Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2015
ReviewRemote ischemic preconditioning and outcome: shall we all have an intermittent tourniquet?
Although advancements in perioperative care have been made over the last decades, the perioperative outcome could not be improved adequately. Therefore, new therapeutic strategies are required to decrease morbidity and all-cause mortality in surgical patients. Remote ischemic preconditioning (RIPC), defined as brief and transient episodes of ischemia at a remote site before a subsequent injury of the target organ, is an adaptive response to protect for organ injury elicited by different stimuli. This review evaluates the current clinical evidence for RIPC as a potential tissue-protective strategy and discusses the underlying mechanism. ⋯ RIPC may offer a novel inexpensive and noninvasive therapeutic strategy to alleviate organ injury in the perioperative period. However, adequately powered, large, multicenter clinical studies are necessary to accurately determine whether ischemic conditioning can improve the clinical outcomes of patients at risk for ischemia-reperfusion injury.
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Curr Opin Anaesthesiol · Apr 2015
ReviewNutrition and metabolic support for critically ill patients.
Acute critical illness increases the risk of malnutrition, are more obese, and have multiple comorbidities and frequent pre-existing nutritional deficits. There is a vast amount of research and literature being written on nutritional practices in the critically ill. We review and discuss herein the important nutrition literature over the past 12 months. ⋯ Nutrition and metabolic support of critically ill patients is a complex and diverse topic. Nutritional measurements, requirements, and modes and routes of delivery are currently being studied to determine the best way to treat these complicated patients. We present just a few of the current controversial topics in this fascinating arena.
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To provide a review of the current literature on the management of obstetric hemorrhage. ⋯ Postpartum hemorrhage is best managed by using a stepwise progressive approach. Manual and pharmacologic interventions are first-line treatments. Second-line treatments are used when bleeding continues; and hysterectomy is reserved for only the most extreme cases. Outcomes may be improved by thorough preparation, anticipating the risk of obstetric hemorrhage, and coordinating consultants for interventional procedures.
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Stress and burnout have arisen as relevant problems to the healthcare workers and the health systems themselves. As anaesthesiologists work in stressful areas of the hospitals, we are exposed to these problems. In this review, we summarize recent studies regarding stress and burnout, exploring possible solutions. ⋯ There is a lack of definitive evidence to guide the management of stress and burnout in medical professions in general and in anaesthesiology in particular. Longitudinal and interventional studies are needed to better determine ways of action. In the meantime, creating a positive work climate and institutional support as well as promoting control over one's job and the autonomy of employees are the most recommended strategies. Workers should also learn how to cope with stressors and practice personal strategies of wellness and resilience to fight against burnout.
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Growth in critical care services has led to a dramatic increase in the need for ICU physicians. The supply of intensivists is not easily increased and there is pressure to solve this problem by increasing the number of patients per intensivist. There is a scarcity of published data addressing this issue, and until recently, there were no guidelines on appropriate ratios of intensivists to patients. ⋯ The complex nature of critical care patients and ICUs make it difficult to provide one specific maximum intensivist-to-patient ratio, but common-sense rules can be applied. These recommendations are predicated on the principles that staffing can impact patient care as well as staff well-being and workforce stability. Also, that worsening patient outcomes, teaching, and workforce issues can be markers of inappropriate staffing. Finally, if the predicted daily workload of an intensivist exceeds the time of a work shift, then adjustments need to be made.