Current opinion in critical care
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Curr Opin Crit Care · Aug 2017
ReviewThe value of dynamic preload variables during spontaneous ventilation.
To discuss the physiological significance and clinical value of dynamic preload variables in spontaneously breathing patients. ⋯ Although originally intended to be used only during mechanical ventilation, 'dynamic parameters' may offer valuable clinical information in spontaneously breathing patients.
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Our understanding of critical illness is transforming as we develop a better understanding of the impact pathogen-associated molecular patterns and damage-associated molecular patterns (DAMPs) have on the pathogenesis of disease. Of the known DAMPs, there is a growing interest in mitochondrial DNA (mtDNA) as a DAMP capable of propagating the inflammatory response seen in sepsis and other conditions. In this review, we describe the varying mechanisms by which mtDNA is translocated from mitochondria into cytosol and the extracellular space where it can illicit an inflammatory response. In addition, we present some of the most recent clinical studies to examine mtDNA in critical illness. ⋯ Although mtDNA is a DAMP shown to be elevated in numerous conditions, the clinical ramifications of this finding remain elusive. Further work is needed to determine if mtDNA can be utilized as a biomarker of disease severity or mortality.
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Curr Opin Crit Care · Jun 2017
ReviewPassive leg raising for assessment of volume responsiveness: a review.
To evaluate the existing evidence on the passive leg raising (PLR) test for fluid responsiveness prediction. ⋯ The current review underlines that PLR is an easy-to-perform and reliable method to assess fluid responsiveness. Its excellent performance is maintained even in many situations in which other dynamic predictive indices are not consistent and represents a valid alternative to the fluid challenge to avoid unnecessary volume administration.
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Curr Opin Crit Care · Jun 2017
ReviewThe past, present, and future of ventilation during cardiopulmonary resuscitation.
To evaluate the past and present literature on ventilation during out of hospital cardiac arrest, highlighting research that has informed current guidelines. ⋯ Future out of hospital cardiac arrest studies are still exploring how to optimize the delivery of ventilation during the initial stages of resuscitation. More prospective studies focusing on ventilation are needed to inform guidelines.