Current opinion in critical care
-
Successful resuscitation requires potentially reversible causes to be diagnosed and reversed, and many of these can readily be diagnosed using echocardiography. Although members of the resuscitation team routinely use adjuncts to their clinical examination in order to differentiate these causes, the use of echocardiography is not yet considered standard. The purpose of this review is to discuss the potential for echocardiography to aid diagnosis and treatment during resuscitation, together with some of the perceived challenges that currently limit its widespread use. ⋯ Persistent and worsening haemodynamic instability are regarded as clear indications for echocardiography. The focused application of this well established technique within the ALS algorithm provides the resuscitation team with a potentially powerful diagnostic tool that can be used to diagnose/exclude some of the potentially treatable causes of cardiac arrest as well as to guide therapeutic interventions. The impact of routine periresuscitation echocardiography on patient outcomes both for in-hospital and prehospital care remains an exciting avenue for future research.
-
We report on the evolution of airway pressure and flow monitoring from a pathophysiological tool to the cornerstone of ventilator-induced lung injury (VILI) prevention. ⋯ Airway pressure and flow monitoring is essential for VILI prevention and for an appropriate setting of mechanical ventilation.
-
Electrical impedance tomography (EIT) noninvasively creates images of the local ventilation and arguably lung perfusion distribution at bedside. Methodological and clinical aspects of EIT when used as a monitoring tool in the intensive care unit are reviewed and discussed. ⋯ Growing evidence suggests that EIT may play an important role in individually optimizing ventilator settings in critically ill patients.
-
Out-of-hospital cardiac arrest (OOHCA) is a common public health problem. Regional systems of care have improved provider experience and patient outcomes for those with ST-elevation myocardial infarction and life-threatening traumatic injury. We review evidence of the effectiveness of regional cardiac resuscitation systems and describe preliminary recommended elements of such systems. ⋯ Many more people could survive OOHCA if regional systems of cardiac resuscitation were established. The time has come to implement such systems whenever feasible.
-
To discuss the role of microcirculatory abnormalities in critically ill patients and the link between systemic hemodynamics and microvascular perfusion. ⋯ Microvascular alterations frequently occur in critically ill patients and these may be implicated in the development of organ failure and are associated with outcome. The link between systemic hemodynamics and microcirculation is relatively loose.