Current opinion in anaesthesiology
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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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Curr Opin Anaesthesiol · Feb 2012
ReviewAtelectasis and perioperative pulmonary complications in high-risk patients.
This review evaluates the link between perioperative lung atelectasis and postoperative pulmonary complications (PPCs) and how appropriate ventilatory strategies could mitigate this problem. ⋯ A goal-directed ventilatory approach keeping an 'open lung' condition during the perioperative period may reduce the incidence of PPCs.
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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.
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Curr Opin Anaesthesiol · Feb 2012
ReviewStrategies to reduce the use of blood products: a European perspective.
Anemia is the most common hematologic problem preoperatively. In itself it compromises the outcome of surgical patients, and additionally results in more frequent allogeneic red blood cell (RBC) transfusions which again independently compromise patient outcome. In elective cardiac surgery as well as in other surgical specialties the use of a patient blood management program will minimize the exposure to blood products, lead to a cost reduction and improve patient's outcome. The aim of this review is to discuss the rationale for patient blood management, explain patient blood management in detail including modern and future transfusion strategies. ⋯ Patient blood management strategies are based on an interdisciplinary multimodal approach including early preoperative recognition and treatment of anemic patients, surgical efforts to minimize blood loss, optimal perfusion strategies to reduce hemodilution and continuous assessment of the bleeding and coagulation status of patients as well as a restrictive volume management. This allows specific and goal-directed treatment of patients, preventing anemia in elective patients, optimizing patient's coagulation status early, minimizing exposure to blood products, reducing costs and improving patient's outcome.