Current opinion in critical care
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Curr Opin Crit Care · Jun 2007
ReviewCompression-only cardiopulmonary resuscitation for bystanders and first responders.
The current resuscitation guidelines consider ventilation and chest compression essential components of resuscitation and therefore only one methodology, standard cardiopulmonary resuscitation, is explicitly recommended for the treatment of both respiratory and cardiac arrests. Pathophysiological and experimental observations argue that this generalization results in suboptimal treatment for victims of cardiac arrest. ⋯ The current resuscitation guidelines regarding the prehospital treatment of victims of adult cardiac arrest should be modified to explicitly permit the use of continuous-chest-compression cardiopulmonary resuscitation.
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Computed tomography (CT) in patients with acute respiratory distress syndrome has shown that intrapulmonary gas is not homogeneously distributed. Although regional ventilation can be studied by isotope and magnetic resonance techniques while aeration of the lungs can be imaged using CT, these techniques are not available at the bedside. Recently, electrical impedance tomography has been introduced as a true bedside technique which provides information on regional ventilation distribution. ⋯ In view of recently published data, it can be concluded that, in critically ill patients, electrical impedance tomography determines reliable regional ventilation. Therefore, this technique has the potential to become a valuable bedside tool.
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Numerous recent reports have described limitations in the quality of cardiopulmonary resuscitation. Thus, there has been increasing interest in the techniques available to monitor quality. This review focuses on the major publications since the review published by the International Liaison Committee on Resuscitation in 2005. Some key articles published prior to this time period have also been included. ⋯ Many options are available to monitor the quality of cardiopulmonary resuscitation. Some have significant limitations, and others are only readily available in hospital. The use of the information from this more intensive monitoring promises to improve outcomes of cardiopulmonary resuscitation.