defibrillators are highly effective at reducing death from ventricular fibrillation and easy access in public areas is most effective. Placement must be prioritized based on public health impact and characteristics of the community.
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Curr Opin Crit Care · Jun 2010
ReviewApproaches to improving cardiac arrest resuscitation performance.
The survival rate from cardiac arrest remains poor despite advances in cardiopulmonary resuscitation (CPR) and postresuscitation therapies. Recent studies have documented many shortcomings during the performance of resuscitation care. We will review the various methods to improve the delivery of resuscitation care described in the current literature. ⋯ By adopting techniques such as simulation, automated feedback, training refreshers, debriefing and CCR, the quality of resuscitation performance can be increased. Future work needs to demonstrate that improved resuscitation performance correlates with decreased mortality.
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The purpose of this study is to discuss recent data relating to the treatment of cardiac arrest survivors. This is a rapidly evolving component of resuscitation medicine that impacts significantly on the quality of survival after cardiac arrest. ⋯ Survivors from cardiac arrest develop a postcardiac arrest syndrome. Postresuscitation care, including primary percutaneous coronary intervention, therapeutic hypothermia, and control of blood sugar, improves survival and neurological outcome in cardiac arrest survivors. Completely reliable prognostication in comatose survivors of cardiac arrest is difficult to achieve.
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We report on the evolution of airway pressure and flow monitoring from a pathophysiological tool to the cornerstone of ventilator-induced lung injury (VILI) prevention. ⋯ Airway pressure and flow monitoring is essential for VILI prevention and for an appropriate setting of mechanical ventilation.