Current opinion in anaesthesiology
-
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.
-
Curr Opin Anaesthesiol · Apr 2020
ReviewFrom the ICU to the operating room: how to manage the patient?
To outline key points for perioperative ICU optimization of nutrition, airway management, blood product preparation and transfusion, antibiotic prophylaxis and transport. ⋯ ICU patients who require surgery may benefit from appropriate perioperative management.
-
Curr Opin Anaesthesiol · Apr 2020
ReviewDoctor and healthcare workers strike: are they ethical or morally justifiable: another view.
This review analyzed legal and ethical issues surrounding recent doctor and healthcare worker (HCW) strikes and considered whether HCW strikes are legally and morally justifiable, underlying causes, and impact of such strikes on healthcare service delivery. ⋯ Doctors and HCWs strikes are lawful deadlock-breaking mechanisms when collective bargaining negotiations have reached an impasse. Doctors' strikes appear to create an ethical conflict with the Hippocratic tradition and obligation to place patients' best interests as the primary moral consideration in medical practice. However, the rise of consumerism in healthcare, and loss of power by doctors, many of whom now work as employees, subject to regulations imposed by different stakeholders, including governments, health-maintenance organizations, and healthcare insurers, has impacted on modern medical practice. Therefore, doctors, like other employees may occasionally resort to strikes to extract concessions from employers. Mortality is rarely increased during HCW strikes, especially where emergency healthcare services are provided.
-
Curr Opin Anaesthesiol · Apr 2020
ReviewInflammatory response in trauma patients: are there ways to decrease the inflammatory reaction?
Trauma patients are considered a complex population of patients in emergency medicine and need extensive, specialized therapy. One major part is the prevention and treatment of the inflammatory response, which occurs in patients after severe injury resulting in complications like endotheliopathy. Likely as a consequence, coagulopathy occurs. Sterile inflammation is hard to address, especially because of the lack of a single activator. Moreover, it is a complex composition of factors that lead to a pathologic immune response. Our understanding of these patterns is increasing, but the complete pathophysiologic changes have yet to be investigated. Therefore, there is no specific target to treat inflammatory response in trauma patients at the moment. ⋯ Our increasing understanding of the immune system have led to new potential therapeutic perspectives. All of these approaches need further research to be validated. As the current therapies are based on empirical strategies and have not changed much over the years, new treatment options would be an important progress.
-
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.