Current opinion in critical care
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Mixed venous and central venous oxygen saturations reflect the balance between oxygen requirement and oxygen delivery, and thus may be used to assess the adequacy of tissue oxygenation. This review discusses recent data on the impact of using venous oximetry by obtaining mixed venous oxygen saturation or central venous oxygen saturation as useful monitoring parameters in critically ill patients. ⋯ Early goal-directed therapy should be implemented in the initial resuscitation of septic patients. Central venous saturation may have prognostic significance following major surgery. Further evaluation of peri-operative trends in central venous saturation is required. Measurement of central venous oxygen saturation can easily be applied in intensive care unit patients and offers a useful, indirect indicator for the adequacy of tissue oxygenation.
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This review will summarize the available data regarding the haemodynamic changes occurring following cardiac arrest in humans and animal models. ⋯ Recent studies have provided important insights into the haemodynamics of cardiac arrest and of cardiopulmonary resuscitation which may inform more effective strategies for the management of cardiac arrest in the future.
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Fluid responsiveness is a relatively new concept. It enables the efficacy of volume expansion to be predicted before use, rather than assessed afterwards, thus avoiding inappropriate fluid infusion. Echocardiography is a fantastic noninvasive tool which can directly visualize the heart and assess cardiac function. Its use was long limited by the absence of accurate indices to diagnose hypovolemia and predict the effect of volume expansion. In the last few years, several French teams have used echocardiography to develop new parameters of fluid responsiveness, taking advantage of its ability to monitor cardiac function beat by beat during the respiratory cycle. ⋯ Echocardiography has been widely demonstrated to predict fluid responsiveness accurately. This is now a complete and noninvasive tool able to accurately determine hemodynamic status in circulatory failure.
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Curr Opin Crit Care · Jun 2006
The problem with and benefit of ventilations: should our approach be the same in cardiac and respiratory arrest?
Recent advances in cardiopulmonary resuscitation have led to greater understanding of cardio-cerebral-pulmonary interactions during the process. The purpose of this discussion is to update the physiologic understanding of these interactions during cardiopulmonary resuscitation, review the detrimental and beneficial effects of ventilation, and identify implications for clinical practice. ⋯ The fundamental hemodynamic principle of intrathoracic pressure defines cardio-cerebral-pulmonary interactions during cardiopulmonary resuscitation. Further research is essential to optimize these interactions during treatment of profound shock.
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We review new findings concerning ventricular function in patients in intensive care units with shock or unexplained respiratory distress syndrome analyzed using echocardiography. ⋯ Using echocardiography the intensivist can examine both the mechanism and the cause of shock or pulmonary edema. It is time to increase the use of this technique in intensive care units.