Current opinion in critical care
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The traumatically injured patient is at high risk for developing venous thromboembolism. Clinical practice guidelines developed by the American College of Chest Physicians and the Eastern Association for the Surgery of Trauma recognize the importance of initiating thromboprophylaxis, but the guidelines lack specific recommendations regarding the timing and dose of pharmacologic thromboprophylaxis. We review the literature regarding initiation of thromboprophylaxis in different injuries, the use of inferior vena cava filters, laboratory monitoring, dosing regimens, and the use of antiplatelet therapy. ⋯ In the setting of blunt traumatic brain and solid organ injury, initiation of pharmacologic thromboprophylaxis 48 h after injury is not associated with increased bleeding complications. There is no consensus or clear data showing which dosing regimen of LMWH is most effective or whether routine laboratory measurements are beneficial for determining effective thromboprophylaxis.
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Curr Opin Crit Care · Dec 2016
ReviewRib fractures in trauma patients: does operative fixation improve outcome?
Renewed interest in surgical fixation of rib fractures has emerged. However, conservative treatment is still preferred at most surgical departments. We wanted to evaluate whether operative treatment of rib fractures may benefit severely injured patients. ⋯ Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.
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Curr Opin Crit Care · Dec 2016
ReviewFamily-centered outcomes during and after critical illness: current outcomes and opportunities for future investigation.
Family-centered outcomes during and after critical illness assess issues that are most important to family members. An understanding of family-centered outcomes is necessary to support the provision of family-centered care and to foster development of interventions to improve care and communication in the ICU. ⋯ Critical illness places a significant burden on family members. A wide variety of family-centered outcomes are available to guide improvements in care and communication. Future research should focus on developing sensitive and responsive measures that capture key elements of the family member experience during and after critical illness.
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Curr Opin Crit Care · Dec 2016
ReviewComputer decision support for acute kidney injury: current and future.
Growing awareness regarding the impact of acute kidney injury (AKI) as a grave consequence of critical illnesses resulted in the expansion of the need for early detection and appropriate management strategies. Clinical decision support systems (CDSS) can generate information to improve the care of AKI patients by providing point-of-care accurate patient-specific information and recommendations. Our objective is to describe the characteristics of CDSS and review the current knowledge regarding the impact of CDSS on patients in the acute care settings, and specifically for AKI. ⋯ The heterogeneity of these studies in their size, design, and conduct has produced controversial findings; hence, this has left the field completely open for further investigations.
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Curr Opin Crit Care · Dec 2016
ReviewResuscitative endovascular balloon occlusion of the aorta: promise, practice, and progress?
Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a minimally invasive damage control procedure for life-threatening abdominal or pelvic haemorrhage. The purpose of this review is to summarize the current understanding and experience with REBOA, outline potential future applications of this technology, and highlight priority areas for further research. ⋯ Noncompressible torso haemorrhage is the leading cause of preventable trauma deaths. The majority of these deaths occur soon after injury, often before any opportunity for definitive haemorrhage control. For a meaningful reduction in trauma mortality, novel methods of rapid haemorrhage control are required.