Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Apr 2022
ReviewPredicting mortality in elderly trauma patients: a review of the current literature.
Advances in medical care allow patients to live longer, translating into a larger geriatric patient population. Adverse outcomes increase with older age, regardless of injury severity. Age, comorbidities, and physiologic deterioration have been associated with the increased mortality seen in geriatric trauma patients. As such, outcome prediction models are critical to guide clinical decision making and goals of care discussions for this population. The purpose of this review was to evaluate the various outcome prediction models for geriatric trauma patients. ⋯ The ideal outcome prediction model for geriatric trauma patients has not been identified. The GTOS demonstrates accurate predictive ability in elderly trauma patients. The addition of medical comorbidities as a variable in outcome prediction tools may result in superior performance; however, additional research is warranted.
-
Curr Opin Anaesthesiol · Apr 2022
ReviewSurgical rib fixation in traumatic rib fractures: is it warranted?
Traumatic chest wall injuries and rib fractures remain a prevalent injury. Despite many advances, these injuries result in high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) is increasing in utilization with expanding indications. Recent studies have demonstrated that many patients may benefit from surgical intervention. ⋯ SSRF has become more prevalent with improving outcomes for patients. Understanding the indications will help expand utilization and improve patient outcomes.
-
The physiologically difficult airway is one in which physiologic alterations in the patient increase the risk for cardiorespiratory and other complications during tracheal intubation and transition to positive pressure ventilation. This review will summarize the recent literature around the emerging concept of the physiologically difficult airway, describe its relevance and various patient types in which this entity is observed. ⋯ Understanding the physiological alterations and the risks involved in patients with a physiologically difficult airway is necessary to optimize the physiology and adopt strategies to avoid complications during tracheal intubation. Further research will help us better understand the optimal strategies to improve outcomes in these patients.
-
Curr Opin Anaesthesiol · Apr 2022
ReviewAirway management in the critically ill patient with COVID-19.
Critically ill Coronavirus disease 2019 (COVID-19) patients needing endotracheal intubation are on the verge of rapid decompensation. The aims of this review were to assess the risks, the preoxygenation, the device and the hemodynamic management of a patient with COVID-19. ⋯ Future trials will better define the role of videolaryngoscopy, apneic oxygenation and mask ventilation during apnea for intubation of COVID-19 patients in ICU. The use of fluid loading and vasopressors remains to be investigated in large randomized controlled studies. Choosing the right time for intubation remains uncertain in clinical practice, and future works will probably help to identify earlier the patients who will need intubation.
-
Curr Opin Anaesthesiol · Apr 2022
ReviewHealthcare disparities in trauma: why they exist and what we can do.
This review will explore the underlying causes of healthcare disparities among trauma patients and offer considerations for reducing inequities to improve trauma care. ⋯ Race, ethnicity, socioeconomic status, and access to healthcare drive outcome disparity among trauma patients. These disparities include reduced healthcare services, inadequate pain management, reduced postdischarge care, and increased mortality. Increasing workforce diversity may mitigate implicit bias and improve cultural competency. Social determinants of health impact the disparities in trauma care and offer a framework to address care through creative solutions.