Current opinion in critical care
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Curr Opin Crit Care · Oct 2007
ReviewHealth policy and future planning for survivors of critical illness.
Few health policy decisions directly address the needs of intensive care unit survivors. This review will assess some of the health system-level barriers to effective post-intensive care unit care and provide a framework for policy decisions directed at improving outcomes for survivors of critical illness. ⋯ Advances in our understanding of the long-term outcomes of critical illness must be accompanied by healthcare system changes designed to meet the specific needs of intensive care unit survivors.
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Until recently the right ventricle's role in myocardial dynamics has not been fully appreciated. This article provides an overview of the pathophysiology, imaging and management of right ventricular dysfunction. ⋯ Acute right ventricular dysfunction is relatively common. There is a lack of convincing evidence in favour of any single treatment modality. Imaging methods now permit a more accurate evaluation of the right ventricle and its function. Combining treatments may offer significant advantages and the imaging and monitoring available allows real-time assessment of the response to intervention. This article illustrates how incomplete our knowledge of this condition and its management within the critical care setting is and reinforces previous calls for suitably designed trials to evaluate and develop guidelines for existing strategies and therapeutic agents.
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In the ICU only half of the patients are volume responsive - that is, they respond to fluid administration by increasing their cardiac output. We aim to summarize the methods available for predicting volume responsiveness, focusing on recent findings in patients with spontaneous breathing activity. ⋯ Predicting the hemodynamic response to fluid administration in patients with acute circulatory failure is of major importance and numerous methods are now available. While the respiratory variations of stroke volume (or its surrogates) can be used in patients fully adapted to their ventilator, the passive leg-raising test has become a reliable predictive method in patients with spontaneous breathing activity.