Current opinion in anaesthesiology
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End-of-life decisions play an important role in the intensive care unit. This review discusses the most important studies on end-of-life decisions published from October 2001 to October 2002. ⋯ The new studies put emphasis on the facts that all care providers should participate in the decision and that communication with surrogates is of extreme importance. Many valid points from other medical fields also apply to the intensive care unit situation.
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To summarize new advances and research findings that relate to the treatment of burn victims. ⋯ The combination of innovative approaches and a dedicated burn team is expected to continue to improve survival in the next few years even in the most severe cases.
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Postoperative pulmonary complications, including pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation, occur commonly and are a significant source of morbidity and mortality. This review will discuss the etiology of postoperative pulmonary complications and the interventions that reduce their risk. ⋯ Understanding risk factors for the development of postoperative pulmonary complications allows targeted interventions aimed at reducing their frequency and severity. Further research is needed to define the role of regional analgesic and anesthetic techniques in reducing postoperative pulmonary complications, and also to define the nature of risk factors and develop better predictive models of patients at risk of developing postoperative pulmonary complications.
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There are significant misunderstandings about the management of perioperative do-not-resuscitate orders. This paper reviews some of the difficulties generated by the halting acceptance and inconsistent implementation of an ethically appropriate perioperative do-not-resuscitate policy that mandates reconsideration of existing do-not-resuscitate orders. It also offers strategies for empowerment of such a policy. ⋯ A well written perioperative do-not-resuscitate policy is essential for surmounting obstacles to a well functioning perioperative do-not-resuscitate system.
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Ensuring quality in prehospital airway management is challenging because the out-of-hospital setting is a fast-paced and unpredictable environment. The first step in meeting this challenge is the recognition by emergency medical service leaders that prehospital airway management is prone to error. Quality core values such as safety, effectiveness, timeliness, efficiency, and equity for prehospital airway management, specifically endotracheal intubation, will be discussed. ⋯ Emergency medical service administrators must critically evaluate the quality of prehospital airway management that they are providing to patients within their system by collecting the data necessary to identify quality issues and developing strategies to implement change. Research into other techniques that can provide ventilation and oxygenation to patients in the prehospital environment and that are safe and effective, such as laryngeal mask airway, need to be performed.