Critical care clinics
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Critical care clinics · Jan 2015
ReviewOrganizational Approaches to Improving Resuscitation Effectiveness.
Hemodynamic instability and shock are important causes of mortality worldwide. Improving outcomes for these patients through effective resuscitation is a key priority for the health system. ⋯ The discussion is rooted in a conceptual model of effective resuscitation based on three domains: monitoring systems, response teams, and feedback mechanisms. Targeting each of these domains in a unified approach helps clinicians effectively treat deteriorating patients, ultimately improving outcomes for this high-risk patient group.
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Critical care clinics · Jan 2015
ReviewDefining Goals of Resuscitation in the Critically Ill Patient.
There is still no "universal" consensus on an optimal endpoint for goal directed therapy (GDT) in the critically ill patient. As in other areas of medicine, this should help providers to focus on a more "individualized approach" rather than a protocolized approach to ensure proper patient care. ⋯ It is essential to also monitor flow variables (cardiac output/stroke volume) and dynamic parameters of fluid responsiveness whenever available. This article will provide a review of current and trending approaches of the goals of resuscitation in the critically ill patient.
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Although use of the classic pulmonary artery catheter has declined, several techniques have emerged to estimate cardiac output. Arterial pressure waveform analysis computes cardiac output from the arterial pressure curve. ⋯ Some newer devices have been developed to estimate cardiac output from an arterial curve obtained noninvasively with photoplethysmography, allowing a noninvasive beat-by-beat estimation of cardiac output. This article describes the different devices that perform pressure waveform analysis.