Current opinion in anaesthesiology
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To provide a practical approach to measure and then improve the quality of an academic anesthesia department. ⋯ Departments of anesthesia should develop performance criteria in multiple domains and recognize the importance of human relationships (between staff and between staff and patients) in quality and safety. To improve the value of anesthesia services, departments should identify their user groups, survey them to determine what attributes are important to the user, then deliver, measure, monitor and improve them on an ongoing basis.
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Curr Opin Anaesthesiol · Apr 2009
ReviewMicrocirculation and mitochondria in sepsis: getting out of breath.
To present the recent findings obtained in clinical and experimental studies examining microcirculatory alterations in sepsis, their link to mitochondrial dysfunction, and current knowledge regarding the impact of these alterations on the outcome of septic patients. ⋯ Even though there is evidence that microcirculatory and mitochondrial dysfunction plays a role in the development of sepsis-induced organ failure, their interaction and respective contribution to the disease remains poorly understood. Future research is necessary to better define such relationships in order to identify therapeutic targets and refine treatment strategies.
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Curr Opin Anaesthesiol · Apr 2009
ReviewRole of storage time of red blood cells on microcirculation and tissue oxygenation in critically ill patients.
To review the current literature on the role of storage time of transfused red blood cells on microcirculation and tissue oxygenation in critically ill patients. ⋯ Large-scale prospective randomized trials are needed to explicitly clarify the role of new transfusion triggers, such as tissue oxygenation, and the impact of storage lesions of packed red blood cells on tissue oxygenation and--more important--on clinical outcomes in different patient populations.
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Curr Opin Anaesthesiol · Apr 2009
ReviewThe impact of the glycocalyx on microcirculatory oxygen distribution in critical illness.
Main problems of critical illness and sepsis are an altered oxygen distribution and microvascular dysfunction linked to tissue oedema. This review seeks to analyse the role of the endothelial glycocalyx in this context. ⋯ Deterioration of the endothelial glycocalyx initiates a breakdown of the vascular barrier in systemic inflammatory response syndrome and sepsis. Preserving this structure in critical illness might be a future therapeutical goal to improve microcirculatory oxygen distribution.
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Curr Opin Anaesthesiol · Apr 2009
ReviewLink between coagulation abnormalities and microcirculatory dysfunction in critically ill patients.
The current review discusses the role of coagulation in microcirculatory abnormalities and whether anticoagulants may improve microvascular perfusion. ⋯ The activation of coagulation may play an indirect role in microvascular dysfunction, through interplay with endothelium and inflammation.