Current opinion in critical care
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The role of cardiac arrest centers, more recently termed Cardiac Receiving Centers, in improving outcomes after successful resuscitation is becoming more and more convincing. But which of all the treatments provided by Cardiac Receiving Centers are most beneficial is less certain. This review examines the role of early coronary angiography and percutaneous coronary intervention in this regard. ⋯ Emergent coronary angiography and percutaneous coronary intervention are the most important Cardiac Receiving Center treatments beyond hypothermia. Providing both of these essential postresuscitation therapies is the very purpose of such centers.
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The 2010 Cardiopulmonary Resuscitation (CPR) Guidelines recommended therapeutic hypothermia for postcardiac arrest syndrome as a beneficial and effective treatment. However, the optimal temperature, method, onset, duration and rewarming rate, and therapeutic window remain unknown. ⋯ One of the most significant advances in CPR treatment in the past decade is therapeutic hypothermia. Although post-ROSC cooling has been shown to improve neurological outcome for patients with out-of-hospital cardiac arrest, intra-arrest cooling during CPR is likely to protect the myocardium from reperfusion injury and enhance neurological benefits.
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Curr Opin Crit Care · Jun 2012
ReviewDispatch-assisted cardiopulmonary resuscitation: the anchor link in the chain of survival.
Early bystander cardiopulmonary resuscitation (CPR) provides a vital bridge after collapse from cardiac arrest until defibrillation can be performed. However, due to multiple barriers and despite large-scale public CPR training, this life-saving therapy is still not rendered in a majority of cardiac arrest events. As a result, cardiac arrest survival remains very low in most communities. ⋯ This review focuses on the rationale and evolving science behind dispatch CPR instructions, as well as some best practices for implementing and measuring dispatch-assisted CPR with the goal of maximizing its potential to save lives from sudden cardiac arrest.
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Curr Opin Crit Care · Jun 2012
ReviewLung monitoring at the bedside in mechanically ventilated patients.
It has become clear that mechanical ventilation itself can cause damage to the lung in critically ill patients, also known as ventilator-induced lung injury (VILI). Insight into the mechanisms of VILI has learned that a compromise must be found between positive end-expiratory pressure (PEEP) induced alveolar recruitment and prevention of hyperinflation. Therefore, there is a need for clinicians to optimize the PEEP settings for the individual patient at the bedside. In this review, we will discuss several lung-monitoring techniques to improve patient ventilator settings. ⋯ In conclusion, both FRC and EIT are promising clinical monitoring systems but clinical studies are needed to prove whether these monitors help the clinician toward effective and better ventilator management.
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Curr Opin Crit Care · Jun 2012
ReviewMonitoring peripheral perfusion in critically ill patients at the bedside.
The goal of circulatory monitoring is the use of an accurate, continuous and noninvasive method that can easily assess tissue perfusion under clinical conditions. As peripheral tissues are sensitive to alterations in perfusion, the noninvasive monitoring of peripheral circulation could be used as an early marker of systemic haemodynamic derangement. We, therefore, aim to discuss the currently available methods that can be used at the bedside as well as the role of peripheral perfusion monitoring in critically ill patients. ⋯ Subjective assessments and optical techniques provide important information regarding peripheral circulation. Moreover, these techniques are relatively easy to implement and interpret at the bedside and can be applied during acute conditions. Further research is warranted to investigate the effects of therapeutic interventions on peripheral perfusion parameters and patient outcome.