Current opinion in critical care
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We review new findings concerning ventricular function in patients in intensive care units with shock or unexplained respiratory distress syndrome analyzed using echocardiography. ⋯ Using echocardiography the intensivist can examine both the mechanism and the cause of shock or pulmonary edema. It is time to increase the use of this technique in intensive care units.
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Curr Opin Crit Care · Jun 2006
ReviewIncidence and significance of gasping or agonal respirations in cardiac arrest patients.
This review examines the clinical significance of agonal respirations associated with cardiac arrest. ⋯ Agonal respirations occur frequently in cardiac arrest. Emergency dispatchers and the general public must be more aware of their presence and significance.
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Tissue hypoperfusion is a common pathophysiologic process leading to multiple organ dysfunction and death. Increases in tissue PCO2 can reflect an abnormal oxygen supply to the cells, so that monitoring tissue PCO2 by the use of gastric or sublingual capnometry may help identify circulatory abnormalities and guide their correction. This review provides an update on these technologies. ⋯ Gastric tonometry was proposed for regional PCO2 monitoring, but it is prone to a number of technical limitations. Sublingual capnometry could offer a valuable alternative for tissue PCO2 monitoring in clinical practice, representing a simple, noninvasive method to monitor tissue perfusion and titrate therapeutic interventions in critically ill patients.
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Curr Opin Crit Care · Jun 2006
ReviewRadiographic measures of intravascular volume status: the role of vascular pedicle width.
A valid, low-cost, high-yield instrument to assess intravascular volume status in critically ill patients does not exist. The portable chest X-ray is a common part of any intensivist's or chest clinician's daily rounds. ⋯ Vascular pedicle width measurement using a standardized approach to daily chest X-ray interpretation represents untapped potential for improving the non-invasive assessment of volume status in critically ill patients.
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Cardiac preload is frequently altered during hemodynamic failure and is a major focus of therapeutic management. The aim of this review was to summarize the invasive indicators of preload and the invasive predictors of preload responsiveness. ⋯ The best prediction of the hemodynamic response to fluid therapy is afforded by functional evaluation of preload responsiveness rather than by static markers of preload.