Current opinion in critical care
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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.
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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.
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Curr Opin Crit Care · Jun 2016
ReviewCurrent status of tissue monitoring in the management of shock.
Tissue monitoring is one of the main strategies at the bedside to guide resuscitation of shock. Advances in tissue monitoring technologies have established noninvasive optical methods and transcutaneous oximetry as modalities of considerable value in the critical care setting for tissue monitoring in shock. The purpose of this article is to highlight the latest developments into the clinical applications of near-infrared spectroscopy, direct visualization of sublingual microcirculation, and transcutaneous oxygen measurements (PtcO2). ⋯ The latest developments of noninvasive optical monitoring and transcutaneous oximetry technologies have helped early identification of septic patients at high risk for microcirculatory failure and could allow more targeted interventions in shock.
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An increasing number of patients are placed on extracorporeal membrane oxygenation (ECMO) for respiratory or cardiac failure. Sound understanding of physiology and configuration of ECMO is essential for proper management. This review covers different monitoring parameters and tools for patients supported with different types of ECMO. ⋯ The review will help physicians better assess adequate ECMO support by using the appropriate parameters for each type of configuration.
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Curr Opin Crit Care · Jun 2016
ReviewHigh-quality cardiopulmonary resuscitation: current and future directions.
Cardiopulmonary resuscitation (CPR) represents the cornerstone of cardiac arrest resuscitation care. Prompt delivery of high-quality CPR can dramatically improve survival outcomes; however, the definitions of optimal CPR have evolved over several decades. The present review will discuss the metrics of CPR delivery, and the evidence supporting the importance of CPR quality to improve clinical outcomes. ⋯ Through recent laboratory and clinical investigations, a more evidence-based definition of high-quality CPR continues to emerge. Exciting opportunities now exist to study quantitative metrics of CPR and potentially guide resuscitation care in a goal-directed fashion. Concepts of high-quality CPR have also informed new approaches to training and quality improvement efforts for cardiac arrest care.