Current opinion in critical care
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Curr Opin Crit Care · Dec 2012
Review Comparative StudyInternational comparisons of intensive care: informing outcomes and improving standards.
Interest in international comparisons of critical illness is growing, but the utility of these studies is questionable. This review examines the challenges of international comparisons and highlights areas in which international data provide information relevant to clinical practice and resource allocation. ⋯ Differences in provision of critical care can be leveraged to inform decisions on allocation of ICU beds, improve interpretation of clinical outcomes, and assess ways to decrease costs of care. International definitions of key components of critical care are needed to facilitate research and ensure rigorous comparisons.
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Curr Opin Crit Care · Dec 2012
ReviewResuscitation and transfusion management in trauma patients: emerging concepts.
Severe trauma is associated with hemorrhage, coagulopathy and transfusion of blood and blood products, all associated with considerable mortality and morbidity. The aim of this review is to focus on resuscitation, transfusion strategies and the management of bleeding in trauma as well as to emphasize on why coagulation has to be monitored closely and to discuss the rationale of modern and future transfusion strategies. ⋯ Close monitoring of bleeding and coagulation in trauma patients allows goal-directed transfusions and thereby optimizes the patient's coagulation, reduces the exposure to blood products, reduces costs and may improve clinical outcome.
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Curr Opin Crit Care · Dec 2012
ReviewCare of the critically ill patient with advanced chronic kidney disease or end-stage renal disease.
The number of individuals with chronic kidney disease (CKD) and end-stage renal disease (ESRD) is rising, and these individuals often require intensive care. ⋯ Despite the manifest physiologic derangements attending CKD/ESRD, a higher burden of comorbid conditions and a greater severity of illness on presentation account for much of the increased mortality. There is no justification for therapeutic nihilism in this population.
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There is still an ongoing debate whether damage control orthopedics (DCO) or other treatment strategies should be favored in the treatment of multiply injured patients. This review gives an overview of the current literature concerning this important question in the treatment of severely injured patients. ⋯ In severely injured patients, DCO should be considered. On the other hand, there is still a lack of randomized studies for a more precise characterization of the patients who benefit from DCO treatment.
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Trauma scoring systems are used by researchers, registries, or individuals to describe injury severity or to estimate the prognosis of trauma patients. Triage scores also may influence the treatment of a trauma case. ⋯ Cross-national comparisons evaluating different scores will further help to identify the optimal scoring system, based on the available information. The inclusion of patients with partially missing data is also an important task for the future.