Current opinion in anaesthesiology
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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.
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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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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.