Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Feb 2012
ReviewStrategies to preempt and reduce the use of blood products: an Australian perspective.
Evidence-based patient blood management (PBM) is aimed at achieving better patient outcomes by relying on a patient's own blood rather than on donor blood. This review covers the rationale behind PBM, the treatment modalities involved and the drivers to adopt PBM as a new standard of care. ⋯ High transfusion variability, adverse transfusion outcomes, limited evidence for the benefit of transfusion particularly in elective patients and high cost of transfusion are challenging the traditional transfusion paradigm. National and state-wide initiatives are underway in Australia to broadly implement PBM and PBM programs as a new and cost-effective standard of care in the public health system.
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Chronic obstructive pulmonary disease (COPD) is a common cause of primary hospital admission and also a common coexisting disease among surgical patients. This translational review focused on recent studies related to the perioperative care of COPD patients. ⋯ Perioperative management as well as modern intensive care concepts are based on avoidance of tracheal intubation if possible, use of regional anesthesia techniques and the early liberation from invasive mechanical ventilation. Noninvasive ventilation has become more and more utilized in recent years to stabilize patients with acute exacerbations of COPD and to treat postoperative pulmonary complications in order to avoid reintubation.
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Managing fluid balance mandates a clear identification of what goals are being sought at a particular point in the patient's pathway, an accurate assessment of both filling status and the degree of tissue hypoperfusion (if present), and a precise evaluation of response. ⋯ Achieving and maintaining optimal fluid balance remains a significant challenge; better monitoring tools and definitive studies are needed.
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Liberation from mechanical ventilation is a defining moment for intubated patients, and thus a critical clinical decision. Extubating the patient too early exposes the patient to extubation failure and reintubation. Waiting too long increases the complications of prolonged intubation. Tools to help the physician with this critical decision and to test readiness have been available for decades, and are continuously being improved. New methods to improve extubation outcomes are also being developed. This review covers the latest studies in order to help physicians take advantage of the latest developments in a rapidly evolving field. ⋯ Recent findings are shedding more light on this topic, and transforming 'the artistic' aspect of weaning and liberation from mechanical ventilation into a more 'scientific' approach that will expedite liberation from mechanical ventilation yet without encountering high failure rates, and without exposing patients to unnecessary risks.