Current opinion in critical care
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This article discusses how standardization of intensive care work may decrease morbidity and mortality in the intensive care unit (ICU) by reducing practice variation and improving the overall quality of care. In this context, standardization should not only apply to the specific medical management of certain high-volume ICU diagnoses but should also be established for daily ICU procedures and information transmission during ward rounds and at the interface of interdisciplinary work. ⋯ Standardization of most aspects of intensive care medicine has an enormous potential to improve patient care and outcome, reduce ICU/hospital length of stay as well as healthcare expenditures. Despite promising results from large studies standards known to improve patient outcome have not yet been widely implemented.
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To discuss the perioperative monitoring tools and targets for haemodynamic optimization and to assess the influence of goal-directed therapy (GDT) on organ function, complications and outcome in different categories of surgical patients. ⋯ GDT provides a number of benefits in major surgery. Based on adequate monitoring, the goal-directed algorithms facilitate early detection of pathophysiological changes and influence the perioperative haemodynamic therapy that can improve the clinical outcome. The perioperative GDT should be early, adequate and individualized for every patient.
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Tissue hypoxia is a key trigger for organ dysfunction. The maintenance of adequate tissue oxygenation is therefore of particular importance during major surgery. In this review, we discuss the physiological basis and the rationale underlying the recent concepts of perioperative oxygen therapy. ⋯ Adequacy of oxygen delivery to tissue oxygen metabolic demand is essential during the perioperative period. The benefit of perioperative oxygen therapy is rather optimizing the DO2 than increasing inspired oxygen. Improving DO2 has been demonstrated in the perioperative period to reduce both morbidity and mortality. Adaptation of DO2 to O2 consumption using specific goals seems promising.
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Intravenous fluids are widely administered in the ICU with the intention of preventing or ameliorating acute kidney injury (AKI). This review focuses on recent studies examining fluid administration and renal function in critical illness to critically examine conventional justifications for fluid administration. ⋯ Adequate volume resuscitation remains a cornerstone to the emergent treatment of critical illness. However, continued fluid administration and positive fluid balances have not been shown to improve renal outcomes and may worsen overall prognosis in AKI. Concerns about renal dysfunction should not deter clinicians from adopting more restrictive approaches to fluid administration.