Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2011
ReviewShould tracheostomy practice in the setting of trauma be standardized?
Trauma is a common predisposing condition in patients developing acute respiratory failure. Selection criteria for tracheostomy use in trauma remain poorly defined. The purpose of this review is to discuss contemporary knowledge regarding the benefits and risks of tracheostomy and to highlight potential strategies to standardize practice. ⋯ Variation in clinical practice is costly. To the extent that variation in tracheostomy practice reflects suboptimal use of this procedure, greater understanding of tracheostomy utility has the potential to enhance the quality of care and more effectively target resources.
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Curr Opin Anaesthesiol · Apr 2011
ReviewPublication fraud: implications to the individual and to the specialty.
To provide a brief review and update on the subject of scientific misconduct relevant to the specialty of anesthesia. The overall goal is to raise awareness amongst readers of the scientific literature that although publication fraud is relatively infrequent, the reasons for fraud are complex and the consequences to the individual and for the specialty are substantial. ⋯ When suspected, alleged misconduct must be thoroughly investigated. When proven, scientific misconduct must be addressed by the relevant institutions and the scientific record must be corrected. Many stakeholders are involved in this complex and most unfortunate process.
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Curr Opin Anaesthesiol · Apr 2011
ReviewOesophageal Doppler monitoring: should it be routine for high-risk surgical patients?
To determine whether sufficient evidence exists to justify routine use of oesophageal Doppler monitoring to guide perioperative haemodynamic management in high-risk surgery. ⋯ Better patient outcomes can be achieved by perioperative haemodynamic optimization using oesophageal Doppler monitoring and should be considered for routine use in most types of high-risk surgery.
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It has become clear from experimental data that prolonged mechanical ventilation can induce diaphragm dysfunction, also known as ventilator-induced diaphragm dysfunction. In this article we will discuss most recent understanding on ventilator-induced diaphragm dysfunction and data on diaphragm dysfunction in patients. ⋯ Diaphragm dysfunction occurs in patients, especially when ventilated with controlled modes of ventilation that minimize diaphragm activity. Time on the ventilator seems to be one of the biggest risk factors resulting in difficulties in weaning patients and prolonging time on the ventilator. Future trials should investigate whether improved patient-ventilator synchrony can reduce ventilator-induced diaphragm dysfunction and decrease weaning failure.