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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Curr Opin Crit Care · Jun 2003
ReviewCardiopulmonary Resuscitation Guidelines 2000 update: what's happened since?
To examine the literature for new resuscitation science since the publication of the Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiac Care. ⋯ In this report, we review these new studies and discuss how they corroborate or alter the published 2000 guidelines.
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Advancements in electronic data acquisition have translated into improved monitoring of victims of cardiac arrest, but initial techniques remain direct observation of pulses and respirations. The most essential monitor continues to be the electrocardiogram. However, monitoring diastolic blood pressure, myocardial perfusion pressure, and end-tidal carbon dioxide are extremely useful. ⋯ Methods of analyzing the ventricular fibrillation waveform include measuring the amplitude and frequency and combining the contributions of amplitude and frequency by various methods to improve discrimination. Other types of monitoring being studied for their usefulness during cardiac arrests include sonography, Bispectral Index monitoring, tissue carbon dioxide monitors, and pupil observation. The test of these monitoring techniques is ultimately their ability to improve patient survival to hospital discharge, which is a major challenge for resuscitation researchers.
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A primary aspect of cardiovascular support of the critically ill patient is the titration of cardiopulmonary therapies based on the baseline cardiopulmonary status and the subsequent physiologic response. Implicit in this paradigm is the monitoring of the processes being titrated. The degree to which a specific physiologic variable, such as mean arterial pressure or arterial oxygen saturation, needs to be assessed is a function of the therapy used, the stability of the patient, the relation among the variables defining the hemodynamic profile, and the ability of the support staff to remain in close attendance at the bedside. ⋯ How, then, does one arrive at the correct formula to prescribe appropriate physiologic monitoring for the patient in the intensive care unit setting? To a large extent this is unknown, primarily because the utility of monitoring techniques to diagnose pathophysiologic processes and the resultant effect of therapy to reverse it is not known for most of the diseases treated in the intensive care unit. Few monitoring techniques have progressed through a logical progression of development to their present level of use. Thus, their use in the management of the critically ill patient cannot be vigorously defended, except under specific conditions.
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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.