Current opinion in anaesthesiology
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This review is designed to update readers on recent discussions and research regarding vulnerable populations in medicine, including patients who are socioeconomically disadvantaged, queer, in prison or labeled with a stigmatizing complex medical disease. ⋯ Greater understanding of the cause of the health effects of being socioeconomically disadvantaged or being a member of a vulnerable population may be the first steps toward specific policy recommendations. Professional medical organizations and advocacy groups should raise awareness, provide education, publish guidelines and define the goals for the medical care for certain vulnerable populations.Vulnerable populations are at risk for disparate healthcare access and outcomes because of economic, cultural, ethnic or health characteristics. Vulnerable populations include patients who are racial or ethnic minorities, children, elderly, socioeconomically disadvantaged, underinsured or those with certain medical conditions. Members of vulnerable populations often have health conditions that are exacerbated by unnecessarily inadequate healthcare.
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Curr Opin Anaesthesiol · Apr 2013
ReviewNoninvasive respiratory support in the perioperative period.
Pulmonary complications ranging from atelectasis to acute respiratory failure are common causes of poor perioperative outcomes. As the surgical population becomes increasingly at risk for pulmonary dysfunction due to increasing age and weight, development of an approach toward respiratory compromise in these patients is becoming ever more important. Given the utility of noninvasive respiratory support (NRS) in acute respiratory failure, it is likewise likely to also be important in the perioperative period. ⋯ Noninvasive respiratory support should be considered an important adjunct in perioperative pulmonary care. Usage should be individually tailored in regard to timing and application modality specific to patient and surgical circumstances. More studies are needed, however, to determine the relationship demonstrated between short-term improvements in lung function and long-term outcomes.
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Curr Opin Anaesthesiol · Apr 2013
ReviewLogistics of transfusion support for patients with massive hemorrhage.
Traditionally, trauma resuscitation protocols have advocated sequential administration of therapeutic components, beginning with crystalloid solutions infused to replace lost intravascular volume. However, rapid restoration of the components of blood is essential for ensuring adequate tissue perfusion and for preventing acidosis, coagulopathy, and hypothermia, referred to as the 'lethal triad' in trauma settings. The review summarizes practical approaches for transfusion support of patients with massive hemorrhage. ⋯ Close monitoring of bleeding and coagulation in trauma patients allows goal-directed transfusions to optimize patients' coagulation, reduce exposure to blood products, and to improve patient outcomes. Future studies are needed to understand and demonstrate improved patient outcomes.
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Physiotherapy in the perioperative period is emerging as an important component of postoperative recovery. This review highlights recent advances in the implementation of physiotherapy in the perioperative period and its enhancement of postsurgical outcomes. ⋯ Timely and early physiotherapy in the perioperative period improves surgical recovery and reduces postoperative complications.
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Curr Opin Anaesthesiol · Apr 2013
ReviewPotential value of protocols in substantially bleeding trauma patients.
Early identification of shock and coagulopathy coupled with damage control resuscitation are central tenets of early trauma management. In traumatic injury, haemorrhage is responsible for almost 50% of deaths occurring within the first 24 h of injury and up to 80% of intraoperative trauma mortalities. Immediate haemorrhagic mortality constitutes the largest group of potentially preventable deaths in the initial 24-h period. This review will discuss the recent changes and advancement of early traumatic coagulopathy and the important role of substantial bleeding protocols (SBPs). ⋯ An SBP addresses the organizational issues necessary to respond to massive blood loss in an immediate and sustained manner. It reduces provider variability, facilitates staff communication and compliance, and simplifies the administration of predefined ratios of blood components. A transfusion subcommittee should be formed to directly address the complex issues of implementing a SBP system.