Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2008
ReviewEarly goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature.
Aggressive approaches to acute diseases such as acute myocardial infarction, trauma, and stroke have improved outcomes. Early goal-directed therapy for severe sepsis and septic shock represents a similar approach. An analysis of the literature assessing external validity and generalizability of this intervention is lacking. ⋯ Early goal-directed therapy modulates systemic inflammation and results in significant reductions in morbidity, mortality, and healthcare resource consumption. Early goal-directed therapy has been externally validated and is generalizable across multiple healthcare settings. Because of these robust findings, further emphasis should be placed on overcoming logistical, institutional, and professional barriers to implementation which can save the life of one of every six patients presenting with severe sepsis and septic shock.
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Curr Opin Anaesthesiol · Apr 2008
ReviewTherapeutic hypothermia after out-of hospital cardiac arrest: how to secure worldwide implementation.
Despite the scientific evidence, therapeutic hypothermia in comatose out-of-hospital cardiac arrest survivors is still not widely used. It is unlikely that technical, logistical and financial barriers alone can explain the geographically large differences in its application. Our review focuses on how generic knowledge on implementation may help speed up the transfer of therapeutic hypothermia into daily practice. ⋯ More than 40 years after the late Peter Safar first suggested therapeutic hypothermia as standard therapy during postresuscitation care, worldwide implementation of this treatment seems possible. To secure this, however, hospitals and health systems must institute well defined implementation plans taking local cultural and organizational barriers into account.
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Curr Opin Anaesthesiol · Apr 2008
ReviewMultimodal multidisciplinary standardization of perioperative care: still a long way to go.
The complexity of the perioperative care process has resulted in a suboptimal use of resources, quality problems and a relatively high incidence of errors. In an attempt to optimize resources, patient safety, and quality, multimodal, multidisciplinary standardization of the care process has become an increasingly recognized goal. ⋯ Although recent literature indicates that standardization of perioperative care improves efficiency, quality, and patient satisfaction, implementation of standardized care is difficult since resistance is still enormous.
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Current cardiopulmonary resuscitation guidelines emphasize that providing high-quality basic life support is the single most important contribution to successful resuscitation. Efficiency of advanced cardiac life support depends on sufficient cardiopulmonary resuscitation performance leading to continuous bloodflow and oxygenation. Existing data show that the quality of cardiopulmonary resuscitation performance is poor. Feedback technologies claim to improve cardiopulmonary resuscitation quality by supporting rescuers in their efforts. ⋯ Since effective basic life support is crucial for victims of cardiac arrest, recent findings that cardiopulmonary resuscitation quality provided by professionals fails to achieve recommended levels is not acceptable. Efforts need to be made in order to improve cardiopulmonary resuscitation quality and to support rescuers by real-time feedback. The technical elements of cardiopulmonary resuscitation feedback need to be carefully studied before being introduced into practice.
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This article reviews new findings on the use of vasopressor agents in septic shock. ⋯ The use of norepinephrine or epinephrine can be left to the discretion of the treating physician. Low-dose vasopressin administration remains an option for catecholamine-refractory septic shock. The potential benefit of early use in combination with a moderate dose of norepinephrine remains to be determined.