Anaesthesia, critical care & pain medicine
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Anaesth Crit Care Pain Med · Aug 2017
GuidelinePreventing medication errors in anesthesia and critical care (abbreviated version).
Drug medication errors remain a major safety issue in anaesthesia and intensive care, and prevention measures need to be strengthened. This is why the French Society of Anaesthesia and Intensive Care and the French Society of Clinical Pharmacy have profoundly reviewed their previous recommendations published in 2007. The 2017 recommendations are based on the literature but also on feedback from field professionals targeting patient safety. ⋯ A risk mapping must be established a priori and medication errors reporting is imperative in order to analyze them a posteriori in departmental meetings (REMED). Self-assessment, or external assessment, must be conducted. All of the proposed recommendations reinforce the culture of safety, which is essential to the practice of anaesthesia and intensive care.
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Anaesth Crit Care Pain Med · Jun 2017
Evaluation of financial burden following complications after major surgery in France: Potential return after perioperative goal-directed therapy.
Perioperative goal-directed therapy (PGDT) has been demonstrated to improve postoperative outcomes and reduce the length of hospital stays. The objective of our analysis was to evaluate the cost of complications, derived from French hospital payments, and calculate the potential cost savings and length of hospital stay reductions. ⋯ Our analysis demonstrates that patients with complications are significantly more expensive to care for than those without complications. In our model, it was projected that implementing PGDT during high-risk surgery may significantly reduce healthcare costs and the length of hospital stays in France while probably improving patient access to care and reducing waiting times for procedures.
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Anaesth Crit Care Pain Med · Apr 2017
ReviewChloride toxicity in critically ill patients: what's the evidence?
Crystalloids have become the fluid of choice in critically ill patients and in the operating room both for fluid resuscitation and fluid maintenance. Among crystalloids, NaCl 0.9% has been the most widely used fluid. ⋯ More balanced solutions therefore may be used especially when large amount of fluids are administered in high-risk patients. In this review, we discuss physiological background favouring the use of balanced solutions as well as the most recent clinical data regarding the use of crystalloid solutions in critically ill patients and patients undergoing major surgery.