Critical care medicine
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Critical care medicine · Sep 2004
Death by hyperventilation: a common and life-threatening problem during cardiopulmonary resuscitation.
This translational research initiative focused on the physiology of cardiopulmonary resuscitation (CPR) initiated by a clinical observation of consistent hyperventilation by professional rescuers in out-of-hospital cardiac arrest. This observation generated scientific hypotheses that could only ethically be tested in the animal laboratory. ⋯ Despite seemingly adequate training, professional rescuers consistently hyperventilated patients during out-of-hospital CPR. Subsequent hemodynamic and survival studies in pigs demonstrated that excessive ventilation rates significantly decreased coronary perfusion pressures and survival rates, despite supplemental CO2 to prevent hypocapnia. This translational research initiative demonstrates an inversely proportional relationship between mean intratracheal pressure and coronary perfusion pressure during CPR. Additional education of CPR providers is urgently needed to reduce these newly identified and deadly consequences of hyperventilation during CPR. These findings also have significant implications for interpretation and design of resuscitation research, CPR guidelines, education, the development of biomedical devices, emergency medical services quality assurance, and clinical practice.
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Critical care medicine · Sep 2004
A proactive approach to improve end-of-life care in a medical intensive care unit for patients with terminal dementia.
To compare usual care with a proactive case-finding approach for critically ill patients with terminal dementia using an inpatient palliative care service. ⋯ Proactive interventions from a palliative care consultant within this subset of patients improved end-of-life care and decreased use of superfluous resources.
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We evaluated the effects of mild hypothermia (32 degrees C), established before experimental intra-abdominal sepsis, on outcome, cytokine pattern, and muscle tissue oxygenation. ⋯ In this rat model of intra-abdominal sepsis, mild preseptic hypothermia (32 degrees C) reduced survival, impaired granulocyte recruitment, and changed cytokine balance, suggesting immunosuppression.
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Critical care medicine · Sep 2004
Recurrent ventricular fibrillation in out-of-hospital cardiac arrest after defibrillation by police and firefighters: implications for automated external defibrillator users.
To determine the prevalence and frequency of recurrent ventricular fibrillation (VF) in patients defibrillated by police and firefighters only and to determine its relation to survival. ⋯ VF recurrence is frequent, variable in time of onset, and unrelated to the performance of bystander CPR. The prevalence and frequency of VF recurrence were unpredictable and do not adversely affect survival. Thus, vigilance for recurrent VF is essential to ensure the survival of patients who are in the care of first responders, even after initial restoration of pulses with shocks.
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It has been shown that hypothermia induced after successful resuscitation of comatose survivors of ventricular fibrillation cardiac arrest improves survival and neurologic function. Recent studies also suggest that earlier induction of hypothermia may yield even more improvement. We sought to determine if a new pump system, in addition to vigorous external chest compression, could rapidly induce hypothermia during cardiopulmonary resuscitation in a porcine model of cardiac arrest. ⋯ Rapid induction of mild hypothermia is feasible with a system that uses venous access, standard access techniques, and external chest compression. Induction of mild hypothermia during cardiac arrest in the field appears feasible and may allow the benefit of very early induction of hypothermia to be determined in patients.