Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2013
ReviewNonventilatory strategies to prevent postoperative pulmonary complications.
In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery. ⋯ Nonventilatory strategies can play an important role in reducing PPCs and improving clinical outcome after noncardiac surgery, especially in high-risk patients.
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Traumatic injury is a major human health problem, with many injured people supported by transfusion of allogeneic blood. Although trauma and transfusion have both been known to have immunomodulatory effects for some time, little is known about their combined effects or the scope and kinetics of such responses. ⋯ The response to trauma and transfusion involves a massive and rapid reorganization of the immune system that can put the patient at increased risk of infection, tissue damage, and organ failure. The scope of the response presents challenges to the development of treatments to control this dysregulation.
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Curr Opin Anaesthesiol · Apr 2013
ReviewDoes training with human patient simulation translate to improved patient safety and outcome?
In this review, we evaluate several articles in an attempt to qualify the effect of human patient simulation in anaesthesia on patient outcome. The recognition of medical error as a significant cause of patient morbidity and mortality has sparked an increased focus on improving healthcare quality and patient safety. Simulation in anaesthesia is a potential tool to help achieve this goal by allowing anaesthesia providers to learn, practice and perfect their craft without a potential harm to patients. It has gained growing traction in the field and is recently a required element in the American Board of Anesthesiology's Maintenance of Certification in Anesthesia programme. ⋯ Despite the adoption of simulation, further study is needed to better qualify its effect on patient safety and outcome.
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Curr Opin Anaesthesiol · Apr 2013
ReviewPredicting postoperative pulmonary complications in the general population.
Postoperative pulmonary complications (PPCs) are common and lead to longer hospital stays and higher mortality. A wide range of patient, anaesthetic and surgical factors have been associated with risk for PPCs. This review discusses our present understanding of PPC risk factors that can be used to plan preoperative risk reduction strategies. The methodological and statistical basis for building risk scores is also described. ⋯ PPC risk prediction scales based on large population studies are being developed. New studies to confirm the validity of these scales in different geographic areas will be needed before we can be sure of their generalizability.
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Curr Opin Anaesthesiol · Apr 2013
ReviewEffects of red blood cell storage in heavily transfused patients.
Most publications on Red Blood Cell (RBC) storage time are performed in patient groups receiving on average 1-4 RBC transfusions. Here we look at the observational results in the more heavily transfused patient populations studied, which are mostly in trauma or cardiac surgery patients. ⋯ Clinical effects of RBC storage turn out to be determined by far more aspects than storage time alone.