Current opinion in critical care
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Curr Opin Crit Care · Jun 2008
ReviewDetection of acute heart failure in chronic obstructive pulmonary disease patients: role of B-type natriuretic peptide.
Unrecognized chronic heart failure is present in 21-30% of chronic obstructive pulmonary disease patients. It may be a precipitating factor for acute exacerbation of chronic obstructive pulmonary disease or may hinder weaning from mechanical ventilation. The aim of the review is to emphasize recent studies that validated measurements of plasma B-type natriuretic peptide in the diagnosis of heart dysfunction in chronic obstructive pulmonary disease patients. ⋯ Recent evidence suggests that natriuretic peptide measurements are accurate in the diagnosis of coexisting left heart failure in chronic obstructive pulmonary disease patients, either in stable condition or during severe cardiopulmonary interactions occurring during acute exacerbation of chronic obstructive pulmonary disease, or evoking weaning difficulties related to left heart dysfunction.
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Curr Opin Crit Care · Jun 2008
ReviewThrombolysis and other drugs during cardiopulmonary resuscitation.
No specific drug therapy has been shown to improve long-term survival after cardiac arrest, and only few drugs have a proven benefit for short-term survival. This study reviews recent studies on drugs during cardiopulmonary resuscitation. ⋯ Epinephrine is the vasopressor of first choice for routine use during cardiopulmonary resuscitation. Arginine vasopressin may be considered in patients presenting with asystole or who are unresponsive to initial treatment with epinephrine. Amiodarone should be used in shock-refractory ventricular fibrillation. Although not recommended for routine use, thrombolytic therapy during cardiopulmonary resuscitation may be considered in patients with suspected pulmonary embolism or after unsuccessful conventional cardiopulmonary resuscitation in patients with a presumably thrombotic cause of cardiac arrest.
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To summarize current opinion and advances in pediatric cardiopulmonary resuscitation, including etiology, pathophysiology, rationale for interventions, and postresuscitation management. ⋯ Recent advances in our understanding of the etiology, pathophysiology, and therapies tied to the timing, phase, and duration of cardiac arrest can improve outcomes for children. New epidemiological data and multicenter studies are ushering in the era of evidence-based pediatric resuscitation therapeutics.
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Curr Opin Crit Care · Jun 2008
ReviewPrevention and therapy of postresuscitation neurologic dysfunction.
The majority of cardiac arrest patients die after successful resuscitation. Despite disappointing survival rates, cardiac arrest research mainly focuses on new therapies applied during cardiac arrest in the out-of-hospital setting, but only little attention is given to therapies mitigating the so-called postresuscitation syndrome. Optimized postresuscitation hospital care might have the potential to substantially improve survival rate in patients after cardiac arrest. ⋯ Therapeutic mild hypothermia (32-34 degrees C) is currently the most advanced medical concept to prevent or mitigate the postresuscitation syndrome. Large prospective randomized clinical trials are needed to investigate normoventilation with blood gases within physiologic range, moderately elevated blood glucose levels, a mean arterial pressure above 80 mmHg, and early reperfusion therapy in all cardiac arrest patients.
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Curr Opin Crit Care · Jun 2008
ReviewMonitoring of endothelial dysfunction in critically ill patients: the role of endothelial progenitor cells.
This review provides an overview of sepsis as a prototypical critical illness and discusses the role of the endothelium in the pathophysiology of sepsis and sepsis-related organ dysfunction, the characterization and functions of endothelial progenitor cells, and investigates these cells both as a prognostic and therapeutic strategy in critically ill patients. ⋯ Circulating endothelial progenitor cells may be an important mechanism of vascular repair, and thus shows significant promise for prognostic and therapeutic strategies in critical illness, namely sepsis and sepsis-related organ dysfunction.