Current opinion in anaesthesiology
-
The past 35 years have provided a wealth of evidence that mechanical ventilation, although potentially life saving, can injure the lungs. Recent evidence suggests that limiting ventilating gas volumes can reduce patient mortality, but may result in progressive parenchymal derecruitment and alveolar hypoventilation, potentially aggravating systemic hypercarbia and hypoxemia. This review summarizes the current recommendations on a controversial, invasive technique termed 'extracorporeal life support' as a means to provide temporary pulmonary support during 'lung-protective' strategies. ⋯ Extracorporeal life support is an invasive technique that can provide support to the failing lung. Clinical trials have demonstrated its efficacy in neonatal and pediatric patients, but data in adults are less clear. An ongoing trial in the UK will soon address this important issue.
-
Ensuring quality in prehospital airway management is challenging because the out-of-hospital setting is a fast-paced and unpredictable environment. The first step in meeting this challenge is the recognition by emergency medical service leaders that prehospital airway management is prone to error. Quality core values such as safety, effectiveness, timeliness, efficiency, and equity for prehospital airway management, specifically endotracheal intubation, will be discussed. ⋯ Emergency medical service administrators must critically evaluate the quality of prehospital airway management that they are providing to patients within their system by collecting the data necessary to identify quality issues and developing strategies to implement change. Research into other techniques that can provide ventilation and oxygenation to patients in the prehospital environment and that are safe and effective, such as laryngeal mask airway, need to be performed.
-
End-of-life decisions play an important role in the intensive care unit. This review discusses the most important studies on end-of-life decisions published from October 2001 to October 2002. ⋯ The new studies put emphasis on the facts that all care providers should participate in the decision and that communication with surrogates is of extreme importance. Many valid points from other medical fields also apply to the intensive care unit situation.
-
Postoperative pulmonary complications, including pneumonia, bronchospasm, respiratory failure and prolonged mechanical ventilation, occur commonly and are a significant source of morbidity and mortality. This review will discuss the etiology of postoperative pulmonary complications and the interventions that reduce their risk. ⋯ Understanding risk factors for the development of postoperative pulmonary complications allows targeted interventions aimed at reducing their frequency and severity. Further research is needed to define the role of regional analgesic and anesthetic techniques in reducing postoperative pulmonary complications, and also to define the nature of risk factors and develop better predictive models of patients at risk of developing postoperative pulmonary complications.
-
Curr Opin Anaesthesiol · Apr 2003
Helicopter trauma transport: an overview of recent outcomes and triage literature.
The purpose of this review is to assess literature pertinent to outcomes benefits accrued by the use of helicopter emergency medical services for trauma transport. A previous annotated bibliography assessed literature published between 1980 and 2000. The goal of this paper is to address developments since fall 2001, and to cast recent studies in the light of earlier work in an attempt to provide a long-range overview of the relevant literature. ⋯ The preponderance of recent and previously extant evidence supports an argument that the helicopter emergency medical services transport is associated with significant benefit for some injured patients. The primary challenges at this time include the determination of which patients benefit and the elucidation of which aspects of the helicopter emergency medical services are responsible for any salutary effects of its utilization.