The past year in critical care medicine was notable for ongoing sequelae of the COVID-19 pandemic, including nationwide shortages and critical care demand in many regions in excess of usual operating capacity. Despite these challenges, evidence-based medicine and investigations into the optimal management of the critically ill continued to be at the forefront. This article is a collection of studies published in 2022 which are specifically relevant to cardiothoracic critical care. These noteworthy publications add to the existing literature across a broad spectrum of topics, from optimal timing of mechanical circulatory support (MCS), delirium prevention, updates in nutrition guidelines, alternative defibrillation techniques, novel ventilator management, and observing the downstream psychological impact of extracorporeal membrane oxygenation (ECMO) therapy.
This chapter evaluates the importance of identifying the oxygen delivery and oxygen consumption balance in critically ill patients. Mixed venous oxygen saturation is a valuable marker of oxygen consumption and delivery in an intensive care unit patient. Organ perfusion can be improved by optimizing all components of the oxygen delivery calculation and decreasing oxygen consumption, if indicated. Several tools that aid in this assessment include pulmonary artery catheter–derived mixed venous oxygen saturation, central venous line–derived central venous saturation, cardiac ultrasonography, and laboratory values such as the arterial blood gas and lactate levels. The chapter also discusses hyperlactatemia. Hyperlactatemia can be due to anaerobic metabolism (type A lactic acidosis) or aerobic metabolism (type B lactic acidosis).
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