Current opinion in critical care
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Curr Opin Crit Care · Jun 2007
ReviewBedside evaluation of pressure-volume curves in patients with acute respiratory distress syndrome.
To describe the physiologic and diagnostic utility of static pressure-volume curves of the respiratory system at the bedside in patients with acute lung injury or acute respiratory distress syndrome. ⋯ Measurement of pressure-volume curves at the bedside in critically ill patients with acute lung injury or acute respiratory distress syndrome should be considered a useful respiratory monitoring tool to assess physiologic lung status and to adjust ventilator settings, when appropriate, to minimize superimposed lung injury associated with mechanical ventilators.
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Curr Opin Crit Care · Jun 2007
ReviewLayperson training for cardiopulmonary resuscitation: when less is better.
Basic cardiopulmonary resuscitation, including use of automated external defibrillators, unequivocally saves lives. However, even when motivated, those wishing to acquire training traditionally have faced a myriad of barriers including the typical time commitment (3-4 h) and the number of certified instructors and equipment caches required. ⋯ Simpler to set-up and implement, the half-hour video-based self-instruction makes it easier for employers, churches, civic groups, school systems and at-risk persons at home to implement such training and it will likely facilitate more frequent re-training. It is now hoped that the ultimate benefit will be more lives saved in communities worldwide.
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Curr Opin Crit Care · Jun 2007
ReviewTranspulmonary dilution-derived extravascular lung water as a measure of lung edema.
This review highlights current insights concerning the (measurement of) extravascular lung water as an index of pulmonary edema, by transpulmonary dilution techniques. The focus is on the applicability of the technique at the bedside in monitoring critically ill patients. ⋯ The thermodilution-derived extravascular lung water is a useful adjunct to assess lung vascular injury, cardiogenic edema and overhydration and to guide treatment in critically ill patients. The effects on morbidity and mortality of this approach need to be studied further.
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Curr Opin Crit Care · Jun 2007
ReviewHow to monitor lung recruitment in patients with acute lung injury.
Bedside assessment of lung recruitment is critical for setting mechanical ventilation during acute respiratory distress syndrome. We review recent findings on this topic and attempt to provide a clinical approach to estimating lung recruitment. ⋯ Two approaches should be considered to estimate lung recruitment: the use of computed-tomography scanning and indices combining different respiratory variables. Future studies, especially on lung-perfusion distribution, are warranted to improve our knowledge of the pathophysiology of lung recruitment.
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Several less invasive cardiac output monitoring techniques are now commercially available and have the potential to replace the pulmonary artery catheter under certain clinical circumstances. The aim of this review is to give a synopsis of the currently available cardiac output measurement methods. This information should help in selecting the appropriate technique in a particular clinical setting. ⋯ Less invasive cardiac output monitoring techniques may replace the pulmonary artery catheter in different clinical settings considering the specific properties of these techniques. The pulmonary artery catheter, however, may still be recommended for cardiac output measurement in specific clinical situations when monitoring of pulmonary artery pressures is desirable.