Current opinion in critical care
-
This article describes and discusses the importance of monitoring patient-ventilator asynchrony, and the advantages and limitations of the specific techniques available at the bedside to evaluate it. ⋯ The prevalence and consequences of asynchronies may be largely underestimated because of a frequent lack of monitoring. Dedicated software solutions that continuously and automatically detect asynchronies may allow both clinical research and clinical applications aimed at determining the effects of asynchronies and minimizing their incidence among critically ill patients.
-
Left ventricular (LV) outflow tract (LVOT) obstruction (LVOTO) is not unusual in ICU patients particularly with septic shock. ⋯ LVOTO is not uncommon in ICU patients and can be observed at the early phase of septic shock. Treatment should include discontinuation of dobutamine infusion and fluid infusion. β blockers can be useful in this clinical situation.
-
Curr Opin Crit Care · Jun 2016
ReviewSee through ECG technology during cardiopulmonary resuscitation to analyze rhythm and predict defibrillation outcome.
Automated external defibrillators require preshock interruptions in cardiopulmonary resuscitation (CPR) to perform rhythm analysis. Artifact filtering technology may provide the opportunity to visualize the underlying ECG trace during CPR. Moreover, a continuous ventricular fibrillation analysis may be performed such to prioritize CPR interventions, that is, chest compression or defibrillation. ⋯ The feasibility of ventricular fibrillation detection during CPR is a challenging issue that, if solved, would enable CPR to continue during the automated external defibrillator rhythm analysis. Furthermore, it would allow a continuous ventricular fibrillation analysis to optimize the timing of defibrillation and maximize the shock success.
-
Curr Opin Crit Care · Jun 2016
ReviewNear-infrared spectroscopy during cardiopulmonary resuscitation and after restoration of spontaneous circulation: a valid technology?
This article explores the status of using near-infrared spectroscopy and reporting cerebral oximetry (rSO2) for cardiac arrest patients. ⋯ Near-infrared spectroscopy and rSO2 have been used as a monitor during CPR, detection of ROSC, after ROSC, and during post-resuscitation care. Prospective, controlled, randomized clinical studies are needed to document their wide use.
-
Prone positioning is recommended as a rescue therapy to improve arterial oxygenation in patients with severe acute respiratory distress syndrome (ARDS). In this review, we summarize the macro and the microcirculatory effects of prone positioning and emphasize which hemodynamic variables can be monitored when this therapy is applied. ⋯ Prone positioning generally exerts beneficial macrocirculatory effects, which can result in increased cardiac output in patients with preload reserve without negatively altering regional circulations.