Current opinion in critical care
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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.
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Curr Opin Crit Care · Aug 2012
ReviewLess-invasive approaches to perioperative haemodynamic optimization.
A number of less-invasive haemodynamic monitoring devices have been introduced in recent years, largely replacing the pulmonary artery catheter (PAC) as a standard monitoring tool. Apart from tracking cardiac output (CO), these monitors provide additional haemodynamic parameters. The aim of this article is to review the most widely used less-invasive monitoring modalities, their technical characteristics and limitations regarding their clinical performance. ⋯ An array of monitoring modalities have been introduced that can reliably track CO in the perioperative setting and make the PAC dispensable in most clinical situations. In order to be used safely and efficiently, knowledge regarding the inherent monitoring techniques and their limitations, their clinical validity and the utility of the parameters provided is crucial.
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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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This article aims to make a review of the up-to-date knowledge on anaphylaxis and outline the recent advances on pathophysiology, diagnosis, and management of anaphylaxis. ⋯ An improvement of rapid diagnosis and treatment combined with education of population will decrease mortality and morbidity of anaphylaxis.