Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2013
ReviewLogistics of transfusion support for patients with massive hemorrhage.
Traditionally, trauma resuscitation protocols have advocated sequential administration of therapeutic components, beginning with crystalloid solutions infused to replace lost intravascular volume. However, rapid restoration of the components of blood is essential for ensuring adequate tissue perfusion and for preventing acidosis, coagulopathy, and hypothermia, referred to as the 'lethal triad' in trauma settings. The review summarizes practical approaches for transfusion support of patients with massive hemorrhage. ⋯ Close monitoring of bleeding and coagulation in trauma patients allows goal-directed transfusions to optimize patients' coagulation, reduce exposure to blood products, and to improve patient outcomes. Future studies are needed to understand and demonstrate improved patient outcomes.
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Curr Opin Anaesthesiol · Apr 2013
Meta AnalysisIntraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis.
It is uncertain whether patients undergoing short-lasting mechanical ventilation for surgery benefit from lung-protective intraoperative ventilatory settings including the use of lower tidal volumes, higher levels of positive end-expiratory pressure (PEEP) and/or recruitment maneuvers. We meta-analyzed trials testing the effect of lung-protective intraoperative ventilatory settings on the incidence of postoperative pulmonary complications. ⋯ Lung-protective intraoperative ventilatory settings have the potential to protect against postoperative pulmonary complications.
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Curr Opin Anaesthesiol · Apr 2013
ReviewPotential value of transfusion protocols in cardiac surgery.
On the one hand, cardiac and aortic surgery is associated with a high rate of allogeneic blood transfusion. On the other hand, both bleeding and allogeneic blood transfusion is associated with increased morbidity, mortality, and hospital costs in cardiac and aortic surgery. This article reviews the current literature between 1995 and 2012 dealing with transfusion protocols in cardiovascular surgery. The 16 studies fitting these search criteria have evaluated the impact of the implementation of ROTEM/TEG based coagulation management algorithms on transfusion requirement and outcome in overall 8507 cardiovascular surgical patients. ⋯ Implementation of POC algorithms including a comprehensive bundle of POC diagnostics (thromboelastometry and whole blood impedance aggregometry) in combination with first-line therapy using immediately available specific coagulation factor concentrates (fibrinogen and prothrombin complex concentrate) and defining strict indications, calculated dosages, and clear sequences for each haemostatic intervention seems to be complex but most effective in reducing perioperative transfusion requirements and has been shown to be associated with a decreased incidence of thrombotic/thromboembolic events, transfusion-related adverse events, as well as with improved patients' outcomes including 6-month mortality.
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Physiotherapy in the perioperative period is emerging as an important component of postoperative recovery. This review highlights recent advances in the implementation of physiotherapy in the perioperative period and its enhancement of postsurgical outcomes. ⋯ Timely and early physiotherapy in the perioperative period improves surgical recovery and reduces postoperative complications.