Critical care : the official journal of the Critical Care Forum
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The C-MAC video laryngoscope substantially reduced poor glottic views and increased intubation success in ICU patients with at least one predictor for difficult intubation. However, all video-assisted and optical intubation devices have different view angles, thus producing different images with particular distortion, and even experts in 'old-fashioned' airway management need a substantial level of training with a certain device before using it safely and successfully in critical situations and patients. Video laryngoscopes, regardless of a particular brand or device, cannot be used intuitively - they require expert skills and routines to be turned into a life-saving airway management tool.
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The early administration of tranexamic acid (TXA) to bleeding trauma patients reduces all-cause mortality without increasing the risk of vascular occlusive events. Indeed, the risk of arterial thrombosis appears to be reduced with TXA. ⋯ These include inhibition of the inflammatory effects of plasmin, effects on platelets and effects on factors V and VIII. If proven, these antithrombotic effects would have major implications for the systemic use of TXA in surgical patients, where TXA has been clearly shown to reduce bleeding.
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Editorial Comment
Crystalloids versus colloids during acute normovolemic anemia: the quest continues...
The optimal kind of fluid for fluid resuscitation during acute, severe hemorrhage is still discussed controversially. Of particular interest in this context is the choice of colloids versus crystalloids and their effect on the critical hemoglobin level. In a previous issue of Critical Care, Pape and colleagues describe the effect of four different volume replacement options on the critical hemoglobin concentration, and show marked differences for the different treatments. Even though some important pathophysiological issues remain unsolved, the current manuscript adds interesting evidence to an ongoing quest.
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Editorial Comment
Etomidate for intubation of patients who have sepsis or septic shock - where do we go from here?
Etomidate is an intravenous induction agent that is associated with hemodynamic stability during intubation. The agent is therefore attractive for use in critically ill patients who have a high risk of hemodynamic instability during this procedure. However, etomidate causes adrenal suppression, which itself has been associated with increased mortality in critically ill patients. The ongoing debate surrounding use of etomidate is thus centered on the immediate favorable hemodynamic profile versus the long-term risks of adrenal insufficiency, particularly in patients who have severe sepsis or septic shock.