Anaesthesiology intensive therapy
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Anaesthesiol Intensive Ther · Jan 2021
Clinical outcomes of critically ill multiple trauma patients with rib fractures. A prospective study with retrospective control.
Rib fracture fixation is becoming more popular and widely accepted among trauma surgeons worldwide as the recommended treatment method for flail chest injury. Recent data demonstrate improved results when compared with non-operative treatment. Improved outcomes were reported regarding ICU stay, need for tracheostomy, length of hospital stay, ventilator-associated pneumonia (VAP), and even death. The objective of this study was to ascertain whether clinical respiratory para-meters are improved after rib fracture fixation procedure. ⋯ We suggest that surgical treatment of flail chest and multiple rib fractures has clinical benefit and improves respiratory parameters even in the presence of multiple trauma injuries.
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Anaesthesiol Intensive Ther · Jan 2021
ReviewCOVID-19: coagulation disorders and anticoagulant treatment in patients hospitalised in ICU.
Patients hospitalized in the intensive care unit (ICU) due to the COVID-19 experience a high incidence (up to 43%) of venous thromboembolic events. While laboratory findings in COVID-19-associated coagulopathy (CAC) show increased D-dimer and fibrinogen levels, the abnormalities in standard coagulation tests and platelet count are minimal. Recent studies suggest contribution of fibrinolysis shutdown to this phenomenon. ⋯ Numerous guidelines and recommendations of scientific societies and groups of specialists have been published. However, there is no single optimal algorithm for anticoagulation treatment and monitoring specific to the ICU patients with COVID-19. The authors have attempted to summarize the data related to CAC and thrombotic disease and develop an algorithm consistent with the latest clinical practice guideline recommendations.
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Anaesthesiol Intensive Ther · Jan 2020
ReviewCOVID-19: What do we need to know about ICU delirium during the SARS-CoV-2 pandemic?
In March 2020, the World Health Organisation announced the COVID-19 pandemic caused by the SARS-CoV-2 virus. As well as respiratory failure, the SARS-CoV-2 may cause central nervous system (CNS) involvement, including delirium occurring in critically ill patients (ICU delirium). Due attention must be paid to this subject in the face of the COVID-19 pandemic. ⋯ Early identification of patients with delirium is critical in patients with COVID-19 because the occurrence of delirium may be an early symptom of worsening respiratory failure or of infectious spread to the CNS mediated by potential neuroinvasive mechanisms of the coronavirus. The purpose of this review is to identify problems related to the development of delirium during the COVID-19 epidemic, which are presented in three areas: i) factors contributing to delirium in COVID-19, ii) potential pathophysiological factors of delirium in COVID-19, and iii) long-term consequences of delirium in COVID-19. This article discusses how healthcare workers can reduce the burden of delirium by identifying potential risk factors and difficulties during challenges associated with SARS-CoV-2 infection.
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Anaesthesiol Intensive Ther · Jan 2020
ReviewThe opioid crisis in North America: facts and future lessons for Europe.
Over the past two decades, opioid-related hospitalizations and deaths in North America have reached the level of a public health emergency. Initially, the epidemic of opioid misuse was largely driven by pharmaceutical companies and initiated by their spread of misinformation, which led physicians to engage in overzealous prescribing behaviour. This was followed by significant harms as deaths related to overdoses on prescription and illicit opioids rose steadily throughout the 1990s and early 2000s. ⋯ This article further explores the evidence surrounding the effectiveness of various treatment strategies and harm-reduction interventions designed to curtail the morbidity and mortality associated with opioid use. Finally, the magnitude of the opioid epidemic in North America is compared to that in European countries. This paper describes the differences in North American and European experiences with opioid overdose and the evidence-based approaches that can be implemented to reduce the mortality and morbidity linked to opioids while simultaneously ensuring adequate pain control for patients.
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Anaesthesiol Intensive Ther · Jan 2020
ReviewReview of the Transitional Pain Service as a method of postoperative opioid weaning and a service aimed at minimizing the risk of chronic post-surgical pain.
Opioid use and prescribing have become a subject of increasing focus and scrutiny. The ongoing "opioid epidemic" in North America has further increased interest in this area. ⋯ The Transitional Pain Service is a multidisciplinary service originating at Toronto General Hospital that employs a multi-faceted approach to monitoring opioid use after discharge from surgery, and aims to safely wean patients from opioids while maintaining effective pain management. This approach and its results will be discussed in this review.