Current opinion in anaesthesiology
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Computed tomography (CT) has fostered pivotal advancements in the understanding of acute lung injury/acute respiratory distress syndrome and ventilator-induced lung injury. Apart from CT-based studies, the past years have seen fascinating work using positron emission tomography, electrical impedance tomography and lung ultrasound as diagnostic tools to optimize mechanical ventilation. This review aims to present the major findings of recent studies on lung imaging. ⋯ Whereas quantitative CT remains the gold standard to assess lung morphology, recruitment and hyperinflation of lung tissue at different inflation pressures, EIT and LUS have emerged as valuable, radiation-free, noninvasive bedside lung imaging tools that should be used together with global parameters like lung mechanics and gas exchange to acquire additional information on recruitability and ventilation distribution.
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Curr Opin Anaesthesiol · Apr 2012
ReviewPlasma/platelets/red blood cell ratio in the management of the bleeding traumatized patient: does it matter?
The scope of this review is to describe what is known about blood product ratios and their effects on acute trauma coagulopathy. Assessing how ratios matter to trauma patients is important to improve massive transfusion strategies. ⋯ Fresh frozen plasma/platelet/red blood cell ratios matter to define the content of packs immediately available within the golden hour to the right, accurately screened trauma patients. Research is needed in developing novel transfusion approaches for massively bleeding patients.
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Curr Opin Anaesthesiol · Apr 2012
ReviewCardiopulmonary exercise testing: does it improve perioperative care and outcome?
We reviewed recent articles, guidelines, and meta-analyses concerning the use of cardiopulmonary exercise testing (CPET) in preoperative risk evaluation and fitness for surgery. When the risk of surgery mortality is high (e.g. >5%), and/or the preoperative state of the patient indicates increased propensity toward morbidity and mortality (advanced age, presence of cardiovascular risk factors, multisystem disease, poor functional status, and so on), the thoroughness of the perioperative assessment should be intensified beyond the standard history and physical, basic laboratories, and electrocardiogram stress testing to include CPET. ⋯ Using a small number of important variables obtained from CPET an accurate picture of the patient's future response to perioperative stress can be obtained. Consideration should be given to performing a CPET in any preoperative patient who has increased risk or is scheduled to undergo a high risk surgical intervention. This strategy assists the anesthetist, surgeon, patients, and their families in appropriate perioperative planning.
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Recent therapeutic and observational studies have demonstrated improved survival with better management of haemostasis early after injury. This review delineates our current understanding of the clinical importance, aetiology and pathophysiology of acute traumatic coagulopathy (ATC). ⋯ Conventional concepts of traumatic coagulopathy as a late occurring condition in response to iatrogenic haemodilution are redundant. ATC is an endogenous impairment of haemostasis that begins at the moment of injury. Further outcome improvements are possible with better understanding of the process by which this coagulopathy develops and how it may be inhibited.
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Curr Opin Anaesthesiol · Apr 2012
ReviewUltrasound-guided peripheral nerve blockade of the upper extremity.
Is ultrasound guidance changing the practice of upper extremity regional anesthesia? This review will aim to describe the findings published in the literature during the previous 18 months. ⋯ Current literature suggests a reduction of the volume of local anesthetics used for ultrasound-guided upper extremity blockades. Dexamethasone may prolong duration of brachial plexus blocks and more frequent use of perineural catheters is encouraged. Controversy over intra-epineurial injections exists and requires additional large-scale studies.