Current opinion in critical care
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To review recently published data on pulmonary artery catheter (PAC) use in critically ill patients and consider optimal use of the PAC in personalized clinical practice. ⋯ Only a small number of acutely ill patients require a PAC and insertion should be individualized based on clinical context, availability of trained staff, and the possibility that measured variables will be able to help guide therapy.
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Acute coronary syndromes represent the commonest cause of out-of-hospital cardiac arrest (OHCA) in adults. Coronary angiography (CAG) followed by percutaneous coronary intervention (PCI) has been established as the treatment strategy for these patients. In this review, we aim first to discuss the potential risks and expected benefits from it, the caveats in its implementation, and the current tools for patient selection. Then summarize the recent evidence on the group of patients without ST-segment elevation on post-return of spontaneous circulation (ROSC) ECG. ⋯ Recent studies show no benefit with immediate CAG in groups of patients without ST-segment elevation on post-ROSC ECG. Further refinements in selecting the appropriate patients for immediate CAG seem necessary.
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The aim of this study was to review the role of haemodynamic monitoring in the perioperative setting, highlighting who are the patients who most benefit, to describe the type of devices, to analyse the scientific evidence and to suggest algorithms of haemodynamic care in high-risk surgical patients. ⋯ In this review, we summarize the benefits of haemodynamic monitoring, the type of devices with advantages and disadvantages, the scientific evidence supporting perioperative haemodynamic therapy, and we suggest a multimodal approach to improve patients' care.
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The aim of this study was to illustrate the varying roles of echocardiography in all phases of shock ranging from a rapid, diagnostic tool at the bedside, to a tool for monitoring the adequacy and effects of shock treatment and finally for identification of patients suitable for de-escalation of therapy. ⋯ This study provides the reader with a structured review on the uses of echocardiography in all phases of shock treatment.
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Curr Opin Crit Care · Jun 2023
ReviewPulse wave analysis: basic concepts and clinical application in intensive care medicine.
The measurement of cardiac output ( CO ) is important in patients with circulatory shock. Pulse wave analysis (PWA) estimates CO continuously and in real-time using the mathematical analysis of the arterial pressure waveform. We describe different PWA methods and provide a framework for CO monitoring using PWA in critically ill patients. ⋯ Noninvasive PWA methods are generally not recommended in critically ill patients (who have arterial catheters anyway). PWA systems can be used to continuously track stroke volume and CO in real-time during tests of fluid responsiveness or during therapeutic interventions. During fluid challenges, continuous CO monitoring is important because - if CO decreases - a fluid challenge can be stopped early to avoid further unnecessary fluid administration. PWA externally calibrated to indicator dilution methods can be used - in addition to echocardiography - to diagnose the type of shock.