Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2016
ReviewCentral venous pressure: soon an outcome-associated matter.
Central venous pressure (CVP) alone has so far not found a place in outcome prediction or prediction of fluid responsiveness. Improved understanding of the interaction between mean systemic pressure (Pms) and CVP has major implications for evaluating volume responsiveness, heart performance and potentially patient outcomes. ⋯ The implication for practice is in the regulation of the circulation. It is demonstrated that control of the blood pressure and cardiac output/venous return calls upon regulation of the volume state (Pms), the heart performance (Eh) and the systemic vascular resistance. Knowledge of the CVP is required to calculate all three.
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Curr Opin Anaesthesiol · Apr 2016
ReviewThe differential diagnosis for failure to wean from mechanical ventilation.
In this review, we discuss the causes for a failed weaning trial and specific diagnostic tests that could be conducted to identify the cause for weaning failure. We briefly highlight treatment strategies that may enhance the chance of weaning success. ⋯ Understanding the complex pathophysiology of weaning failure in combination with a systematic diagnostic approach allows identification of the primary cause of weaning failure. This will help the clinician to choose a specific treatment strategy and therefore may fasten liberation from mechanical ventilation.
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Curr Opin Anaesthesiol · Apr 2016
ReviewTrauma-associated bleeding: management of massive transfusion.
Early treatment goals in the bleeding trauma patient have changed based on recent research findings. Trauma patients requiring a massive transfusion protocol have shown a decreased mortality based on a more aggressive and balanced approach to blood product resuscitation. This chapter will review the recent advances in managing the bleeding trauma patient. ⋯ There is now evidence to support the early use of a 1 : 1 : 1 blood product transfusion protocol to restore lost circulating volume, improve oxygen carrying capacity, replace diluted platelets, and replenish clotting factors in massively bleeding trauma patients. Further study is needed to determine whether prehospital initiation of blood products and pharmacological adjuncts will improve outcomes.
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The aim of this review was to examine the main determinants of cardiac dysfunction in critically ill patients, as well as how a reduction in cardiac performance influences other organ function. ⋯ The heart should never be regarded as an isolated organ. When dealing with cardiac dysfunction, clinicians must consider the underlying pathophysiology, potential myocardial depressant effects of intensive treatments, and the complex interaction with other organ function.
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Infections are common complications in critically ill patients and are frequently treated with antibiotics. Unfortunately, delivery of optimal therapy is complicated because efficacy of antimicrobials is influenced by the timing of treatment initiation, the use of combination therapy, and the optimization of drug dosing. ⋯ The optimal use of antibiotics in the management of severe infections is an important challenge for ICU physicians. Antimicrobial therapy needs to be individualized according to specific patient characteristics, infecting organisms, and susceptibility patterns.