Current opinion in anaesthesiology
-
Curr Opin Anaesthesiol · Apr 2023
ReviewA review of the utility of high-frequency oscillatory ventilation in burn and trauma ICU patients.
The purpose was to examine the utility of high-frequency oscillatory ventilation (HFOV) in trauma and burn ICU patients who require mechanical ventilation, and provide recommendations on its use. ⋯ Although some studies have shown promise and improved outcomes associated with HFOV, we recommend its use as a rescue modality for patients who have failed conventional ventilation.
-
Curr Opin Anaesthesiol · Apr 2023
ReviewTraumatic brain injury and RSI is rocuronium or succinylcholine preferred?
Traumatic brain injury is widespread and has significant morbidity and mortality. Patients with severe traumatic brain injury often necessitate intubation. The paralytic for rapid sequence induction and intubation for the patient with traumatic brain injury has not been standardized. ⋯ In patients with traumatic brain injury necessitating intubation, rocuronium appears to be safer than succinylcholine.
-
Curr Opin Anaesthesiol · Apr 2023
ReviewErrors in medicine: punishment versus learning medical adverse events revisited - expanding the frame.
Despite healthcare workers' best intentions, some patients will suffer harm and even death during their journey through the healthcare system. This represents a major challenge, and many solutions have been proposed during the last decades. How to reduce risk and use adverse events for improvement? ⋯ Focus must shift from an individual perspective to the system, promoting learning rather than punishment and disciplinary sanctions, and the recent opioid epidemic is an example of bad guidelines.
-
Curr Opin Anaesthesiol · Apr 2023
ReviewBiochemical disturbance in damage control resuscitation: mechanisms, management and prognostic utility.
With advances in resuscitative techniques, trauma patients are surviving increasingly severe injuries and physiological insult. Timely recognition of futility remains important in terms of patient dignity and resource preservation yet is increasingly challenging in the face of these advances. The understanding of biochemical derangement from pathophysiological processes of trauma and iatrogenic effects of resuscitation has expanded recently. ⋯ These findings will contribute to a greater understanding among anaesthesiologists of the causative mechanisms and effects of biochemical derangement after severe injury and aid them in the delivery of well tolerated and effective damage control resuscitation. Gaps in the evidence base are highlighted to encourage future work.
-
Curr Opin Anaesthesiol · Apr 2023
ReviewPediatric trauma center vs. adult trauma center: which is better?
Pediatric trauma centers (PTCs) have been championed as multidisciplinary facilities specializing in the care of pediatric trauma, the leading cause of childhood mortality in the United States. 1 However, the vast majority of pediatric trauma is still seen in trauma centers focused on treating adults. This article reviews the latest evidence comparing the relative strengths of PTCs and adult trauma centers (ATCs) in treating childhood injury. ⋯ It is difficult to demonstrate a difference in outcomes for children treated at PTCs vs. ATCs. However, PTCs do offer a multidisciplinary, nuanced approach to pediatric trauma care, which may result in long term benefits and offer opportunities for regional collaboration.