Current opinion in anaesthesiology
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Use of ultrasound in the acute care setting has become more common in recent years. However, it still remains underutilized in the perioperative management of critical patients. In this review, we aim to increase the awareness of ultrasound as an important diagnostic modality that can be used in the perioperative period to improve patient care. Our main focus will be in describing the diagnostic uses of ultrasound to identify cardiac, pulmonary, airway and vascular diseases commonly encountered in acute care settings. ⋯ This article covers the recent developments and literature available on point of care ultrasound and its utilization in the perioperative period. We have not covered some other important uses of ultrasound such as abdominal examination looking at the aorta and other abdominal organs. This was beyond the scope of this article.
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Every year, thousands of heart and lung transplants are performed worldwide. As experience and clinical acumen advance, both fields are continually evolving. This review elucidates and describes many of the recent changes in practice and future directions of heart and lung transplantation. Preoperative, intraoperative and postoperative developments are presented with supporting evidence in these continually evolving fields. ⋯ This review investigates and summarizes the recent changes and advancements in heart and lung transplantation. Mechanical circulatory support and extracorporeal membrane oxygenation are increasingly used in the perioperative setting, and continuing research will evaluate their safety profiles. Optimizing and tailoring immunosuppression regimens for transplant recipients continue to be the subject of ongoing investigation.
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Bleeding in trauma carries a high mortality and is increased in case of coagulopathy. Our understanding of hemostasis and coagulopathy has improved, leading to a change in the protocols for hemostatic monitoring. This review describes the current state of evidence supporting the use of viscoelastic hemostatic assays to guide trauma resuscitation. ⋯ We are moving toward avoiding coagulopathy by individualized, goal-directed transfusion therapy, using viscoelastic hemostatic assays to guide ongoing resuscitation of actively bleeding patients in a goal-directed manner.