Current opinion in critical care
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Curr Opin Crit Care · Jun 2005
ReviewHow does interruption of cardiopulmonary resuscitation affect survival from cardiac arrest?
Survival rates from cardiac arrest are unacceptably low. The present review aims to summarize recent contributions to cardiopulmonary resuscitation research in relation to hemodynamic consequences and especially survival resulting from interruption of chest compressions for defibrillation and rescue breathing. ⋯ Interruption of cardiopulmonary resuscitation negatively affects survival from cardiac arrest. Fewer interruptions for interventions and interventions that take less time may improve survival.
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Curr Opin Crit Care · Jun 2005
ReviewRegional carbon dioxide monitoring to assess the adequacy of tissue perfusion.
Tissue dysoxia is now widely regarded as the major factor leading to organ dysfunction in critically ill patients. Recent data suggests that early aggressive resuscitation of critically ill patients, which limits and/or reverses tissue dysoxia may prevent progression to organ dysfunction and improve outcome. The traditional clinical and laboratory markers used to assess tissue dysoxia are, however, insensitive and have numerous limitations. Regional carbon dioxide monitoring appears to be ideally suited to monitoring the adequacy of resuscitation. This review provides an update on this evolving technology. ⋯ Sublingual capnometry may be the ideal technology for guiding early goal directed therapy. This technology may be useful for monitoring tissue oxygenation, titrating therapeutic interventions, and as an end point for resuscitation in critically ill and injured patients.
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Despite a more widespread knowledge of basic cardiopulmonary resuscitation maneuvers in the community, the survival rate for patients with cardiac arrest has remained essentially unchanged in the past 30 years. Over the past few decades, many different compression-ventilation ratios have been studied in terms of best coronary and cerebral oxygen delivery, restoration of spontaneous circulation, and neurologic outcome. This article summarizes the recent evidence presented at the International Consensus on Resuscitation Science in January 2005. ⋯ The optimal compression-ventilation ratio is still unknown and the best tradeoff between oxygenation and organ perfusion during cardiopulmonary resuscitation is probably different for each patient and scenario. A discrepancy between what is recommended by the current guidelines and the 'real world' of cardiopulmonary resuscitation has resulted in a near flat survival rate from cardiac arrest in the past few years.
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Central venous pressure is a very common clinical measurement, but it is frequently misunderstood and misused. As with all hemodynamic measurements, it is important to understand its basic principles. ⋯ The clinical application of central venous pressure measurement requires a good understanding of the concept of the interaction of the function of the heart with the function of the return of blood to the heart.