Current opinion in critical care
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Curr Opin Crit Care · Aug 2016
ReviewPostoperative complications of patients undergoing cardiac surgery.
Cardiac surgery is at high risk for the development of postoperative complications involving cardiovascular and respiratory system, as well as kidneys and central nervous system. The aim of this review is to provide an overview on the most recent findings concerning the type and incidence of different complications after cardiac surgery and to summarize the current recommendations. ⋯ Cardiac surgery is still at high risk for postoperative complications. The optimal type of anaesthesia, protective mechanical ventilation during and after surgery as well as haemodynamic management with vasoactive and inotropic drugs is still to be determined.
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Curr Opin Crit Care · Aug 2016
Postoperative complications in cardiac patients undergoing noncardiac surgery.
In this article we review the current knowledge on the underlying mechanisms of perioperative myocardial injury, the preoperative methods of predicting these complications, the diagnostic tools for detecting perioperative myocardial injuries, and the available protective strategies to prevent or attenuate the extent of myocardial injury. ⋯ These new insights will help to better tailor individual strategies to prevent or minimize perioperative cardiac complications. Especially, early diagnosis and intensification of treatment will get specific interest in the coming years.
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Curr Opin Crit Care · Aug 2016
ReviewPeri- and postoperative cognitive and consecutive functional problems of elderly patients.
From an elderly patient's perspective, acute and chronic cognitive disturbances are among the most harmful complications that can occur following surgery. For elderly patients, these complications often mean the end of an independent life. This article focuses on this serious aspect, which is increasingly prevalent in our aging society. Cognitive disturbances are associated with severe outcome impairments and increased mortality. This article aims to provide a current overview regarding the diagnosis, pathophysiology, prevention, and treatment of this severe social problem. ⋯ Especially in elderly patients, postoperative delirium constitutes a common, severe complication. Early diagnosis and supportive treatment are essential to improve outcome. To date, no pharmacological treatment strategy was effective, so that further research about the underlying pathophysiology and the development of treatment strategies are urgently required.
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The perioperative care of obese patients can often be challenging, as the presence of comorbidities is common in this patient population. In this article, we present recent data on perioperative complications of obese patients and discuss relevant details for daily practice, including drug dosing, airway management, and mechanical ventilation. ⋯ Intensive care physicians who treat obese patients need to be trained in the management of the difficult airway. The application of PEEP and the use of recruitment maneuvers may lead to improved intraoperative oxygenation, but current data do not allow recommending the use of high PEEP combined with lung recruitment maneuvers in this population.
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Curr Opin Crit Care · Aug 2016
ReviewBedside nutrition evaluation and physical assessment techniques in critical illness.
The purpose of this review is to highlight emerging techniques used to determine body composition early in ICU stay, their prediction of poor outcome, and what is required before they can be more widely used. ⋯ Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting have each been found to be better predictors of poor outcome than BMI in ICU patients.Mid-arm muscle circumference, SGA fat loss, and SGA muscle wasting may be able to identify patients who are most likely to benefit from enhanced nutrition support.We need further research incorporating the use of these simple measures to evaluate their ability to accurately identify patients most likely to benefit from enhanced nutritional support.