Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2022
ReviewReview of pediatric hypercarbia and intraoperative management.
Hypercarbia in pediatric patients is an important component of intraoperative management. Despite marked advances in medicine and technology, it is uncertain what the physiological CO2 range in neonates, infants and small children. This data is extrapolated from the adult population. We are going to review advantages and disadvantages of CO2 measurement techniques, causes and systemic effects of hypercarbia. We are going to discuss how to approach management of intraoperative hypercarbia. ⋯ Pediatric anesthesiologists and their teams must remain vigilant and anticipate these developments. Care must be taken to avoid any rapid changes in these vulnerable patients to minimize risks of adverse outcomes.
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Despite significant advances in trauma management over the last twenty years, uncontrolled hemorrhage remains the leading cause of preventable death in trauma. We review recent changes affecting hemorrhage control resuscitation. ⋯ Improving trauma coagulopathy diagnostics and hemorrhage control are vital if we are to decrease the mortality associated with trauma.
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Curr Opin Anaesthesiol · Apr 2022
ReviewPredicting mortality in elderly trauma patients: a review of the current literature.
Advances in medical care allow patients to live longer, translating into a larger geriatric patient population. Adverse outcomes increase with older age, regardless of injury severity. Age, comorbidities, and physiologic deterioration have been associated with the increased mortality seen in geriatric trauma patients. As such, outcome prediction models are critical to guide clinical decision making and goals of care discussions for this population. The purpose of this review was to evaluate the various outcome prediction models for geriatric trauma patients. ⋯ The ideal outcome prediction model for geriatric trauma patients has not been identified. The GTOS demonstrates accurate predictive ability in elderly trauma patients. The addition of medical comorbidities as a variable in outcome prediction tools may result in superior performance; however, additional research is warranted.
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Curr Opin Anaesthesiol · Apr 2022
ReviewExtracorporeal cardiopulmonary resuscitation: is it futile?
Extracorporeal cardiopulmonary resuscitation (ECPR) is a treatment modality used to restore end-organ perfusion in the setting of refractory cardiac arrest in patients receiving cardiopulmonary resuscitation (CPR). Despite advances in medicine, survival from cardiac arrest remains low with conventional CPR. The body of literature relating to ECPR is limited to retrospective studies and case series, with data that are inconsistent. Routine use of ECPR is not currently endorsed by the American Heart Association. ⋯ ECPR may be considered as an adjunct to CPR in cases of refractory cardiac arrest. The success of ECPR relies on specialized expertise, thoughtful patient selection, and timely initiation.
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Curr Opin Anaesthesiol · Apr 2022
ReviewExamining intersectionality in anesthesiology training, academics, and practice.
Intersectionality, or the overlapping nature of social categorizations, such as race, class, and gender, creates interdependent systems of discrimination, disadvantage, and health disparities. The present review examines common shortcomings to diversity management, and proposes targeted improvement frameworks for anesthesiology departments that would offer competitive advantage in training, hiring, and retention, and improved care delivery aimed toward reducing health disparities. ⋯ The synergy of intersectionality mounts considerable challenges that impact patients, colleagues, and communities of practice. Examining intersectionality in education and workplace policy affords tremendous opportunity for improving quality of care for marginalized populations, reducing healthcare costs, and normalizing culture that is inclusive, equitable, and empowering.