Current opinion in anaesthesiology
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Ventilator-associated pneumonia remains an important topic (or subject) in the care of the critically ill. Issues related to ventilator-associated pneumonia are now particularly acute given the continued increase in rates of antimicrobial resistance seen in intensive care units. This review examines the latest literature in this area, including promising approaches to infection prevention and recently developed guidelines to aid clinicians in limiting, identifying and treating ventilator-associated pneumonia. ⋯ Recent studies have started to illuminate the full magnitude of the impact of ventilator-associated pneumonia in the intensive care unit and suggest potential measures for intervention. Hopefully, additional work will aid in eventual development of effective preventive, diagnostic and therapeutic strategies that can reliably improve patient outcomes.
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Curr Opin Anaesthesiol · Apr 2006
ReviewOperating room design and its impact on operating room economics.
Operating rooms are high-cost/high-revenue environments. In an era of rising costs and declining reimbursement, it is essential to optimize the effectiveness of the operating room suite, maximizing throughput of profitable cases while minimizing the costs of necessary, but unprofitable, procedures. ⋯ Redesigning perioperative systems can increase operating room throughput, but not all case mixes benefit from the required additional resources. Thus hospitals should choose judiciously if, and to what degree, high throughput environments are implemented. Once implemented, access to these environments can be used as an incentive for improved surgical performance.
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Curr Opin Anaesthesiol · Feb 2006
ReviewAnesthetic considerations in patients with previous thoracic surgery.
This review presents an overview of the different problems and challenges after thoracic surgery. It covers the pathophysiological changes that may occur regularly in the early and late period following surgery. In addition, surgical complications with anesthesiological implications for diagnosis, treatment and prevention are discussed, and consequences for anesthesia in further major and thoracic surgical procedures are shown. ⋯ Current literature presents no general recommendations on how to manage patients after recent thoracic surgery. Therefore it is necessary to find an individual strategy to handle possible complications and well known pathophysiological changes. Knowledge and understanding of the etiology, the pathophysiology and the risk factors of the perioperative period, allows prevention and target intervention aimed at reducing morbidity and mortality following surgery.