Current opinion in anaesthesiology
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Traumatic injury is a major human health problem, with many injured people supported by transfusion of allogeneic blood. Although trauma and transfusion have both been known to have immunomodulatory effects for some time, little is known about their combined effects or the scope and kinetics of such responses. ⋯ The response to trauma and transfusion involves a massive and rapid reorganization of the immune system that can put the patient at increased risk of infection, tissue damage, and organ failure. The scope of the response presents challenges to the development of treatments to control this dysregulation.
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Curr Opin Anaesthesiol · Apr 2013
Meta AnalysisIntraoperative ventilatory strategies to prevent postoperative pulmonary complications: a meta-analysis.
It is uncertain whether patients undergoing short-lasting mechanical ventilation for surgery benefit from lung-protective intraoperative ventilatory settings including the use of lower tidal volumes, higher levels of positive end-expiratory pressure (PEEP) and/or recruitment maneuvers. We meta-analyzed trials testing the effect of lung-protective intraoperative ventilatory settings on the incidence of postoperative pulmonary complications. ⋯ Lung-protective intraoperative ventilatory settings have the potential to protect against postoperative pulmonary complications.
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Curr Opin Anaesthesiol · Apr 2013
ReviewNonventilatory strategies to prevent postoperative pulmonary complications.
In this review, we aimed at providing the most recent and relevant clinical evidence regarding the use of nonventilatory strategies to prevent postoperative pulmonary complications (PPCs) after noncardiac surgery. ⋯ Nonventilatory strategies can play an important role in reducing PPCs and improving clinical outcome after noncardiac surgery, especially in high-risk patients.
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Curr Opin Anaesthesiol · Apr 2013
ReviewEthical considerations for discontinuing pacemakers and automatic implantable cardiac defibrillators at the end-of-life.
As the use of intracardiac devices has increased, the awareness of the burdens of the devices, especially the uncomfortable defibrillator shocks, has also increased. Some patients have requested device deactivation and some physicians have expressed reluctance to do so. This review will update physicians about the ethical acceptability of removal of intracardiac devices. ⋯ Physicians ought to initiate a deactivation conversation, ideally at the time of implantation. Sharing case studies about the deactivation process will enable physicians to enhance their ability to guide patients and family through thoughtful decision-making. Guidelines for deactivation should be promulgated throughout institutions that serve patients with intracardiac devices.
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Diagnosis and treatment of trauma-induced coagulopathy (TIC) presents a challenge for trauma care providers. Viscoelastic tests (VETs) including thromboelastometry and thrombelastography are increasingly used to diagnose TIC and guide hemostatic therapy. We summarize the concept of individualized, goal-directed coagulation management using coagulation factor concentrates. ⋯ VETs are useful in the diagnosis of TIC, allowing precise deficits in the coagulation process to be identified and specifically targeted with coagulation factor concentrates.