Current opinion in critical care
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The ANDROMEDA-SHOCK trial positioned capillary refill time (CRT) assessment as a novel resuscitation target for septic shock.The purpose of this article is to summarize pathophysiological determinants of CRT, review new technical developments on peripheral perfusion assessment, and explore recent evidence on the role of CRT monitoring in septic shock and other critical conditions. ⋯ Recent data confirm the relevance of peripheral perfusion assessment in septic shock and other conditions in critically ill patients. Future studies should confirm these findings, and test the potential contribution of technological devices to assess peripheral perfusion.
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Curr Opin Crit Care · Jun 2023
ReviewAdvantages and limitations of noninvasive devices for cardiac output monitoring: a literature review.
Individualized hemodynamic optimization often requires cardiac output monitoring, mostly for goal-directed therapy in the operating room and fluid responsiveness assessment in the intensive care unit. Different technologies for noninvasive cardiac output determination have become available over the recent years. It is therefore crucial for care providers to be made aware of the advantages and limitations of those different devices for an appropriate use at the bedside. ⋯ Noninvasive cardiac output monitoring may have a clinical impact on patient outcomes. Further studies are required to evaluate their clinical relevance, notably in the intensive care unit. Noninvasive monitoring opens up the possibility for hemodynamic optimization in specific or low-risk populations, the benefit of which remains to be assessed.
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The aim of this study was to review the role of haemodynamic monitoring in the perioperative setting, highlighting who are the patients who most benefit, to describe the type of devices, to analyse the scientific evidence and to suggest algorithms of haemodynamic care in high-risk surgical patients. ⋯ In this review, we summarize the benefits of haemodynamic monitoring, the type of devices with advantages and disadvantages, the scientific evidence supporting perioperative haemodynamic therapy, and we suggest a multimodal approach to improve patients' care.
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Curr Opin Crit Care · Jun 2023
ReviewThe role of the electroencephalogram and evoked potentials after cardiac arrest.
In comatose cardiac arrest survivors, the electroencephalogram (EEG) is the most widely used test to assess the severity of hypoxic-ischemic brain injury (HIBI) and guide antiseizure treatment. However, a wide variety of EEG patterns are described in literature. Moreover, the value of postarrest seizure treatment is uncertain. Absent N20 waves of short-latency somatosensory-evoked potentials (SSEPs) are a specific predictor of irreversible HIBI. However, the prognostic significance of the N20 amplitude is less known. ⋯ Standardized EEG terminology and quantitative approach to SSEP are promising for improving the neuroprognostic accuracy of these tests. Further research is needed to identify the potential benefits of antiseizure treatment after cardiac arrest.
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The aim of this study was to illustrate the varying roles of echocardiography in all phases of shock ranging from a rapid, diagnostic tool at the bedside, to a tool for monitoring the adequacy and effects of shock treatment and finally for identification of patients suitable for de-escalation of therapy. ⋯ This study provides the reader with a structured review on the uses of echocardiography in all phases of shock treatment.