Current opinion in anaesthesiology
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Medical care costs represent a large proportion of the gross domestic product in developed countries, and intensive care units (ICUs) consume a significant amount of those resources. The aim of this review is to analyze how the healthcare cost problem is studied in critically ill patients. ⋯ Although economic justification should not be the only issue to influence treatments offered in the ICU, increasing use of tools such as cost-benefit analyses is needed to help with medical decisions on the critically ill patient.
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Curr Opin Anaesthesiol · Apr 2009
ReviewThe role of thromboelastometry and recombinant factor VIIa in trauma.
Recombinant factor VIIa (rFVIIa) and thromboelastography have acquired increasing importance in patients with severe bleeding and coagulopathy. This article reviews the current opinions regarding their use, with the purpose of clarifying the ambiguities that exist in dealing with trauma patients. ⋯ Thromboelastometry may guide the medical staff when and to whom rFVIIa could be administered. Evidence also encourages the use of rFVIIa in traumatic brain injury. More research is required to prove decreases in mortality using both thromboelastography and rFVIIa in trauma, with a focus on clear end points and goal-directed therapy.
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Curr Opin Anaesthesiol · Apr 2009
ReviewTransfusion in trauma: why and how should we change our current practice?
Major trauma is often associated with hemorrhage and transfusion of blood and blood products, which are all associated with adverse clinical outcome. The aim of this review is to emphasize why bleeding and coagulation has to be monitored closely in trauma patients and to discuss the rationale behind modern and future transfusion strategies. ⋯ Future transfusion strategies are based on early and continuous assessment of the bleeding and coagulation status of trauma patients. This allows specific and goal-directed treatment, thereby optimizing the patient's coagulation status early, minimizing the patient's exposure to blood products, reducing costs and improving the patient's outcome.
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Curr Opin Anaesthesiol · Apr 2009
ReviewAnesthetic process, organization, management and economic issues: the French perspective.
Anesthesia is a three-step process: preoperative evaluation, the intervention itself and postanesthetic care. In France, this scheme has been legally regulated since 1994. Since then, significant progress has been made in terms of safety. Nevertheless, challenges in the delivery and financing of anesthesia services persist; in particular, demographic (patients and medical staff, as in other western countries), budgetary and organizational restrictions. ⋯ Paths to improvement of delivery of anesthesia in France may include: more optimal sharing of medical resources; better utilization of operating sites, perhaps by consolidating and reducing locations; applying improved organizational skills; and improved risk management.
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Curr Opin Anaesthesiol · Apr 2009
Time for changing coagulation management in trauma-related massive bleeding.
New insights into the pathophysiology of trauma-induced coagulopathy, the increasing availability of point-of-care devices and awareness of side effects of intravenous fluids and traditional fresh frozen plasma therapy has encouraged new concepts for managing massive blood loss. ⋯ During massive blood loss, viscoelastic measurements should guide aggressive treatment of deficiency or hyperfibrinolysis or both. In addition, the impact of contributing factors should be considered and as far as possible corrected. New data underscore the importance of avoiding hypoperfusion, and the use of coagulation factor concentrates should enable more effective correction of coagulopathy.