Current opinion in critical care
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Tissue hypoperfusion is a common pathophysiologic process leading to multiple-organ dysfunction and death. An important goal of hemodynamic monitoring is the early detection of inadequate tissue perfusion and oxygenation. The use of simple, noninvasive monitoring techniques has the advantage of facilitating earlier initiation of therapy. Near-infrared spectroscopy has emerged in recent years as a tool for monitoring peripheral oxygenation (StO2) in various tissues, including muscle. Here, we review our current knowledge about the applicability, usefulness, and limitations of near-infrared spectroscopy as a technique to evaluate muscle oxygenation in acutely ill patients. ⋯ Near-infrared spectroscopy provides a noninvasive measure of muscle oxygen metabolism and microvascular dysfunction in critically ill patients. It may be useful to guide the management of critically ill patients.
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To discuss the advantages and disadvantages of various methods of airway management during cardiopulmonary resuscitation. The role of ventilation during out-of-hospital cardiopulmonary resuscitation is also discussed. ⋯ Supraglottic airway devices are a logical alternative to tracheal intubation when cardiopulmonary resuscitation is undertaken by individuals who are not highly skilled and experienced intubators. By teaching laypeople compression-only cardiopulmonary resuscitation, it is hypothesized that rates of bystander cardiopulmonary resuscitation, and therefore survival after out-of-hospital cardiac arrest, will increase.
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Cardiac arrest of patients during anesthesia has been the driving force behind the development of this specialty. Safer procedures, new anesthetics, and technical improvements such as monitoring devices and ventilators have successfully reduced intraoperative mortality. Nevertheless, modern technology itself creates specific risks; and causes, diagnosis, and management of anesthesia-related cardiac arrest differ considerably from situations encountered elsewhere. ⋯ The anesthetic environment has become much safer than it was 50 years ago. For a successful management of cardiac arrest during operative procedures, not only individual knowledge and skills but also institutional safety culture have to be implemented into education, training, and everyday practice of this specialty.
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Curr Opin Crit Care · Jun 2008
ReviewPrediction of volume responsiveness in critically ill patients with spontaneous breathing activity.
Predicting volume responsiveness in patients with spontaneous breathing activity is a difficult challenge in the emergency room as well as in the intensive care unit because heart-lung interactions indices cannot be reliably used as they can be in mechanically ventilated patients fully adapted to their ventilator. The aim of this review is to summarize the different tools that have been proposed to predict the hemodynamic response to fluid infusion in the presence of spontaneous breathing activity. ⋯ The passive leg-raising test is the only method that has been repeatedly shown to be reliable for predicting volume responsiveness in patients who experience spontaneous breathing. The appropriate utilization of this test requires a real-time assessment of its effects on systemic blood flow.