Current opinion in critical care
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Assessment of cardiovascular stability using ventilation-induced changes in measured physiological variables, referred to as functional hemodynamic monitoring, usually requires measurement of ventilation-induced changes in venous return. Thus, it is important to understand the determinants of these complex heart-lung interactions. ⋯ Functional hemodynamic monitoring is becoming more prevalent. For it to be used effectively, the operator needs to have a solid understanding of how ventilation induces both pulse pressure variation and stroke volume variation in that specific patient.
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Curr Opin Crit Care · Oct 2007
ReviewPrompt antibiotic administration and goal-directed hemodynamic support in patients with severe sepsis and septic shock.
Treatment protocols targeting the rapid administration of appropriate antibiotics and hemodynamic support are now recognized as a key measure in the initial care of patients presenting with severe sepsis and septic shock. Strong evidence exists showing that time parameters, particularly in the emergency department, are as important as the nature of the treatment administered. The concept of sepsis bundles integrates evidence-based and time-sensitive issues, derived from international sepsis guidelines, to ensure that all eligible patients receive the right treatment as early as possible. ⋯ It seems logical that timely and protocolized treatment for patients presenting with severe sepsis and septic shock will impact on outcome. It remains to be shown, however, whether translating evidence into clinical practice will increase adherence to the bundles and positively impact on survival.
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Curr Opin Crit Care · Oct 2007
ReviewPercutaneous left ventricular assist devices for treatment of patients with cardiogenic shock.
This review will discuss the rationale and clinical utility of percutaneous left ventricular assist devices in the management of patients with cardiogenic shock. ⋯ The advent of percutaneous left ventricular assist devices constitutes an important advance in the management of patients with severe cardiogenic shock and may serve as bridge to recovery or heart transplantation in carefully selected patients. While improvement of hemodynamic parameters appears promising, it remains to be determined whether this benefit translates into improved clinical outcome.