Current opinion in critical care
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Curr Opin Crit Care · Jun 2013
ReviewThe role of invasive techniques in cardiopulmonary evaluation.
To discuss the role of the invasive monitoring techniques pulmonary artery catheter (PAC) and transpulmonary thermodilution (TPD) for cardiopulmonary monitoring in the critically ill patient. ⋯ This review highlights that PAC and TPD have an important role in cardiopulmonary monitoring of critically ill patients. Both techniques can be used efficiently to diagnose the nature of circulatory or respiratory failure and to monitor the effects of therapies. The choice of the technique should be guided by the patient's condition and the need for additional measurements rather than based on physician's preferences.
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To describe the theory behind arterial waveform analysis, the different variables that may be obtained using this method, reliability of measurements and their clinical relevance. Areas for future research are identified. ⋯ Despite significant limitations in measurement accuracy and inter-device differences, arterial waveform analysis is a potentially useful tool for monitoring the central circulation in critically ill patients. Future studies investigating the effects of haemodynamic management guided by arterial waveform variables in critically ill patients are urgently needed. The evaluation of cardiopulmonary interactions and usefulness of dP/dt are other areas that require further investigation.
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Curr Opin Crit Care · Jun 2013
ReviewVentilation parameters used to guide cardiopulmonary function during mechanical ventilation.
To describe the newly introduced ventilation parameters that are used at the bedside to estimate cardiopulmonary function during positive pressure ventilation (PPV). ⋯ The utility of lung ultrasound is expanding. Although the clinical implications of FRC measurement and lung monitoring with imaging tools such as EIT are starting to be realized, their efficacy in severe hypoxic respiratory failure should be evaluated further in well designed clinical trials. To improve the preemptive management of impending respiratory failure, an alarm index that integrates noninvasive cardiopulmonary function parameters should be developed.
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Curr Opin Crit Care · Jun 2013
Review Observational StudyAirway management in cardiopulmonary resuscitation.
The optimal method for airway management during cardiac arrest is unknown. This review summarizes recent evidence comparing the use of basic and advanced airway interventions [insertion of supraglottic airway (SGA) devices and tracheal intubation], including the role of capnography during cardiac arrest. ⋯ Most of the evidence about airway management during cardiac arrest comes from observational studies. The best airway option is likely to be different for different rescuers, and at different time points of the resuscitation process. Properly designed, prospective, randomized trials are needed to help determine the optimal airway strategy. In our view, there is currently sufficient clinical equipoise to support such trials.