Current opinion in critical care
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Curr Opin Crit Care · Jun 2003
ReviewMyocardial protection during resuscitation from cardiac arrest.
Successful treatment of cardiac arrest requires that an electrically stable and mechanically competent cardiac activity be promptly reestablished. However, many interventions used to attempt to reestablish cardiac activity may also inflict additional myocardial injury and, in turn, compromise resuscitability. In this review, we examine mechanisms of such myocardial injury and discuss potential new strategies for myocardial protection during resuscitation from cardiac arrest. ⋯ The growing body of research in these areas is bringing hope that in a not so distant future new approaches and interventions for cardiac resuscitation could be available for resuscitation of humans in various clinical settings.
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To review important areas of current and novel hemodynamic monitoring practice in the intensive care unit and to highlight potential areas of physiologic and clinical use or misuse, as well as areas of uncertainty and ongoing controversy. ⋯ The effectiveness of hemodynamic monitoring in the intensive care unit remains inadequately tested and unproven. New tools are now rapidly emerging to challenge established technologies. Formal assessment of their efficacy and effectiveness is needed to avoid a repeat of the pulmonary artery catheter experience.
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Curr Opin Crit Care · Jun 2003
ReviewCardiorespiratory interactions and blood flow generation during cardiac arrest and other states of low blood flow.
Recent advances in cardiopulmonary resuscitation have shed light on the importance of cardiorespiratory interactions during shock and cardiac arrest. This review focuses on recently published studies that evaluate factors that determine preload during chest compression, methods that can augment preload, and the detrimental effects of hyperventilation and interrupting chest compressions. ⋯ Cardiorespiratory interactions are of profound importance in states of cardiovascular collapse in which increased negative intrathoracic pressure during decompression of the chest has a favorable effect and increased intrathoracic pressure with ventilation has a detrimental effect on survival rate.
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Respiratory monitoring tools remain important in the overall assessment of a patient in the ICU. A working knowledge of the various tools is helpful in applying their use to patient care. ⋯ This review discusses traditional methods of respiratory system evaluation and their current controversies. Attention is also given to newer modalities, including those that are investigational or currently limited to bench application, that show promise of future application in ICU clinical practice.