Current opinion in anaesthesiology
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Guidelines for weaning from sedation and weaning from ventilator gained increasing interest in recent years. This includes patients with acute respiratory distress syndrome, as well as other mechanically ventilated patients. This review will give an overview of the current literature and practice guidelines in ventilator and sedation weaning. ⋯ The most important conclusion we come to from recent randomized controlled trials is that only using an integrative algorithm for sedation and ventilator weaning can improve survival of ICU patients.
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Lung transplantation has been one of the great medical advances as the last option for the treatment of end-stage pulmonary disease. Optimal pulmonary care of potential donors and recipients can definitely increase the number of successful lung retrievals and reduce the incidence of complications. ⋯ Perioperative ventilatory care of the transplanted patient still represents a challenge for the ICU clinician. The lung-protective strategy and the early application of carbon dioxide removal systems can increase the number of lung donor eligibility. Further studies are needed to increase the viability of other organs and to develop new strategies that reduce the risk of ischemia-reperfusion injury, which still represents the most common complication in the postoperative period.
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Anaesthesiologists have a significantly higher frequency of substance abuse by a factor of nearly 3 when compared with other physicians. This is still a current problem that must be reviewed. ⋯ As drug abuse among anaesthesiologists has continued, new studies have been conducted to know the theories about susceptibility. Written substance abuse policies and controls must be taken in place and in all countries.
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Curr Opin Anaesthesiol · Apr 2012
ReviewPlasma/platelets/red blood cell ratio in the management of the bleeding traumatized patient: does it matter?
The scope of this review is to describe what is known about blood product ratios and their effects on acute trauma coagulopathy. Assessing how ratios matter to trauma patients is important to improve massive transfusion strategies. ⋯ Fresh frozen plasma/platelet/red blood cell ratios matter to define the content of packs immediately available within the golden hour to the right, accurately screened trauma patients. Research is needed in developing novel transfusion approaches for massively bleeding patients.