Current opinion in critical care
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The holy grail of circulatory monitoring is an accurate, continuous and relatively noninvasive means of assessing the adequacy of organ perfusion. This could be then advantageously used to direct therapeutic interventions to prevent both under-treatment and over-treatment and thus improve outcomes. However, in view of the heterogeneous response (adaptive or maladaptive) of different organs to various shock states, any monitor of perfusion adequacy cannot reflect every organ system, but should at least detect early deterioration in a 'canary' organ. Tissue oxygen tension reflects the balance between local oxygen supply and demand, and could thus be a potentially useful monitoring modality. This article examines the different technologies available and reviews the current literature regarding its utility as a monitor. ⋯ Monitoring of tissue oxygen tension may offer a potentially useful tool for clinical management though significant validation needs to be first performed to confirm its promise.
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The fluid challenge is used in the fluid management of many sick patients. The principle behind the fluid challenge technique is that by giving a small amount of fluid in a short period of time, the clinician can assess whether the patient has a preload reserve that can be used to increase the stroke volume with further fluids. The key components of a fluid challenge are described. ⋯ A fluid challenge identifies and simultaneously treats volume depletion, whilst avoiding deleterious consequences of fluid overload through its small volume and targeted administration.
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Summary estimates indicate that bystander cardiopulmonary resuscitation (CPR) can improve the chances of out-of-hospital cardiac arrest survival two-fold to three-fold. And yet, only a minority of arrest victims receive bystander CPR. This summary will review the challenges and approaches to achieve early and effective bystander CPR. ⋯ Recent developments in bystander CPR have simplified arrest recognition and improved CPR training, while retaining CPR effectiveness. The goal of these developments is to increase and improve bystander CPR and in turn improve resuscitation.
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Drug therapy continues to be recommended as part of cardiac arrest management. There has been increasing transparency about the lack of evidence to support such drug therapy, and the gaps identified in our knowledge have stimulated ongoing research. This review aims to highlight recently published articles that relate to the use of drugs during cardiopulmonary resuscitation (CPR). ⋯ The use of some drugs (e.g. epinephrine) can be recommended in cardiac arrest, but only on the basis of short-term benefits. These short-term benefits need to be converted into long-term outcomes by optimizing management in the postarrest period. Potential drug strategies need to be evaluated in settings in which the drug is administered in a timely fashion, good CPR is provided, and postresuscitation care has been optimized.
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Curr Opin Crit Care · Jun 2011
ReviewTherapeutic hypothermia after cardiac arrest: where are we now?
Therapeutic hypothermia is widely recommended after cardiac arrest. In this review, we present publications reflecting the current discussion and opinions related to use of therapeutic hypothermia in comatose adult cardiac arrest survivors. ⋯ Although only proven beneficial for patients with ventricular fibrillation, the majority of centres today use therapeutic hypothermia also for comatose survivors with other initial rhythms. Some controversies still exist; the optimal target temperature, timing and duration of cooling have not yet been defined, and some researchers still think that the concept of therapeutic hypothermia is not satisfactorily proven scientifically. A new randomized study comparing temperature management to 36°C with 33°C is therefore underway.