Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2011
ReviewThe complex interplay between delirium, sedation, and early mobility during critical illness: applications in the trauma unit.
Critically ill patients are prescribed sedatives and analgesics to decrease pain and anxiety, improve patient-ventilator dyssynchrony and ensure patient safety. These medications may themselves lead to delirium and ICU-acquired weakness, which are associated with worse clinical outcomes. This review will focus on the epidemiology of these two disease processes and discuss strategies aimed at reducing these devastating complications of critical illness. ⋯ Delirium and ICU-acquired weakness are complications of critical illness associated with worse clinical outcomes and functional decline in survivors. An evidence-based approach based on the following tenets - minimization of sedative medication, particularly benzodiazepines, delirium monitoring and management and early mobilization may mitigate these complications.
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Decisions to withdraw or withhold potentially life-sustaining treatment are common in intensive care and precede the majority of deaths. When families resist or oppose doctors' suggestions that it is time to stop treatment, it is often unclear what should be done. This review will summarize recent literature around futility judgements in intensive care emphasising ethical and practical questions. ⋯ Specific criteria for unilateral withdrawal of treatment have proved hard to define or defend. However, it is ethical for doctors to decline to provide treatment that is medically inappropriate or futile. Understanding the justification for a futility judgement may be relevant to deciding the most appropriate way to resolve futility disputes.
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Curr Opin Anaesthesiol · Apr 2011
ReviewShould tracheostomy practice in the setting of trauma be standardized?
Trauma is a common predisposing condition in patients developing acute respiratory failure. Selection criteria for tracheostomy use in trauma remain poorly defined. The purpose of this review is to discuss contemporary knowledge regarding the benefits and risks of tracheostomy and to highlight potential strategies to standardize practice. ⋯ Variation in clinical practice is costly. To the extent that variation in tracheostomy practice reflects suboptimal use of this procedure, greater understanding of tracheostomy utility has the potential to enhance the quality of care and more effectively target resources.
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Curr Opin Anaesthesiol · Apr 2011
ReviewPublication fraud: implications to the individual and to the specialty.
To provide a brief review and update on the subject of scientific misconduct relevant to the specialty of anesthesia. The overall goal is to raise awareness amongst readers of the scientific literature that although publication fraud is relatively infrequent, the reasons for fraud are complex and the consequences to the individual and for the specialty are substantial. ⋯ When suspected, alleged misconduct must be thoroughly investigated. When proven, scientific misconduct must be addressed by the relevant institutions and the scientific record must be corrected. Many stakeholders are involved in this complex and most unfortunate process.