Current opinion in critical care
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To identify the recent literature supporting the ability of anesthesiologists to impact morbidity and mortality outside of the immediate intraoperative period. ⋯ Anesthesiologists should consider implication of goal-directed therapy in high-risk surgical patients, adhere to the American College of Cardiology/American Heart Association guidelines with regard to perioperative β-blockade, critically assess the data to support their choice of synthetic colloids over crystalloids, explore all possible strategies for avoiding perioperative transfusion, and be cognizant of their potential contribution to perioperative infectious morbidity.
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Curr Opin Crit Care · Aug 2012
ReviewImportance of intravenous fluid dose and composition in surgical ICU patients.
This review discusses the importance of intravenous fluid dose and composition in surgical ICU patients. On the basis of updated physiologic postulates, we suggest guidelines for the use of crystalloids and colloids. Goal-directed fluid therapy is advocated as a means for avoiding both hypovolemia and hypervolemia. ⋯ The routine replacement of unmeasured presumed fluid deficits is not appropriate. In critically ill patients, resuscitation with intravenous fluids should produce a demonstrable enhancement of perfusion. Individualized goal-directed therapy using functional hemodynamic parameters can optimize resuscitation and 'deresuscitation'.
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Postoperative delirium is a pervasive and complicated process that poses numerous challenges for the perioperative physician and entails significant consequences for the patient. ⋯ All told, the cost of delirium in the United States alone is estimated to be between US$ 38 and 152 billion. Thus, it is no surprise that there is considerable interest in understanding and treating the problem.
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Curr Opin Crit Care · Aug 2012
ReviewDescending thoracic aortic surgery: update on mortality, morbidity, risk assessment and management.
The purpose of this review is to summarize the literature on thoracic aortic surgery, as well as key management guidelines in the perioperative period. This is particularly timely, as endovascular techniques continue to evolve and become more available. ⋯ With the expanded use of endovascular techniques to treat aortic disease, midterm and long-term outcome studies and comparisons to open surgical approach are now being published with increasing frequency. This review analyzes the available literature on preventing adverse outcomes after descending thoracic aortic surgery, with specific attention to mortality, morbidity, risk assessment and management in the perioperative setting.
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Curr Opin Crit Care · Aug 2012
ReviewThe use of simulation in healthcare: from systems issues, to team building, to task training, to education and high stakes examinations.
Simulation in healthcare is becoming increasingly used. This review will spotlight some of the uses of simulation in healthcare training. ⋯ This article will review some recent studies showing how simulation can have a positive effect on patient outcomes and skill retention, uncover systems issues related to patient safety, and how simulation can be used in credentialing, and other high stakes examinations.