Current opinion in critical care
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Curr Opin Crit Care · Jun 2007
ReviewThe impedance threshold valve for adult cardiopulmonary resuscitation: a review of the literature.
Heart-lung interaction is an important parameter in the understanding of blood-flow induction during cardiopulmonary resuscitation. The impedance threshold valve is a device which has been created to increase venous return by occluding the airway during the decompression phase of cardiopulmonary resuscitation. This review analyzes the available literature focusing on the rationale of this device. ⋯ It seems clear, from both animal and human data, that enhancement of preload by a decrease in the intrathoracic pressures in the decompression phase improves overall cardiopulmonary resuscitation efficacy. By this means, the impedance threshold valve may be beneficial in patients in asystole or shock-refractory ventricular fibrillation. The potential long-term benefits of this new valve remain under investigation.
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To update the situation over the past few years on the clinical application of volumetric measures of preload in critically ill patients. ⋯ Volumetric measures of preload are good preload indexes. These data are to be interpreted together with the clinical patient's condition, conventional hemodynamic data and the course of illness in critically ill patients. In order to evaluate whether the application of a predefined therapy algorithm based on volumetric monitoring can improve patients' outcome, more studies are needed.
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Curr Opin Crit Care · Jun 2007
ReviewCompression-only cardiopulmonary resuscitation for bystanders and first responders.
The current resuscitation guidelines consider ventilation and chest compression essential components of resuscitation and therefore only one methodology, standard cardiopulmonary resuscitation, is explicitly recommended for the treatment of both respiratory and cardiac arrests. Pathophysiological and experimental observations argue that this generalization results in suboptimal treatment for victims of cardiac arrest. ⋯ The current resuscitation guidelines regarding the prehospital treatment of victims of adult cardiac arrest should be modified to explicitly permit the use of continuous-chest-compression cardiopulmonary resuscitation.