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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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.
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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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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.
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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.