Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2015
ReviewConsiderations for anesthesia staffing in a trauma center: new standards, education, and safety.
A review of recent updates to trauma anesthesia service requirements in the USA and UK, the evolving role of the trauma anesthesiologist, and opportunities for education and training. Considerations of cost and safety for staffing arrangements are discussed. ⋯ There is a growing recognition that trauma anesthesiology represents a distinct area of subspecialty knowledge. Anesthesiology specialty organizations advocate for trauma-specific knowledge and training for trauma anesthesia providers. Requiring the in-house presence of anesthesia providers in level I and level II trauma centers may impose significant costs on medical centers that do not currently provide those services.
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Curr Opin Anaesthesiol · Apr 2015
ReviewNutrition and metabolic support for critically ill patients.
Acute critical illness increases the risk of malnutrition, are more obese, and have multiple comorbidities and frequent pre-existing nutritional deficits. There is a vast amount of research and literature being written on nutritional practices in the critically ill. We review and discuss herein the important nutrition literature over the past 12 months. ⋯ Nutrition and metabolic support of critically ill patients is a complex and diverse topic. Nutritional measurements, requirements, and modes and routes of delivery are currently being studied to determine the best way to treat these complicated patients. We present just a few of the current controversial topics in this fascinating arena.
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Recent advances in the understanding of transfusion practices during hemorrhagic shock in trauma have led to early administration of thawed plasma in increased ratios to packed red blood cells and have improved survival in the most severely injured patients. As an appreciation for the sequelae of massive transfusion continues to mature, it is becoming apparent that a more targeted approach to coagulation deficiencies may offer an advantage. ⋯ The use of factor concentrates to target specific phases of coagulation may offer benefit over blood product ratio-driven transfusion. The outcome benefit of factor concentrates, however, has not yet been demonstrated in well powered prospective trials.
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To provide a review of the current literature on the management of obstetric hemorrhage. ⋯ Postpartum hemorrhage is best managed by using a stepwise progressive approach. Manual and pharmacologic interventions are first-line treatments. Second-line treatments are used when bleeding continues; and hysterectomy is reserved for only the most extreme cases. Outcomes may be improved by thorough preparation, anticipating the risk of obstetric hemorrhage, and coordinating consultants for interventional procedures.
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To describe the epidemiology, pathophysiology, diagnosis and management of perioperative acute kidney injury (AKI) in elderly patients. ⋯ Postoperative AKI incidence is expected to rise as the number of elderly patients undergoing surgery is increasing. Biomarkers of early AKI will likely be important for the future development and validation of novel treatment strategies. The haemodynamic management of the elderly surgical patient should focus on avoiding hypotension and high central venous pressures.