Current opinion in critical care
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Postresuscitation myocardial dysfunction (PRMD) is a frequent complication, which worsens the hemodynamic status and can be lethal. Early identification and treatment of this cardiac complication is one of the key therapeutic goals during hospitalization of these patients. ⋯ Reversibility of PRMD justifies an aggressive management strategy, including detection of myocardial ischemia, inotropic support, and in the most severe cases, mechanical circulatory assistance. Hemodynamic dysfunction should not influence the decision to continue treatment because it is often reversible - the neurological status is much more likely to determine the ultimate outcome.
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Curr Opin Crit Care · Jun 2013
ReviewBlood content analysis for evaluating cardiopulmonary function.
To review the role of blood analysis in cardiac and pulmonary evaluation. ⋯ The ongoing research on blood contents has not resulted in any new outstanding markers to the critical care physician to use in evaluating cardiopulmonary function, with the exception of high-sensitive cTn. Yet, many recent studies assist the clinician by providing a better understanding of how to use routine tools, like arterial and venous blood gas analysis, more effectively and offer guidance in optimizing Hb and lactate blood levels.
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Left-ventricular diastolic dysfunction is associated with various conditions frequently encountered in ICU patients. Due to prolonged relaxation and increased left-ventricular stiffness, patients with diastolic dysfunction are at high risk of developing abrupt pulmonary venous congestion. The present review describes the clinical spectrum of left-ventricular diastolic abnormalities in ICU patients. ⋯ Left-ventricular diastolic dysfunction accounts for a growing proportion of cardiogenic pulmonary edema and weaning failure in ICU patients. It may be reversible when induced by sepsis or myocardial ischemia. Its prognostic value in the ICU settings remains to be further investigated.
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Curr Opin Crit Care · Jun 2013
ReviewFrom speckle tracking echocardiography to torsion: research tool today, clinical practice tomorrow.
Speckle tracking is the latest available technology in echocardiography. However, the technology is still mainly used as a research tool. The potential applications of speckle tracking are many, including cardiac synchronization, regional wall motion analysis, and in the areas of cardiac mechanic studies. This review presents the background theory of speckle tracking echocardiography (STE) and how this technology can be extended to velocity vector analysis, strain, and torsion measurements. The interpretations of these measurements are covered. We also present some potential applications in the critical care setting. ⋯ Speckle tracking can be used to measure instantaneous myocardial contractility, strain, and left ventricular torsion. It is still a research tool at present, but shows the promise of being a clinical tool in the future.