ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

The failure of current medical practice to effectively treat most victims of cardiac arrest indicates the need for improved therapies. In this report, research studies of external methods of reestablishing blood flow during cardiopulmonary resuscitation (CPR) are reviewed. Emphasis is on mechanisms of CPR and efficacy measurements, with special reference to the effects of newly introduced techniques, including interposed abdominal compression CPR, pneumatic vest CPR, active compression-decompression CPR, and “Lifestick” (Datascope Corp., Fairfield, NJ) CPR. The early promise shown by these new techniques is likely to lead to new options for closed chest CPR.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Epinephrine increases coronary and cerebral blood flow during cardiopulmonary resuscitation (CPR) through α-adrenergic mechanisms. Although experimental studies and preliminary clinical observations suggested that standard doses of epinephrine are too low, several major clinical trials failed to demonstrate significant improvement with high-dose therapy. The limited effectiveness of epinephrine in any dose may be in part due to the adverse effects of β-adrenergic stimulation on myocardial oxygen requirements during ventricular fibrillation. However, there is no convincing evidence that vasoconstricting agents lacking β-adrenergic effects are more efficacious. Because the intense sympathetic neurohumoral stimulation of the heart that accompanies cardiac arrest results in high myocardial oxygen requirements, it is unlikely that any pharmacologic intervention will be able to prevent myocardial ischemia during CPR unless myocardial oxygen requirements are reduced. Moreover, the potential efficacy of pharmacologic interventions during CPR is limited by the overwhelming influences of underlying disease processes and the duration of antecedent circulatory arrest on resuscitation outcomes.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Basic life support, as recommended by the American Heart Association, is a complex psychomotor task that is difficult to learn, teach, remember, and perform. In addition, concerns regarding mouth-to-mouth ventilation create barriers to the performance of cardiopulmonary resuscitation. Although currently recommended basic life support focuses initially on airway and breathing, recent investigations question the importance of assisted ventilation during the first few minutes of cardiopulmonary resuscitation. Animal studies have established that substantial ventilation occurs during cardiopulmonary resuscitation with chest compressions alone. More importantly, data from animal models and a prehospital study suggest that successful resuscitation and long-term survival from cardiac arrest are comparable after chest compressions with or without assisted ventilation. The present emphasis on airway, breathing, circulation (the ABCs) should shift to a greater emphasis on effective chest compressions. Cardiopulmonary resuscitation involving chest compressions only may be the best initial basic life support for prehospital cardiac arrest victims, especially if it leads to higher rates of bystander cardiopulmonary resuscitation.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Monitoring is one of the cornerstones of modern intensive care. Unfortunately, randomized trials have not determined the exact modalities that should be monitored in the ICU. This paper reviews the purposes, problems, errors, assessments, and the future of monitoring in the critical care unit.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

We present the recent literature on computerized patient data management systems in the ICU, and define our expectations of use of these systems in the ICU. These expectations and suggestions are based on the literature as well as our experience in evaluating these systems. A patient data management system should communicate with and capture information from the different monitors, ventilators, and electronic instruments (eg, infusion pumps) used in the ICU, while presenting selected relevant values and trends on the patient's screen. The ICU patient data management system should communicate with other information systems and automatically transfer demographic and laboratory data and imaging results. In the future these systems should also include decision support systems.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

Regional tissue hypoxia often goes unrecognized in critically ill patients. Tonometry is a relatively noninvasive technique that helps monitor the adequacy of cellular energy balance by assessing elevations in tissue CO2. This information provides an assessment of aerobic energy balance in the gut mucosa, a tissue that is exquisitely sensitive to alterations in perfusion and oxygenation. Tonometry measures gastric or intestinal mucosal Pco2by allowing the equilibration of CO2partial pressure in a fluid-filled balloon with the Pco2of the mucosal interstitial fluid. There is sufficient information in the clinical literature to support the prognostic utility of gastric tonometry. Moreover, the information obtained with gastric tonometry comes at relatively low cost and with minimal risk to the patient. At present, gastric tonometry has the drawback of being a relatively cumbersome technique that is labor intensive and prone to errors. New technologic advances should improve the timeliness of the information and minimize measurement errors.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

It is essential to monitor respiratory functions in unstable patients. Although there is no good substitute for careful clinical observation of a patient's respiratory status, the technology available today is quite helpful in evaluating various respiratory parameters. In the ICU, monitoring the respiratory status may help determine the need for mechanical ventilation. It may also monitor ventilator safety, determine disease progression, and help decide when to wean the patient from mechanical ventilation. Taken together, various respiratory parameters provide useful information about trends in oxygenation, ventilation, and mechanics. The article reviews current concepts of respiratory monitoring of critically sick patients.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID

摘要:

There is no dispute that rigorously conducted experiments or randomized controlled trials of sufficient statistical power are the gold standard research design to detect important beneficial or harmful effects of existing or new interventions. In practice, however, there are a number of situations in which random allocation is not possible for either ethical or logistic reasons. The alternative in these situations is to use observational methods, in which the outcome of care patients receive as part of their natural treatment is studied. Before drawing inferences from the outcomes of groups of intensive care patients receiving different interventions, the confounding factors (ie. the characteristics that could affect both their selection and risk for a particular outcome) have to be taken into account. This is the purpose of measurement and adjustment for case mix. Case mix measurement and adjustment is, therefore, a methodologic tool for approximating randomization when randomization is not possible, The ability to make inferences from observed differences in outcomes among patient groups hinges on the ability to measure and adjust for case mix. However, there are a number of theoretical and practical problems of measuring case mix in intensive care. This article selectively reviews some of the studies published during the past year that used the case mix measurement known as the Acute Physiology And Chronic Health Evaluation (APACHE) II.

ISSN:1070-5295    

出版商:OVID    

年代:1996

数据来源: OVID