Current opinion in critical care
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Curr Opin Crit Care · Jun 2016
ReviewAssessment of the effects of inspiratory load on right ventricular function.
The right ventricle (RV) plays a pivotal role during respiratory failure because of its high sensitivity to small loading changes during inspiration. Both RVs, preload and afterload, are altered during inspiration, either in spontaneous breathing or during mechanical ventilation. Some clinical situations especially affect RV load during inspiration, for example acute asthma and acute respiratory distress syndrome. The aim of this review is to explain and to summarize the different mechanisms leading to RV failure in these situations. ⋯ RV is very sensitive to abnormal inspiration, which is always responsible for an increase in its afterload. Pulse pressure variations, central venous pressure and especially echocardiography may monitor RV function in abnormal clinical situations. The pulmonary artery catheter was also proposed although now less used.
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Curr Opin Crit Care · Jun 2016
ReviewIs hypothermia indicated during cardiopulmonary resuscitation and after restoration of spontaneous circulation?
Targeted temperature management (TTM) after cardiac arrest has become a standard therapy in postresuscitation care. However, many questions addressing the optimum treatment protocol remain unanswered. ⋯ To maximize its beneficial potential, TTM should be customized to resuscitation covariates. Despite open questions on the optimum treatment protocol, active cooling should be started as soon as possible and hyperthermic conditions should be prevented in any case. To answer the question if intra-arrest cooling or prehospital cooling induction is indicated, additional studies are needed.
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Curr Opin Crit Care · Jun 2016
ReviewFlow-directed vs. goal-directed strategy for management of hemodynamics.
For the past 15 years, there has been a strong push to use goal-directed protocols for resuscitating critically ill patients and to manage perioperative patients. However, recent large clinical trials have failed to find evidence of improved outcome with this approach. ⋯ A clinical approach that uses monitored values such as cardiac output as a feedback tool to evaluate the response to therapeutic interventions in individual patients may be better than protocols that set fixed targets for all study participants.
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The aim of this review is to update and discuss the use of mechanical chest compression devices in treatment of cardiac arrest. ⋯ Mechanical chest compression devices have been developed to better deliver uninterrupted chest compressions of good quality. Prospective large randomized studies have not been able to prove a better outcome compared to manual chest compressions; however, latest guidelines support their use when high-quality manual chest compressions cannot be delivered. Mechanical chest compressions can also be preferred during transportation, in the cath-lab and as a bridge to more invasive support like extracorporeal membrane oxygenation.
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This article summarizes current knowledge of the causes and consequences of interruption of chest compressions during cardiopulmonary resuscitation. ⋯ It is important to avoid any unnecessary pause in chest compressions before and after a defibrillation shock. Pauses should be kept to an absolute minimum, preferably to less than 10 s.