Best practice & research. Clinical anaesthesiology
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewScores for preoperative risk evaluation of postoperative mortality.
Preoperative risk evaluation scores are used prior to surgery to predict perioperative risks. They are also a useful tool to help clinicians communicate the risk-benefit balance of the procedure to patients. This review identifies and assesses the existing preoperative risk evaluation scores (also called prediction scores) of postoperative mortality in all types of surgery (emergency or scheduled) in an adult population. ⋯ We found 26 scores described within 60 different reports. The most suitable scores with the highest validity identified for anaesthesia practice were the Preoperative Score to Predict Postoperative Mortality (POSPOM), the Universal ACS NSQIP surgical risk calculator (ACS-NSQUIP), the Clinical Frailty Scale (CFS) and the American Society of Anesthesiologists Physical Status (ASA-PS) classification system. While other scores identified in this review could also be endorsed, their level of validity and generalizability to the general surgical population should be carefully considered.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewCentral venous catheter insertion: Review of recent evidence.
Guidelines for prevention of catheter-related bloodstream infection (CR-BSI) describe a series of recommendations for correct insertion and handling of central venous catheters (CVCs). Since their implementation, quality programs such as "Zero bacteremia" have achieved a reduction in CR-BSI rates, but there is still room for further improvement. ⋯ These examples of new tools among others might help to further decrease infection rates. This article aims to review new evidence-based strategies to reduce catheter insertion-related infection.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewAnaesthesia and perioperative incident reporting systems: Opportunities and challenges.
Incident Reporting Systems (IRS) continue to be an important influence on improving patient safety. IRS can provide valuable insights into how to prevent patients from being harmed at the organizational level. ⋯ Health care organizations need to develop effective strategies built on trust and truth telling to improve the impact of IRS. This requires strategies to address the limited resources to analyse the near-misses or adverse events; avoid the punitive drift through maintaining the anonymity and protective legislation; integrating IRS and avoiding its confusion with mandatory adverse event response systems; training data analysts to focus on the system instead of the individual through a balanced simple taxonomy; combine the analyses at the local level, to reinforce effective and personalized feedback, with the potential of a national or supranational learning platform.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewSex and gender differences in anesthesia: Relevant also for perioperative safety?
Sex (a biological determination) and gender (a social construct) are not interchangeable terms and both impact perioperative management and patient safety. Sex and gender differences in clinical phenotypes of chronic illnesses and risk factors for perioperative morbidity and mortality are relevant for preoperative evaluation and optimization. ⋯ Transgender patients represent a vulnerable population who need special perioperative care. Gender balance increases team performance and may improve perioperative outcomes.
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Best Pract Res Clin Anaesthesiol · May 2021
ReviewOptimizing airway management and ventilation during prehospital advanced life support in out-of-hospital cardiac arrest: A narrative review.
Airway management and ventilation are essential components of cardiopulmonary resuscitation to achieve oxygen delivery in order to prevent hypoxic injury and increase the chance of survival. Weighing the relative benefits and downsides, the best approach is a staged strategy; start with a focus on high-quality chest compressions and defibrillation, then optimize mask ventilation while preparing for advanced airway management with a supraglottic airway device. ⋯ Capnography has many advantages and should be used routinely. Optimizing ventilation strategies, harmonizing ventilation with mechanical chest compression devices, and implementation in complex and stressful environments are challenges we need to face through collaborative innovation, research, and implementation.