Current opinion in critical care
-
Curr Opin Crit Care · Jun 2003
ReviewStrategies for reversing shock-resistant ventricular fibrillation.
Shock-resistant ventricular fibrillation is defined as ventricular fibrillation persisting after three defibrillation attempts. In approximately 10 to 25% of all cardiac arrests, shock-resistant ventricular fibrillation develops, and 87 to 98% of these patients die. ⋯ Biphasic defibrillation and intravenous amiodarone are useful in shock-resistant ventricular fibrillation.
-
A primary aspect of cardiovascular support of the critically ill patient is the titration of cardiopulmonary therapies based on the baseline cardiopulmonary status and the subsequent physiologic response. Implicit in this paradigm is the monitoring of the processes being titrated. The degree to which a specific physiologic variable, such as mean arterial pressure or arterial oxygen saturation, needs to be assessed is a function of the therapy used, the stability of the patient, the relation among the variables defining the hemodynamic profile, and the ability of the support staff to remain in close attendance at the bedside. ⋯ How, then, does one arrive at the correct formula to prescribe appropriate physiologic monitoring for the patient in the intensive care unit setting? To a large extent this is unknown, primarily because the utility of monitoring techniques to diagnose pathophysiologic processes and the resultant effect of therapy to reverse it is not known for most of the diseases treated in the intensive care unit. Few monitoring techniques have progressed through a logical progression of development to their present level of use. Thus, their use in the management of the critically ill patient cannot be vigorously defended, except under specific conditions.
-
To review important areas of current and novel hemodynamic monitoring practice in the intensive care unit and to highlight potential areas of physiologic and clinical use or misuse, as well as areas of uncertainty and ongoing controversy. ⋯ The effectiveness of hemodynamic monitoring in the intensive care unit remains inadequately tested and unproven. New tools are now rapidly emerging to challenge established technologies. Formal assessment of their efficacy and effectiveness is needed to avoid a repeat of the pulmonary artery catheter experience.
-
Curr Opin Crit Care · Jun 2003
ReviewCardiorespiratory interactions and blood flow generation during cardiac arrest and other states of low blood flow.
Recent advances in cardiopulmonary resuscitation have shed light on the importance of cardiorespiratory interactions during shock and cardiac arrest. This review focuses on recently published studies that evaluate factors that determine preload during chest compression, methods that can augment preload, and the detrimental effects of hyperventilation and interrupting chest compressions. ⋯ Cardiorespiratory interactions are of profound importance in states of cardiovascular collapse in which increased negative intrathoracic pressure during decompression of the chest has a favorable effect and increased intrathoracic pressure with ventilation has a detrimental effect on survival rate.
-
Respiratory monitoring tools remain important in the overall assessment of a patient in the ICU. A working knowledge of the various tools is helpful in applying their use to patient care. ⋯ This review discusses traditional methods of respiratory system evaluation and their current controversies. Attention is also given to newer modalities, including those that are investigational or currently limited to bench application, that show promise of future application in ICU clinical practice.