Current opinion in critical care
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Curr Opin Crit Care · Jun 2008
ReviewDeveloping alternative strategies for the treatment of traumatic haemorrhagic shock.
The optimal strategy of stabilizing haemodynamic function in uncontrolled traumatic haemorrhagic shock states is unclear. Although fluid replacement is established in controlled haemorrhagic shock, its use in uncontrolled haemorrhagic shock is controversial, because it may worsen bleeding. ⋯ A multicenter, randomized, controlled, international clinical trial is being initiated to assess the effects of arginine vasopressin (10 IU) vs. saline placebo in prehospital traumatic haemorrhagic shock patients, not responding to standard shock treatment, being managed by helicopter emergency medical services [vasopressin in traumatic haemorrhagic shock (VITRIS.at) study].
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Curr Opin Crit Care · Jun 2008
ReviewImproving cardiopulmonary resuscitation quality to ensure survival.
There is correlation between quality of bystander cardiopulmonary resuscitation and patient survival. Recent developments in defibrillator technology enable recording of cardiopulmonary resuscitation quality, and have shown quality of professional cardiopulmonary resuscitation far from guidelines' levels for factors such as chest compression depth and rate, ventilation rate, and pauses in chest compressions. The effects of cardiopulmonary resuscitation quality factors on patient survival are presently under scrutiny. ⋯ Cardiopulmonary resuscitation quality affects survival after cardiac arrest. Reporting cardiopulmonary resuscitation quality data should be standard in all studies of cardiac arrest as effects of studied interventions can depend on or influence cardiopulmonary resuscitation quality. These data are also valuable in quality improvement processes both in-hospital and out-of-hospital.
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Curr Opin Crit Care · Jun 2008
ReviewIntraabdominal pressure monitoring during fluid resuscitation.
Elevated intraabdominal pressure is commonly encountered in the critically ill, has detrimental effects on all organ systems, and is associated with significant morbidity and mortality. Serial intraabdominal pressure measurements are essential to the diagnosis, management, and fluid resuscitation of patients who develop intraabdominal hypertension and/or abdominal compartment syndrome. ⋯ Serial intraabdominal pressure measurements are essential for the diagnosis and management of intraabdominal hypertension/abdominal compartment syndrome. Intraabdominal pressure must be measured accurately and utilized in a goal-directed fashion to guide fluid and end-organ resuscitation. As a result of its ability to predict survival among the critically ill, intraabdominal pressure should be routinely monitored in the patient who demonstrates risk factors for intraabdominal hypertension/abdominal compartment syndrome.
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Curr Opin Crit Care · Jun 2008
ReviewPrevention and therapy of postresuscitation neurologic dysfunction.
The majority of cardiac arrest patients die after successful resuscitation. Despite disappointing survival rates, cardiac arrest research mainly focuses on new therapies applied during cardiac arrest in the out-of-hospital setting, but only little attention is given to therapies mitigating the so-called postresuscitation syndrome. Optimized postresuscitation hospital care might have the potential to substantially improve survival rate in patients after cardiac arrest. ⋯ Therapeutic mild hypothermia (32-34 degrees C) is currently the most advanced medical concept to prevent or mitigate the postresuscitation syndrome. Large prospective randomized clinical trials are needed to investigate normoventilation with blood gases within physiologic range, moderately elevated blood glucose levels, a mean arterial pressure above 80 mmHg, and early reperfusion therapy in all cardiac arrest patients.
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To summarize current opinion and advances in pediatric cardiopulmonary resuscitation, including etiology, pathophysiology, rationale for interventions, and postresuscitation management. ⋯ Recent advances in our understanding of the etiology, pathophysiology, and therapies tied to the timing, phase, and duration of cardiac arrest can improve outcomes for children. New epidemiological data and multicenter studies are ushering in the era of evidence-based pediatric resuscitation therapeutics.