Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2014
ReviewFluid management in the cardiothoracic intensive care unit: diuresis - diuretics and hemofiltration.
The present review discusses the current concepts of fluid management in cardiothoracic surgery, and its clinical implications with special reference to organ-related complications and their prevention. ⋯ The optimal fluid management in cardiothoracic patients has not been settled. Results of recent clinical published trials highlight the need for minimizing fluid administration and attempting to use diuretics to achieve a negative fluid, although hypovolemia and hypoperfusion should be carefully considered. An individualized optimization of fluid status, using goal-directed therapy, has emerged as a possible preferable approach. The old debate between crystalloid and colloid solutions has been partially solved, as some colloids have demonstrated deleterious effect on renal function and coagulation system. Various preventive strategies have also emerged for minimizing fluid-related complications.
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Curr Opin Anaesthesiol · Apr 2014
ReviewPreventing and managing perioperative pulmonary complications following cardiac surgery.
To provide an update of research findings on the mechanisms underlying respiratory complications after cardiac surgery, especially acute respiratory distress syndrome, transfusion-related lung injury and ventilation-associated pneumonia. The article will review some of the preventive and therapeutic measures that can be implemented to reduce these complications, focusing on the use of protective invasive ventilation and postextubation noninvasive ventilation. ⋯ Postoperative pulmonary complications are common, but severe complications are infrequent. Their reduction requires measures to prevent infection and mechanical ventilation-associated lung injury through the use of low tidal volumes and early extubation. Noninvasive ventilation after extubation can be utilized to avoid reintubation and the associated increased morbidity and mortality. However, noninvasive ventilation should be done under rigorous conditions and by following strict criteria.
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Curr Opin Anaesthesiol · Apr 2014
ReviewInflammatory response to trauma: implications for coagulation and resuscitation.
Recent studies have changed our understanding of the timing and interactions of the inflammatory processes and coagulation cascade following severe trauma. This review highlights this information and correlates its impact on the current clinical approach for fluid resuscitation and treatment of coagulopathy for trauma patients. ⋯ Traumatic injuries continue to be a significant cause of mortality worldwide. Recent advances in understanding the mechanisms of end-organ failure, and modulation of the inflammatory response has important clinical implications regarding fluid resuscitation and treatment of coagulopathy.
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Physician-assisted suicide (PAS) and euthanasia have been increasingly discussed in end-of-life care, as PAS and euthanasia have now been legalized in three European countries and PAS has been legalized in Washington, Oregon, and Montana in the USA. This review focuses on some aspects of PAS and euthanasia and discusses deep terminal sedation (DTS), which is increasingly used to treat intractable symptoms at the end of life. ⋯ Caution is warranted regarding PAS and euthanasia, as vulnerable patients may still be at risk. More research is needed to characterize the use (and misuse) of DTS.
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Trauma care has been a low priority topic in the global health agenda until recently, despite its social and economic impact. Although prevention is the key, provision and quality of trauma care has been the weakest link in the survival chain. We aim to summarize the differences in global trauma care to propose solutions in this article. ⋯ Several core strategies have been identified: human resource planning; physical resources (equipment and supplies); and administration (quality improvement and data collection) need to be developed for effective and adaptable prehospital care, patient transfer, in-hospital care and rehabilitation systems for injured persons worldwide. Clear definition of the problem to propose solutions is critical.