Current opinion in critical care
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To describe our knowledge about in-hospital cardiac arrest (IHCA) including recent developments. ⋯ In-hospital cardiac arrest is a global health problem with a 25% survival in high-income settings. There remain significant opportunities to both decrease the incidence of, and outcomes from IHCA.
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Despite improvements over time, cardiac arrest continues to be associated with high rates of mortality and morbidity. Several methods can be used to achieve airway patency during cardiac arrest, and the optimal strategy continues to be debated. This review will explore and summarize the latest published evidence for airway management during cardiac arrest. ⋯ Observational studies continue to dominate the evidence base relating to cardiac arrest airway management. Cardiac arrest registries enable these observational studies to include many patients; however, the design of such studies introduces considerable bias. Further randomized clinical trials are underway. The current evidence does not indicate a substantial improvement in outcome from any single airway strategy.
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The purpose of this article is to review the current status of public access defibrillation and the various utility modalities of early defibrillation. ⋯ Recent advances in the use of public access defibrillation show great potential for optimizing early defibrillation. With new technological solutions, AEDs can be transported to the cardiac arrest location reaching OHCAs in both public and private locations. Furthermore, new technological innovations could potentially identify and automatically alert the emergency medical services in nonwitnessed OHCA previously left untreated.
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Devices for assessing microcirculation at the bedside have been a technological breakthrough in the critical care field. Thanks to this technology, a large body of scientific evidence has highlighted the relevance of microcirculatory disruptions during critical illness. The goal of this review is to analyze the current knowledge concerning microcirculation monitoring, mainly focused on clinically available devices. ⋯ Currently, there are several methods for microcirculatory monitoring. To properly apply and correctly interpret the information they provide, clinicians should know the fundamental principles and the strengths and weaknesses of the clinically available devices.
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Curr Opin Crit Care · Jun 2023
ReviewWhich haemodynamic monitoring should we chose for critically ill patients with acute circulatory failure?
To discuss the suitable haemodynamic monitoring for critically ill patients with shock. ⋯ For monitoring critically ill patients with shock, minimally or noninvasive systems are not reliable or informative enough. In the most severe patients, a reasonable monitoring policy can combine continuous monitoring by transpulmonary thermodilution systems or the pulmonary arterial catheter, with an intermittent assessment with ultrasound and measurement of tissue oxygenation.