Current opinion in anaesthesiology
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The aim of this review is to examine literature relating to the withdrawal of life-sustaining therapy (WLST). ⋯ Discussions of end-of-life issues early in the course of a patient's health care will contribute to the healthcare team's understanding and respect of the patient's wishes. This article addresses the withdrawal of left ventricular assist devices; attending physicians and physicians in training perspectives of WLST; do physicians distinguish between withholding and WLST; the timing of WLST; guidelines for the process of WLST; and pediatrics and end-of-life decisions.
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Curr Opin Anaesthesiol · Apr 2018
ReviewRenal replacement therapy in critically ill patients: who, when, why, and how.
The increasing incidence of acute kidney injury has the immediate effect of a growing need for renal replacement therapy (RRT). Shedding light on the questions of who, when, why, and how RRT should be performed is difficult to accomplish because of ambiguous study results, poor quality evidence, and low standardization. ⋯ The best management of RRT is still a subject of controversy. Continuous RRT with regional citrate anticoagulation via a temporary catheter in a jugular vein is the recommended first choice treatment option in critically ill patients with acute kidney injury.
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Deep vein thrombosis (DVT) and pulmonary embolus are major causes of hospital-related morbidity and mortality, and are recognized as complications in patients with traumatic injury. Despite the significant morbidity and mortality associated with DVTs, prophylaxis and treatment are still not well understood and remain the subject of research and debate. ⋯ In trauma patients with traumatic injury, early identification and targeted VTE prophylaxis in trauma patients may prevent this life-threatening complication.
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End-of-life (EOL) care can be stressful for clinicians as well as patients and their relatives. Decisions to withhold or withdraw life-sustaining therapy vary widely depending on culture, beliefs and organizational norms. The following review will describe the current understanding of the problem and give an overview over interventional studies. ⋯ EOL care is associated with negative outcomes for ICU clinicians and relatives, but strength of evidence for interventions is weak because we lack understanding of associated factors like work conditions, organizational issues or individual attitudes. In order to develop complex interventions that can successfully mitigate stress related to EOL care, more research is necessary, which takes into account all potential determinants.
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Curr Opin Anaesthesiol · Apr 2018
ReviewRole of the anesthesiologist-intensivist outside the ICU: opportunity to add value for the hospital or an unnecessary distraction?
Given the extremely expensive nature of critical care medicine, it seems logical that intensivists should play an active role in designing efficient systems of care. The true value of intensivists, however, is not well defined. ⋯ Anesthesiologist-intensivists working outside their usual environment provide leadership and clinical guidance towards improving patient outcomes.