Articles: cations.
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Curr Opin Crit Care · Feb 2025
ReviewAdvances in achieving lung and diaphragm-protective ventilation.
Mechanical ventilation may have adverse effects on diaphragm and lung function. Lung- and diaphragm-protective ventilation is an approach that challenges the clinician to facilitate physiological respiratory efforts, while maintaining minimal lung stress and strain. Here, we discuss the latest advances in monitoring and interventions to achieve lung- and diaphragm protective ventilation. ⋯ Achieving lung- and diaphragm-protective ventilation may require more than a single intervention; it demands a comprehensive understanding of the (neuro)physiology of breathing and mechanical ventilation, along with the application of a series of interventions under close monitoring. We suggest a bedside-approach to achieve lung- and diaphragm protective ventilation targets.
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Nearly 30 million, mostly rurally located Americans lack timely access to level I or II trauma center care, resulting in inefficient resource use and potentially preventable death. Although significant progress has been made in the care of the injured patient during the last few decades, rural trauma patients continue to face significant challenges in accessing high-quality trauma care with resultant outcomes disparities and increased expenditures associated with potentially avoidable interfacility transfers. ⋯ Although telehealth has been used in trauma with some success, it remains underused. Members of a 2023 American College of Surgeons Committee on Trauma Spotlight Session on the role of teletrauma present an introduction to the applications, potential benefits, and future directions for telehealth use in trauma care.
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The incidence of central venous catheter-related thrombosis and the long-term effects of thrombosis on catheterized veins in neonates are unknown. The authors therefore determined the incidence of central venous thrombosis, identified associated risk factors, and evaluated outcomes at 6 months. ⋯ Covert central venous thrombosis is frequent in neonates who have central venous catheters, and complications are most common in patients who have large intravascular thrombi. Neonates with large intravascular thrombi should be followed and considered for anticoagulation.
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The future of global neurosurgery should focus on addressing the unmet neurosurgical need from a health system approach should we hope to achieve sustainable and ethical change. In this article, we review the global building blocks, as defined by the World Health Organization, and use this framework to propose strategies to strengthen neurosurgical care on the global frontier. The targets for Universal Healthcare Coverage by 2030, as outlined by the United Nations Sustainable Development Goals, are reviewed, and the role of neurosurgeons in addressing the global targets is discussed. ⋯ The execution of these global targets and indicators within the context of health system strengthening will be a persistent challenge, given the complexity of health system and its components. The neurosurgical community must continue to support, promote, and diversify collaborations, especially among deserts of neurosurgical care across the world. Innovative technology and education are essential to this global dilemma.
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Objective intraoperative performance metrics are a new resource for the field of surgical data science. In this study, we conducted a comprehensive review to analyze the existing literature on robotic surgical objective performance indicators (OPIs). ⋯ Clinically, OPIs have been used to predict postoperative patient outcomes and measure intraoperative efficiency. OPIs have shown promise in preliminary surgical education and patient outcomes-related studies, and further multicenter collaborative research will be imperative to validate the use of OPIs in the field of surgery.