Current opinion in critical care
-
To discuss recent data that may influence defibrillation in clinical practice and improve outcome after cardiac arrest from a shockable rhythm. ⋯ A defibrillation strategy that enables rhythm analysis to recognize ventricular fibrillation, defibrillator charging and optimally timed shock delivery with minimal or no interruptions to chest compressions should improve the chances of shock success. Performance debriefing of rescuers and recognizing that the risk to rescuers during defibrillation has been overstated should also help minimize interruptions to chest compressions for shock delivery.
-
The present review discusses the evolution of the microcirculation from a theoretical idea to a clinical concept, as a result of the introduction of direct in-vivo observation techniques. ⋯ Direct in-vivo observation of the microcirculation has enabled the construction of microcirculatory failure as a clinical concept in the critically ill. Aiming for promicrocirculatory recruitment strategies in order to improve outcome will be the challenge for the near future.
-
To emphasize the importance and clinical implications of right ventricular function assessment in many situations encountered by intensivists and to explain in practical terms how to perform such an assessment at the bedside. ⋯ Assessment of right ventricular function in the ICU is crucial in many situations because right ventricular failure may be responsible for, or participate in, shock in pulmonary embolism, acute respiratory distress syndrome and septic shock. The best method is echocardiography, which is noninvasive and accurate.
-
To discuss the concept and implementation of regionalized postcardiac arrest care. ⋯ It is feasible to implement a large system of care in which eligible postcardiac patients are triaged to centers capable of delivering standardized, state-of-the art postarrest care. Further research is warranted to determine the optimal design of such a system of care.
-
Curr Opin Crit Care · Apr 2009
ReviewManagement of cardiac arrest patients to maximize neurologic outcome.
Each year, hundreds of thousands of people will be resuscitated after a cardiac arrest. A significant portion of these patients will lapse into a disease state which is the product of modern emergency and critical care medicine: the postcardiac arrest syndrome. The ability to return a patient to his or her prior state of health after cardiac arrest, once completely beyond the capacities of clinicians, is now one of the most important areas of medical science. Much of this ability depends on preserving the nervous system from a complicated sequence of secondary injuries, which ensue from global ischemia. ⋯ This study reviews the latest advances in treating patients after cardiac arrest in the emergency department and critical care unit environments.