Anaesthesiology intensive therapy
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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
ReviewAdvanced airway management in out-of-hospital cardiac arrest - to intubate or not to intubate: a narrative review of the existing literature.
Restoring partial flow of oxygenated blood is a fundamental goal of cardiopulmonary resuscitation. The ideal devices used for this purpose should have features such as low incidence of complications, high survival rate, rapid control of the airway, and adequate ventilation. Besides limiting the frequency and duration of interruptions in chest compressions, they can improve the survival and clinical outcomes of return of spontaneous circulation during cardiopulmonary resuscitation. ⋯ However, optimal airway management during out-of-hospital cardiac arrest is a controversial issue. The proposed standard of care, i.e. endotracheal intubation, may have paradoxical adverse effects on intended outcomes by interrupting cardiopulmonary resuscitation and by reduction of coronary and cerebral perfusion pressure during resuscitation. The aim of this narrative review is to provide health care providers with an overview of relevant studies in the area, with a focus on alternative advanced airway techniques.