Current opinion in anaesthesiology
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End-of-life decisions play an important role in the intensive care unit. This review discusses the most important studies on end-of-life decisions published from October 2001 to October 2002. ⋯ The new studies put emphasis on the facts that all care providers should participate in the decision and that communication with surrogates is of extreme importance. Many valid points from other medical fields also apply to the intensive care unit situation.
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Postoperative pulmonary complications, including pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation, occur commonly and are a significant source of morbidity and mortality. This review will discuss the etiology of postoperative pulmonary complications and the interventions that reduce their risk. ⋯ Understanding risk factors for the development of postoperative pulmonary complications allows targeted interventions aimed at reducing their frequency and severity. Further research is needed to define the role of regional analgesic and anesthetic techniques in reducing postoperative pulmonary complications, and also to define the nature of risk factors and develop better predictive models of patients at risk of developing postoperative pulmonary complications.
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Curr Opin Anaesthesiol · Apr 2003
Helicopter trauma transport: an overview of recent outcomes and triage literature.
The purpose of this review is to assess literature pertinent to outcomes benefits accrued by the use of helicopter emergency medical services for trauma transport. A previous annotated bibliography assessed literature published between 1980 and 2000. The goal of this paper is to address developments since fall 2001, and to cast recent studies in the light of earlier work in an attempt to provide a long-range overview of the relevant literature. ⋯ The preponderance of recent and previously extant evidence supports an argument that the helicopter emergency medical services transport is associated with significant benefit for some injured patients. The primary challenges at this time include the determination of which patients benefit and the elucidation of which aspects of the helicopter emergency medical services are responsible for any salutary effects of its utilization.
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There is growing evidence that in end-stage shock or during cardiac arrest, inappropriately low endogenous vasopressin plasma levels may be responsible for pathologic vasodilatation, inadequate organ perfusion, and poor outcome. The purpose of this article is to review recent publications featuring arginine vasopressin as a potent vasoconstrictor in various shock states such as systemic vasodilatation, severe hypovolemia, or cardiac arrest. ⋯ Vasopressin administration is emerging as a rational and promising therapy in the management of various shock states and cardiac arrest.
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Curr Opin Anaesthesiol · Apr 2003
Treatment of sepsis and septic shock: is there a light at the end of the tunnel?
For years, the field of sepsis research was extremely active; the net result, however, was rather disappointing. Sepsis is still a major problem in intensive care units worldwide. Frustratingly, sepsis is characterized by a high morbidity and mortality. Although multiple (animal) studies with promising results have been published, the clinical situation has changed only a little. However, the recent 2 or 3 years of sepsis research brought significant results that will have a significant impact on clinical routine. ⋯ A breakthrough in sepsis research was long awaited. Recent clinical studies demonstrated that an improvement in outcome can be achieved even with simple means. This review focuses on these new therapeutic concepts, hopefully helping to transfer scientific advantages into everyday clinical routine.