Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2013
ReviewPotential value of transfusion protocols in cardiac surgery.
On the one hand, cardiac and aortic surgery is associated with a high rate of allogeneic blood transfusion. On the other hand, both bleeding and allogeneic blood transfusion is associated with increased morbidity, mortality, and hospital costs in cardiac and aortic surgery. This article reviews the current literature between 1995 and 2012 dealing with transfusion protocols in cardiovascular surgery. The 16 studies fitting these search criteria have evaluated the impact of the implementation of ROTEM/TEG based coagulation management algorithms on transfusion requirement and outcome in overall 8507 cardiovascular surgical patients. ⋯ Implementation of POC algorithms including a comprehensive bundle of POC diagnostics (thromboelastometry and whole blood impedance aggregometry) in combination with first-line therapy using immediately available specific coagulation factor concentrates (fibrinogen and prothrombin complex concentrate) and defining strict indications, calculated dosages, and clear sequences for each haemostatic intervention seems to be complex but most effective in reducing perioperative transfusion requirements and has been shown to be associated with a decreased incidence of thrombotic/thromboembolic events, transfusion-related adverse events, as well as with improved patients' outcomes including 6-month mortality.
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Curr Opin Anaesthesiol · Apr 2013
ReviewPredicting postoperative pulmonary complications in the general population.
Postoperative pulmonary complications (PPCs) are common and lead to longer hospital stays and higher mortality. A wide range of patient, anaesthetic and surgical factors have been associated with risk for PPCs. This review discusses our present understanding of PPC risk factors that can be used to plan preoperative risk reduction strategies. The methodological and statistical basis for building risk scores is also described. ⋯ PPC risk prediction scales based on large population studies are being developed. New studies to confirm the validity of these scales in different geographic areas will be needed before we can be sure of their generalizability.
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Curr Opin Anaesthesiol · Apr 2013
ReviewEffects of red blood cell storage in heavily transfused patients.
Most publications on Red Blood Cell (RBC) storage time are performed in patient groups receiving on average 1-4 RBC transfusions. Here we look at the observational results in the more heavily transfused patient populations studied, which are mostly in trauma or cardiac surgery patients. ⋯ Clinical effects of RBC storage turn out to be determined by far more aspects than storage time alone.
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This review is designed to update readers on recent discussions and research regarding vulnerable populations in medicine, including patients who are socioeconomically disadvantaged, queer, in prison or labeled with a stigmatizing complex medical disease. ⋯ Greater understanding of the cause of the health effects of being socioeconomically disadvantaged or being a member of a vulnerable population may be the first steps toward specific policy recommendations. Professional medical organizations and advocacy groups should raise awareness, provide education, publish guidelines and define the goals for the medical care for certain vulnerable populations.Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare.
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Curr Opin Anaesthesiol · Apr 2013
ReviewNoninvasive respiratory support in the perioperative period.
Pulmonary complications ranging from atelectasis to acute respiratory failure are common causes of poor perioperative outcomes. As the surgical population becomes increasingly at risk for pulmonary dysfunction due to increasing age and weight, development of an approach toward respiratory compromise in these patients is becoming ever more important. Given the utility of noninvasive respiratory support (NRS) in acute respiratory failure, it is likewise likely to also be important in the perioperative period. ⋯ Noninvasive respiratory support should be considered an important adjunct in perioperative pulmonary care. Usage should be individually tailored in regard to timing and application modality specific to patient and surgical circumstances. More studies are needed, however, to determine the relationship demonstrated between short-term improvements in lung function and long-term outcomes.