摘要:

Mechanical measures intended to increase blood flow to vital organs are the mainstay of therapy for patients in cardiac arrest. Several new cardiopulmonary resuscitation techniques and devices have been developed and tested since the first report of manual closed-chested cardiopulmonary resuscitation nearly four decades ago. These include vest cardiopulmonary resuscitation, active compression-decompression cardiopulmonary resuscitation, an intra-aortic perfusion balloon pump, and an inspiratory impedance threshold valve, interposed abdominal counterpulsation cardiopulmonary resuscitation, and phased thoracic-abdominal compression and decompression. Many of these new mechanical advances in the treatment of cardiac arrest are currently undergoing clinical evaluation in patients in cardiac arrest. Although some of those new methods and techniques have shown promise in small human clinical trials, none have yet to be found to be conclusively superior to manual closed-chested cardiopulmonary resuscitation.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Both health care professionals and the general public are reluctant to perform mouth-to-mouth ventilation because of the widespread fear of contracting contagious diseases. Although several laboratory studies have shown that both gasping and chest compressions result in significant minute ventilation during cardiopulmonary resuscitation (CPR), these strategies may only be applicable if a rescuer is without equipment and chooses to withhold mouth-to-mouth ventilation. The gold standard for CPR performed by professional rescuers is endotracheal intubation and ventilation with oxygen; this remains the best therapy for both ventilation and prevention of aspiration. The European Resuscitation Council has recently recommended that tidal volume be decreased from between 0.8 and 1.2 L to 0.5 L during basic life support CPR, partly to decrease inspiratory flow rate and airway pressure and, therefore, minimize stomach inflation. This strategy provides reasonable ventilation during CPR while avoiding massive gastric inflation, winch in turn may result in life-threatening complications.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Defibrillation is probably the single most important lifesavmg procedure for adult patients with sudden cardiac death. Recent advances in both the practical and the electrical delivery of shocks offer improved prospects for success. We can now foresee both the exciting possibilities offered by new, small, light, reliable, and inexpensive automatic defibnllators and their widespread use by medically trained and lay persons. Such developments serve to focus attention on the importance of the recognition of and prompt response to cardiac arrest by the general public and the emergency services.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Hemodynamic monitoring continues to be used in the diagnosis and treatment of critically ill patients. In recent years, some progress has been made in decreasing the complications inherent to invasive monitoring. New technological developments now enable clinicians to continuously monitor arterial blood gas parameters. Despite extensive clinical experience with the pulmonary artery catheter, controversy still surrounds its use. In this article, the authors review recent literature related to arterial, central venous pressure, and pulmonary artery catheter monitoring.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

The most important factors in the treatment of sepsis, acute respiratory distress syndrome, and multiorgan dysfunction syndrome are early intervention and prevention. Rapid institution cf early and appropriate antibiotics, early debridement of wounds, and restoration of adequate tissue perfusion through aggressive fluid resuscitation are considered the mainstay of therapy for these critically ill patients. Because tissue oxygen debt has been linked to mortality and the development of organ failure, monitoring oxygen delivery and consumption has become important in the management of inflammatory shock. Routine vital signs, at best, indirectly assess global perfusion and certainly do not provide accurate information as to the adequacy of perfusion in regional tissue beds. Regional acidosis may occur despite adequate fluid resuscitation and restoration of global oxygen delivery. Unfortunately, the failure of global measures of oxygen transport and consumption to clearly demonstrate a beneficial impact in outcome studies leave; the clinician with precious little to guide him or her in the resuscitation of patients in inflammatory shock states. The clinical value of global increases in oxygen delivery and consumption for inflammatory shock now must be considered questionable, leaving the bedside critical care clinician in limbo. We cannot rely on routine vital signs to assure us that we have restored adequate levels of oxygen delivery to our patients, and yet no other measures of tissue perfusion have proven efficacious. Monitoring and normalizing lactate levels may be helpful, and we must await further studies before recommending the routine use of tonometry. In conclusion, routine monitoring of oxygen delivery and consumption may be helpful to provide the clinician with a good overall measure of global oxygen transport, which, although better than routine vital signs, still does not provide the ultimate measure of “adequate tissue perfusion.” The future of monitoring oxygen delivery and consumption may lie at a cellular and microcirculatory level.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Transesophageal echocardiography (TEE) has evolved to become one of the most versatile modalities for diagnosing, monitoring, and treating critically ill patients. Presently, the principal indications for TEE are imaging structures, such as the left atrial appendage or the thoracic aorta, that are inadequately displayed on transthoracic echocardiography; assessing endocarditis, intracardiac thrombus, valvular malfunction, or aortic dissection; and monitoring left and right ventricular wall motion. TEE has several important advantages over other imaging techniques. The most important advantages are its capacity for bedside use and the avoidance of intravenous contrast material in patients at risk for renal failure. We review and summarize the recent literature on the application of TEE in critical care medicine and define our expectations for future use of TEE in the intensive care unit.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

This paper discusses new techniques for measuring cardiac output noninvasively, and their applications in critically ill and injured patients. Determination of cardiac output has become an integral part of clinical critical care. Since the availability of pulmonary artery catheters in the mid 1 970s, much of the therapy and diagnosis in the intensive care unit is directed by the measurements obtained through invasive hemodynamic monitoring. Costs and complications associated with invasive hemodynamic monitoring are a major concern, limiting the availability of this information to the intensive care unit and the operating room. Advances in technology and understanding of physiology offer the opportunity to measure cardiac output noninvasively. A noninvasive approach will reduce costs and complications and provide the capacity to obtain information wherever the patient may be located.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID

摘要:

Inhaled nitric oxide is a pulmonary vasodilator that is acquiring a place in clinical medicine, both as a diagnostic test of pulmonary vascular reactivity and as a therapeutic agent for pulmonary hypertension and respiratory failure. Although the therapeutic use of inhaled nitric oxide is of major clinical importance, improper delivery or inadequate monitoring may produce unwanted side effects. An ideal system will deliver a wide range of precise nitric oxide doses regardless of the mode of ventilation. It will have on-line analysis of nitric oxide, nitrogen dioxide, and oxygen; incorporate stringent controls for exhaled gases; and will have alarms to protect against excessing dosing or inadvertent discontinuation. This review discusses current literature relevant to the evolution of delivery systems from makeshift designs adapted and modified by individual investigators to commercially available mechanical ventilators specifically designed to deliver nitric oxide that utilize microprocessor controlled, mass flow regulated technology. Current methods for monitoring nitric oxide, including electrochemical and chemiluminescent devices, have advantages and limitations which are discussed in conjunction with the major recognized toxicities associated with the technical aspects of delivery and monitoring of the drug.

ISSN:1070-5295    

出版商:OVID    

年代:1997

数据来源: OVID