Critical care : the official journal of the Critical Care Forum
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Neutropenia recovery may be associated with deterioration in oxygenation and exacerbation of pre-existing pulmonary disease. However, risk factors for acute respiratory distress syndrome (ARDS) during neutropenia recovery in patients with hematologic malignancies have not been studied. ⋯ Patients with hematologic malignancies complicated by pneumonia during neutropenia are at increased risk for ARDS during neutropenia recovery.
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Whereas the pulmonary artery catheter (PAC) is still widely used in guiding assessment and treatment of heart failure, controversy surrounding its safety and efficacy has prompted development of newer, less invasive techniques. For these purposes, the transpulmonary thermodilution technique allows assessment of preload, cardiac output, filling volumes, and metrics of contractility without the need to pass a catheter through the right heart. ⋯ The results add to a growing body of evidence that the PAC adds little to information attainable by less invasive methods in many conditions, including acute heart failure. Whether newer devices improve outcome needs to be tested in well-controlled prospective trials.
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The assessment of volume responsiveness and the decision to administer a fluid bolus is a common dilemma facing physicians caring for critically ill patients. Static markers of cardiac preload are poor predictors of volume responsiveness, and dynamic markers are often limited by the presence of spontaneous respirations or cardiac arrhythmias. Passive leg raising (PLR) represents an endogenous volume challenge that can be used to predict fluid responsiveness. ⋯ Non-invasive SV measurement and PLR can predict fluid responsiveness in a broad population of medical ICU patients. Less than 50% of ICU patients given fluid boluses were volume responsive.
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Sepsis-induced myocardial dysfunction has traditionally been thought of as principally affecting systolic heart function. One of the primary reasons for this concept is that systolic dysfunction is relatively easy to conceptualize, visualize, and measure. With the advent of preload-independent measurements for diastolic function, both measurement and conceptual difficulties are being resolved, and a new realm of evidence is beginning to emerge regarding the aberrations that are found during cardiac relaxation in sepsis. A recent article in Critical Care brings this issue into sharper focus.
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Comment
Searching for an ideal hemodynamic marker to predict short-term outcome in cardiogenic shock.
Cardiogenic shock is a lethal condition. Physicians are searching for hemodynamic markers which could help risk-stratification of patients in this picture. Torgersen and coworkers present an hourly time integral of the cardiac power index and cardiac index drops to predict outcomes in the setting of cardiogenic shock. Continuous monitoring of hemodynamic markers may have a role in prediction of outcomes.