Current opinion in anaesthesiology
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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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Curr Opin Anaesthesiol · Apr 2013
ReviewDo corticosteroids improve outcome for any critical illness?
Corticosteroids have been widely administered in critically ill patients for various indications. Their clinical benefit is broadly investigated but remains controversial. The purpose of this review is to explore the use of corticosteroids in intensive care, their impact on patient outcome and to provide practical guidance for the use of corticosteroids in the ICU. ⋯ Critical illnesses stem from a group of heterogeneous medical conditions. Failure to target subgroups more likely to benefit from the use of corticosteroids may be one explanation for the largely disappointing results in clinical trials, thus, far.
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Curr Opin Anaesthesiol · Apr 2013
ReviewPredicting postoperative pulmonary complications in high-risk populations.
Our objective is to describe prediction models for surgical patients who have suspected obstructive sleep apnea (OSA) at risk for postoperative respiratory complications and for surgical patients at risk for postoperative acute respiratory distress syndrome (ARDS). ⋯ Evidence is emerging that early identification of modifiable risk factors and implementation of 'protective' management strategies may lead to reduction of severe postoperative pulmonary complications.