Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2006
ReviewCardiopulmonary resuscitation algorithms, defibrillation and optimized ventilation during resuscitation.
In 2005, the American Heart Association released its Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. This article reviews the treatment algorithms for Advanced Cardiac Life Support, citing the evidence on which the Guidelines are based. Additional focus is placed on defibrillation and optimized ventilation. ⋯ Despite advances in resuscitation science, basic life support remains the key to improving survival outcomes. Ultimately, as new knowledge is gained, we believe resuscitation therapies will be more individualized, on the basis of pathophysiology and etiology of the initial cardiac arrest.
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Curr Opin Anaesthesiol · Apr 2006
ReviewCost drivers in anesthesia: manpower, technique and other factors.
This article reviews the recent literature on cost drivers in anesthesia with respect to staff, techniques and drug costs, and with special focus on anesthesia workflow in the postanesthesia care unit. Moreover, the costs of post-operative pain management provided by an acute pain service are highlighted. ⋯ Clear definition of the meaning of cost drivers and of criteria which allow assessment of patients' condition, and peri-operative standard operating procedures are warranted to ensure comparability of economic data in anesthesia.
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Transfusion therapy in the intensive care unit is an ever-growing field, with new understanding of potential complications, new drug therapies to reduce the need for transfusion, and new additions in component therapy. In addition to the risks of sepsis, ABO blood group mismatch, and other complications associated with transfusion, the intensivist needs to be familiar with alternative therapies to minimize transfusion. ⋯ Recognizing early signs of transfusion-related acute lung injury may aid in the treatment and reporting of this entity. Realizing the mechanism and severity of immunosuppression associated with transfusion may alter transfusion triggers in the intensive care unit. rHuEPO and aprotinin are now being used with increasing frequency to increase red cell counts and minimize the need for transfusion. Recombinant factor FVIIa targets coagulation cascade activation which helps to reduce the number of units of blood products transfused in the actively bleeding patient.
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Ventilator-associated pneumonia remains an important topic (or subject) in the care of the critically ill. Issues related to ventilator-associated pneumonia are now particularly acute given the continued increase in rates of antimicrobial resistance seen in intensive care units. This review examines the latest literature in this area, including promising approaches to infection prevention and recently developed guidelines to aid clinicians in limiting, identifying and treating ventilator-associated pneumonia. ⋯ Recent studies have started to illuminate the full magnitude of the impact of ventilator-associated pneumonia in the intensive care unit and suggest potential measures for intervention. Hopefully, additional work will aid in eventual development of effective preventive, diagnostic and therapeutic strategies that can reliably improve patient outcomes.