Current opinion in critical care
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This review will examine the current scenario of critical care medicine and describe trends for the future. ⋯ The future of ICU will rely on management and teamwork. The costs of critical care will be restrained through the use of better management, guidelines, and skepticism regarding new technologies and drugs. Policy makers will help society build better strategies for critical care services.
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To discuss the recent literature concerning the significance of respiratory complications as a determining factor in postoperative complications after major surgery. Although many studies have identified risk factors focusing on the prevention of respiratory complications, these complications continue to be a significant cause of morbidity and mortality. Here, we will examine the diagnosis, contributing factors, consequences, and early treatment of respiratory complications. ⋯ Postoperative respiratory complications may have significant deleterious consequences. Increasing the understanding of the underlying causes of respiratory complications and developing early treatment strategies will likely provide improved benefits. To date, early treatment with prophylactic or therapeutic continuous positive airway pressure has proved beneficial in an abdominal surgical patient population; however, the efficacy in a general population remains unclear.
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Curr Opin Crit Care · Aug 2009
ReviewPatient-related risk factors for postoperative adverse events.
The risk of adverse outcome in patients undergoing major surgery is affected both by cardiorespiratory fitness, and the presence and severity of comorbidities. Accurate risk stratification is essential for the identification of patients who may benefit from specific perioperative management strategies or from an augmented level of perioperative care. Risk stratification techniques include risk prediction models, assessment of functional capacity and novel biochemical markers. This review examines the evidence for the use of these different techniques in perioperative patients. ⋯ The development of improved risk stratification techniques would be assisted by large-scale epidemiological studies. Improvements to currently used risk prediction models are likely to result from the use of variables which more objectively measure patient health and fitness than current tools, and may use a combination of all the above techniques to improve predictive accuracy.
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To provide updated information on recent developments within individual components of multimodal interventions to improve postoperative outcome (fast-track methodology). ⋯ Procedure-specific standardization of perioperative care programs (the fast-track methodology) should be adopted more widely and adjusted to current scientific evidence.