Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · Jun 2013
ReviewMonitoring cardiac function: echocardiography, pulse contour analysis and beyond.
Haemodynamic monitoring has developed considerably over the last decades, nowadays comprising a wide spectrum of different technologies ranging from invasive to completely non-invasive techniques. At present, the evidence to continuously measure and optimise stroke volume, that is, cardiac output, in order to prevent occult hypoperfusion in the perioperative setting and consequently to improve patients' outcome is substantial. ⋯ Recent trials have shown that perioperative mortality is higher than anticipated, emphasising the need for the speciality of anaesthesiology to face the problem and to translate proven concepts into clinical routine to improve patients' outcome. One basic principle of these concepts is to monitor and to optimise cardiac function by means of advanced haemodynamic monitoring, using echocardiography, pulse contour analysis and beyond.
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Best Pract Res Clin Anaesthesiol · Jun 2013
ReviewIntra-abdominal hypertension: definitions, monitoring, interpretation and management.
This review will describe the definitions on intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). In order to understand these definitions the reader must be aware of the interactions between intra-abdominal pressure (IAP) and intra-abdominal volume (IAV), explaining why dramatic IAP increases can be observed in some patients related to anthropomorphic measurements, body positioning, use of positive pressure ventilation, or relatively small accumulations of fluid or blood. The adverse effects related to increased IAP have been named IAH for moderate cases and ACS for advanced cases. ⋯ The definitions and guidelines have recently been revised according to evidence based medicine and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This review will be based on the revised guidelines. The standard method to measure IAP is via the bladder and as experience with IAP measurement has evolved considerably, a number of tips and potential pitfalls are listed.
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Best Pract Res Clin Anaesthesiol · Jun 2013
ReviewThe oxygen supply-demand balance: a monitoring challenge.
The principal task of acute critical care is to avoid or correct oxygen debt by increasing oxygen delivery (DO2) and/or decreasing oxygen consumption (VO2). The most commonly used methods to assess the relationship of adequate delivery and consumption are mixed venous oxygen saturation and its surrogate, central venous oxygen saturation (ScvO2). The purpose of this article is to review the values and limitations of the two parameters and evaluate the clinical use of ScvO2 in certain clinical scenarios, such as anaemia and transfusion, hypovolaemia, major surgery, septic shock, and in difficult-to-wean patients.