New horizons (Baltimore, Md.)
-
Rapid progress has been made in the use of linear and nonlinear time series analysis of heart rate and blood pressure variability as an indicator of disease severity and prognosis for patients in shock. Clinical and experimental studies have demonstrated the potential for linear and nonlinear measurements as a method for quantifying changes in neuroautonomic cardiovascular regulatory mechanisms. ⋯ In addition, these measures may also enable detection of early changes in neuroautonomic cardiovascular regulatory mechanisms during the development of shock before the onset of overt hypotension and inadequate tissue perfusion or may be used to assess the response to therapy. Further studies are needed to establish the role of these tools in clinical use.
-
Why some patients develop postoperative surgical wound infection and others do not remains a mystery. There are many risk factors for infection, and mathematical scoring systems are often good predictors of infection; yet, some patients with a plethora of risk factors fail to develop surgical site infections. Even patients with established abdominal infection do not automatically develop wound infection. ⋯ Care and attention to the theater operating environment is important, especially for cases in which airborne transmission of bacteria should be controlled, e.g., ultraclean air systems for implant surgery. In elective surgery, the source of bacteria that cause infection is either the patient's normal flora (e.g., skin or bowel), i.e., endogenous, or the surgical staff or environment, i.e., exogenous. Surgical expertise and theater discipline are essential components in the fight against surgical sepsis.
-
The pathophysiology of cardiogenic shock in infants and children is multifactorial and include noncardiac as well as cardiac etiologies, both congenital and acquired heart disease. The management of patients in cardiogenic shock requires a rational approach that is based upon the underlying pathophysiology. ⋯ In this article, the pathophysiology of cardiogenic shock and the use of echocardiography in reaching a differential diagnosis are discussed. In addition, the management of cardiogenic shock is reviewed.