Current opinion in anaesthesiology
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The alteration of circadian rhythms in the postoperative period has been demonstrated to influence the outcomes. With this narrative review we would revise how anesthesia, surgery and intensive care can interfere with the circadian clock, how this could impact on the postsurgical period and how to limit the disruption of the internal clock. ⋯ The synergic effect of anesthesia, surgery and postoperative intensive care on circadian rhythms require a careful approach to the patient considering a role for therapies and interventions aimed to re-establish the normal circadian rhythms. Over time, approach like the Awakening and Breathing Coordination, Delirium Monitoring and Management, Early Mobility and Family engagement and empowerment bundle can implement the clinical practice.
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The availability of large datasets and computational power has prompted a revolution in Intensive Care. Data represent a great opportunity for clinical practice, benchmarking, and research. Machine learning algorithms can help predict events in a way the human brain can simply not process. This possibility comes with benefits and risks for the clinician, as finding associations does not mean proving causality. ⋯ Data have always been part of the work of intensivists, but the current availability has not been completely exploited. The intensive care community has to embrace and guide the data science revolution in order to decline it in favor of patients' care.
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Patient decision aids are educational tools used to assist patients and clinicians in healthcare decisions. As healthcare moves toward patient-centered care, these tools can provide support to anesthesiologists by facilitating shared decision-making. ⋯ Patient decision aids can support patient-centered care delivery and shared decision-making, especially in the field of anesthesia. Current research involves implementing the use of patient decision aids in the discussion for monitored anesthesia care. Further development of quality metrics is needed to improve the decision aids and maximize decision quality.
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Curr Opin Anaesthesiol · Apr 2020
ReviewIs there an indication to utilize intravenous iron in acute trauma patients? Why, how, and when.
Traumatic injury has been described as a growing pandemic which has significant implications for global health. In the trauma setting, anemia is a common occurrence and is frequently inadequately addressed. It is associated with significant morbidity and incurs great cost - both to the patient and to the health system. The cause is multifactorial, and the pathophysiology is incompletely understood. Appropriate care of the trauma patient is a multidisciplinary responsibility and a focused approach to anemia is vital. The recommendation for restrictive transfusion strategies and the potential benefit of intravenous iron (IVI) in the perioperative setting, make the intervention an attractive proposition in the anemic trauma patient. ⋯ Suboptimally managed anemia impacts on clinical outcome and contributes to the burden of costs associated with trauma. The cause of the anemia associated with trauma is multifactorial and should be addressed at several levels. The role of IVI in this setting is yet to be clearly defined.
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Communication and teamwork are essential to enhance the quality of care, especially in operating rooms and ICUs. In these settings, the effective interprofessional collaboration between surgeons and intensivists impacts patients' outcome. This review discusses current opinions and evidence for improving communication strategies and the relationship between surgeons and intensivists/anesthesiologist. ⋯ Although limited, current evidence suggests to improve communication and teamwork in patient perioperative care. Further research is needed to strengthen the surgeon-intensivist relationship and to deliver high-quality patient care.