Current opinion in anaesthesiology
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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
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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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
ReviewCoagulopathy in trauma patients: what are the main influence factors?
Coagulopathy and bleeding after severe injury is a common problem. Whenever caring for critically ill patients, clinicians must anticipate, recognize and manage the coagulopathy of trauma. When left untreated, cardiovascular shock and multiorgan system failure ensue. Uncompensated hemorrhage often culminates in death, highlighting the significance of recognizing the main influences in coagulopathy of trauma. ⋯ Although mortality previously was thought to be summarily independent of medical interventions and resuscitations, we now know the opposite to be true; it is our expectation and indeed our obligation to recognize and manage the coagulopathy of trauma better than in past years. In as much as we continue to prevent acidosis, hypothermia and the progressive coagulopathy following injury, trauma victims the world over are benefiting and surviving longer, living proof that demonstrates the utility of managing the coagulopathy of trauma.
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Curr Opin Anaesthesiol · Apr 2009
ReviewAlterations of mitochondrial function in sepsis and critical illness.
Septic shock is the consequence of a conflict between a pathogenic agent and the immune system of the host. This conflict induces an immune-mediated cytokine storm, with a whole-body inflammatory response often leading to multiple organ failure. Although extensively studied, the pathophysiology of sepsis-associated multiorgan failure remains unknown. One postulated mechanism is changes in mitochondrial function with an inhibition of mitochondrial respiratory chain and a decrease of oxygen utilization. ⋯ A pivotal role is suggested for mitochondrial dysfunction during the occurrence of multiorgan failure. Understanding the precise effect of sepsis on the mitochondrial function and the involvement of mitochondria in the development of multiple organ failure is fundamental. More human studies are thus necessary to clarify the mitochondrial dysfunction in the various phases of sepsis (early and late phase) before testing therapeutic strategies targeting mitochondria.