Current opinion in critical care
-
Curr Opin Crit Care · Jun 2008
ReviewCardiac arrest resuscitation: neurologic prognostication and brain death.
Persistent coma after cardiac arrest is a source of great emotional and financial cost to grieving family members in particular and the healthcare system in general. Neurologic prognostication helps guide appropriate discussions between family members and healthcare providers. Recent advances in therapeutic care increase the challenges, both medical and financial, on local practitioners. ⋯ Evidence-based tests of prognostication for neurologic outcome after cardiac arrest are presented. A review of the practice of withdrawal of life-sustaining therapies and the diagnosis of brain death is also provided. The reader is cautioned that most prognostic studies do not include possible amelioration with the use of therapeutic hypothermia.
-
The measurement of cardiac output in the critically ill constitutes a vital part in the management of these patients. Minimally invasive techniques are gaining popularity as they allow continuous cardiac output monitoring while avoiding the risks associated with pulmonary artery catheterization. This article focuses on some of the commonly used minimally invasive devices that rely on pulse contour waveform analysis. ⋯ The minimally invasive cardiac output monitoring devices available differ in their methodology and application. Currently there is conflicting evidence as to the accuracy of some of these systems and further investigation into their clinical application is required.
-
To evaluate the recent literature on the utility of the pulse oximetry plethysmographic curve to assess macrocirculation and microcirculation monitoring in intensive care patients. ⋯ A growing number of recent clinical studies demonstrated that plethysmographic dynamic indices are useful methods to assess fluid responsiveness. Any alternating signal processing of the raw data curves, however, may be detrimental for this purpose, as significant clinically relevant information could be lost after perpetual adjustment of filtering. Hence, time will tell if the pulse oximetry plethysmographic curve will succeed other methods as a noninvasive approach to monitor haemodynamics of critically ill patients.
-
Curr Opin Crit Care · Jun 2008
ReviewIntraabdominal pressure monitoring during fluid resuscitation.
Elevated intraabdominal pressure is commonly encountered in the critically ill, has detrimental effects on all organ systems, and is associated with significant morbidity and mortality. Serial intraabdominal pressure measurements are essential to the diagnosis, management, and fluid resuscitation of patients who develop intraabdominal hypertension and/or abdominal compartment syndrome. ⋯ Serial intraabdominal pressure measurements are essential for the diagnosis and management of intraabdominal hypertension/abdominal compartment syndrome. Intraabdominal pressure must be measured accurately and utilized in a goal-directed fashion to guide fluid and end-organ resuscitation. As a result of its ability to predict survival among the critically ill, intraabdominal pressure should be routinely monitored in the patient who demonstrates risk factors for intraabdominal hypertension/abdominal compartment syndrome.
-
To briefly review recent advances in the noninvasive assessment of arterial pressure (indirect methods) in the field of critical care. ⋯ Intraarterial blood pressure must be preferred over noninvasive blood pressure recordings when critical decisions are required. In hemodynamically stable patients, valuable information may be obtained by using noninvasive techniques, amongst which arterial tonometry seems especially promising.