Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2022
ReviewEarly tracheostomy: on the cutting edge, some benefit more than others.
The decision to undergo early tracheostomy in critically ill patients has been the subject of multiple studies in recent years, including several meta-analyses and a large-scale examination of the National in-patient Sampling (NIS) database. The research has focused on different patient populations, and identified common outcomes measures related to ventilation. At the crux of the new research is the decision to undergo an additional invasive procedure, mainly tracheostomy, rather than attempt endotracheal tube ventilation with or without early extubation. Notably, recent research indicates that neurological and SARS-CoV-2 (COVID-19) patients seem to have an exaggerated benefit from early tracheostomy. ⋯ Specific populations such as neurosurgical and COVID-19 patients have clearly defined benefits following early tracheostomy. Although the benefit is less pronounced, there does seem to be an advantage in general ICU patients with regards to ventilator-free days and lower incidence of ventilator-associated pneumonia. In these patients, large-scale examination points to a clear mortality benefit.
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The purpose of this review is to look at the current evidence on the consequences of intraoperative hypotension and discuss improvements that can be implemented for its prevention. ⋯ There should be a shift in paradigm in focusing on the prevention of intraoperative hypotension instead treatment. The suggested goals to help maintaining hemodynamic stability during anesthesia include ensure adequate blood pressure and flow; hypotension prevention; and ensure adequate anesthetic depth without overdose.
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Curr Opin Anaesthesiol · Apr 2022
ReviewWhole blood use in trauma resuscitation: targeting prehospital transfusion.
Trauma resuscitation management has evolved over the years with a more nuanced understanding of the injured patient's physiologic state of shock. The purpose of this review is to discuss the role of whole blood administration in the prehospital setting in the resuscitation of the trauma patient. ⋯ The timing of resuscitation and its components deserve special attention when improving outcomes for trauma patients requiring massive transfusion.
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COVID-19 pandemic has created profound ethical challenges, not only for clinical decision-making but also for defining physician professional conduct. ⋯ There is a need to redefine existing medical professionalism standards so that future healthcare professionals are well prepared to deal with similar public health crisis.
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Despite significant advances in trauma management over the last twenty years, uncontrolled hemorrhage remains the leading cause of preventable death in trauma. We review recent changes affecting hemorrhage control resuscitation. ⋯ Improving trauma coagulopathy diagnostics and hemorrhage control are vital if we are to decrease the mortality associated with trauma.