Current opinion in anaesthesiology
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Curr Opin Anaesthesiol · Apr 2008
ReviewEarly goal-directed therapy in severe sepsis and septic shock: a contemporary review of the literature.
Aggressive approaches to acute diseases such as acute myocardial infarction, trauma, and stroke have improved outcomes. Early goal-directed therapy for severe sepsis and septic shock represents a similar approach. An analysis of the literature assessing external validity and generalizability of this intervention is lacking. ⋯ Early goal-directed therapy modulates systemic inflammation and results in significant reductions in morbidity, mortality, and healthcare resource consumption. Early goal-directed therapy has been externally validated and is generalizable across multiple healthcare settings. Because of these robust findings, further emphasis should be placed on overcoming logistical, institutional, and professional barriers to implementation which can save the life of one of every six patients presenting with severe sepsis and septic shock.
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Curr Opin Anaesthesiol · Apr 2008
ReviewTeamwork and the legal and ethical responsibility of the anaesthetist.
Anaesthetists are members of the operating team. Although the surgeons usually consider themselves to be the leaders of the team, all members, including the anaesthetist, have their own legal, ethical and professional responsibilities. ⋯ Anaesthetists have to be more aware of their position in the care team and pay more attention to their legal, ethical and professional responsibilities.
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Current cardiopulmonary resuscitation guidelines emphasize that providing high-quality basic life support is the single most important contribution to successful resuscitation. Efficiency of advanced cardiac life support depends on sufficient cardiopulmonary resuscitation performance leading to continuous bloodflow and oxygenation. Existing data show that the quality of cardiopulmonary resuscitation performance is poor. Feedback technologies claim to improve cardiopulmonary resuscitation quality by supporting rescuers in their efforts. ⋯ Since effective basic life support is crucial for victims of cardiac arrest, recent findings that cardiopulmonary resuscitation quality provided by professionals fails to achieve recommended levels is not acceptable. Efforts need to be made in order to improve cardiopulmonary resuscitation quality and to support rescuers by real-time feedback. The technical elements of cardiopulmonary resuscitation feedback need to be carefully studied before being introduced into practice.
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Curr Opin Anaesthesiol · Apr 2008
ReviewRole of glutamine supplementation in critically ill patients.
To update the documentation concerning the clinical use of glutamine supplementation in critically ill patients. Outcome, patient safety and future plans are examined. ⋯ The use of intravenous glutamine supplementation in critically ill patients on total parenteral nutrition is currently the standard of care. The use of exogenous glutamine supplementation in critically ill patients on enteral nutrition is still not supported by sufficient evidence. The use of plasma glutamine concentration as an indicator for glutamine deficiency and a possible indicator for supplementation is suggested.
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To present the pharmacologic and biologic profile of levosimendan and discuss potential indications in the treatment of sepsis and septic shock, with a special focus on myocardial and pulmonary dysfunction. ⋯ There is increasing evidence that levosimendan exerts beneficial effects in the treatment of sepsis-induced myocardial and pulmonary dysfunction. Future large-scale multicenter clinical trials are now needed to clarify whether levosimendan improves the overall outcome of patients with sepsis and septic shock.