Professionalism: microaggression in the healthcare setting
Purpose of review
Microaggressions are daily commonplace, subtle behaviors and attitudes toward others that arise from conscious or unconscious bias. Not only can microaggressions affect one's access to power, resources, and opportunity, but they could also contribute to the persistent disparities faced by marginalized groups among healthcare professionals as well as patients.
Recent findings
Physicians, especially those in perioperative specialties, commonly have distress during their medical training. Workplace mistreatment, such as discrimination, has been commonly reported by residents across multiple specia...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
Blood transfusion and alternatives in Jehovah's Witness patients
Purpose of review
More than 8.5 million people in the world observe the Jehovah's Witness faith, and require unique consideration for perioperative blood management as they generally refuse transfusion of blood and blood products. This review addresses a collaborative approach to each patient throughout the perioperative arena. The principles of this approach include optimization of hemoglobin levels preoperatively, attention to blood-salvaging methods intraoperatively, and minimization of blood draws postoperatively. In addition, we review the technologies currently in development as transfusion alternatives, includin...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: ETHICS, ECONOMICS AND OUTCOME: Edited by Alice A. Tolbert Coombs Source Type: research
COVID-19: should we consider it as a septic shock? (The treatment of COVID-19 patients in the ICU)
Purpose of review
The severe acute respiratory syndrome coronavirus 2 associated coronavirus disease 2019 (COVID-19) illness combines a syndrome of viral replication and a host dysregulated inflammatory response. Despite sharing a similar etiology, COVID-19 patients present different patterns from asymptomatic to severely hypoxemic patients. In some patients, patterns of multiorgan failure have been observed similarly to patients with bacterial sepsis. This review aimed to analyze the currently available data on the treatment of COVID-19, specifically the most studied antiviral agents and therapies targeting the immune...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Hemadsorption
Purpose of review
To review pathophysiological pathways of immune system response to infections, which may justify mediators removal by extracorporeal blood purification therapies (EBPTs) in critically ill septic patients. Moreover, we presented an overview of the EBPTs mostly used in clinical practice with the aim to modulate immune system dysfunction in sepsis.
Recent findings
Sepsis is a life-threatening disease and recent findings showed that its pathophysiology relies on dysregulated immune system response to pathogen invasion of the body. In the light of this view, EBPTs have been demonstrated effective to...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Mechanical ventilation in septic shock
Purpose of review
The aim of this study was to review the most recent literature on mechanical ventilation strategies in patients with septic shock.
Recent findings
Indirect clinical trial evidence has refined the use of neuromuscular blocking agents, positive end-expiratory pressure (PEEP) and recruitment manoeuvres in septic shock patients with acute respiratory distress syndrome. Weaning strategies and devices have also been recently evaluated. The role of lung protective ventilation in patients with healthy lungs, while recognized, still needs to be further refined. The possible detrimental effects of sponta...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Hemodynamic support in septic shock
Purpose of review
The current article reviews recent findings on the monitoring and hemodynamic support of septic shock patients.
Recent findings
The ultimate goal of hemodynamic resuscitation is to restore tissue oxygenation. A multimodal approach combining global and regional markers of tissue hypoxia seems appropriate to guide resuscitation. Several multicenter clinical trials have provided evidence against an aggressive fluid resuscitation strategy. Fluid administration should be personalized and based on the evidence of fluid responsiveness. Dynamic indices have proven to be highly predictive of responsiven...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
A narrative review on antimicrobial therapy in septic shock: updates and controversies
Purpose of review
Antibiotics are an essential treatment for septic shock. This review provides an overview of the key issues in antimicrobial therapy for septic shock. We include a summary of available evidence with an emphasis on data published in the last few years.
Recent findings
We examine apparently contradictory data supporting the importance of minimizing time to antimicrobial therapy in sepsis, discuss approaches to choosing appropriate antibiotics, and review the importance and challenges presented by antimicrobial dosing. Lastly, we evaluate the evolving concepts of de-escalation, and optimization of...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Septic shock: a microcirculation disease
Purpose of review
The aim of this study was to discuss the implication of microvascular dysfunction in septic shock.
Recent findings
Resuscitation of sepsis has focused on systemic haemodynamics and, more recently, on peripheral perfusion indices. However, central microvascular perfusion is altered in sepsis and these alterations often persist despite normalization of various macro haemodynamic resuscitative goals. Endothelial dysfunction is a key element in sepsis pathophysiology. It is responsible for the sepsis-induced hypotension. In addition, endothelial dysfunction is also implicated involved in the activa...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Pathophysiology of sepsis
Purpose of review
To provide a current overview of sepsis pathophysiology.
Recent findings
The emphasis on sepsis pathophysiology has moved away from the pathogen - the initiating factor - and instead is focussed upon the abnormal and exaggerated host response. Instead of targeted eradication of the infection, the host response activates or suppresses multiple downstream pathways, leading to multiple organ dysfunction.
Summary
Sepsis represents a dysregulated host response to infection leading to organ dysfunction. Here, the pathogen triggers an initial exaggerated inflammatory-immune response that leads ...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Epidemiology of sepsis and septic shock
Purpose of review
The epidemiology of sepsis and septic shock has been challenging to study for multiple reasons. These include changing diagnostic definitions, as well a high concentration of sepsis-related studies published from high-income countries (HICs), despite a large global burden. This section attempts to address the incidence of sepsis throughout the years and worldwide.
Recent findings
The incidence of sepsis and septic shock has continued to increase since the first consensus definitions (Sepsis-1) were established in 1991, and the latest definitions (Sepsis-3) provide a better reflection of mortali...
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Editorial: Septic shock: what we should know… or almost!
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Marc Leone Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 12, 2021 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
COVID in obstetrics: labor analgesia and cesarean section
Purpose of review
This review is based on the latest evidence to provide a good standard of care for COVID-19 parturients and protection to healthcare givers.
Recent findings
COVID-19 by itself is not an indication for cesarean section. Different publications demonstrated the efficacy of neuraxial analgesia/anesthesia for delivery. Although SARS-CoV-2 was associated with a certain neurotropism, neuraxial block was not associated with neurological damage in COVID-19 parturients, and seems as safe and effective as in normal situations. It permits to avoid a general anesthesia in case of intrapartum cesarean sectio...
Source: Current Opinion in Anaesthesiology - January 18, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARIES Source Type: research
Roadmap: one anesthesiology department's strategic approach to COVID-19
Purpose of review
The COVID-19 pandemic has driven transformation in every aspect of the healthcare delivery system. The unpredictable onset and magnitude of COVID-19 infections resulted in wide gaps in preparedness for healthcare systems. The development of protocols to address both scarcity of resources and staff protection continues to be essential for risk mitigation.
Recent findings
The northeast region of the United States had a rapid early surge of COVID-19 infections leading to the exhaustion of critical care capacity. In addition, northeastern hospitals experienced decrease in elective surgical interven...
Source: Current Opinion in Anaesthesiology - January 18, 2021 Category: Anesthesiology Tags: SPECIAL COMMENTARIES Source Type: research
Regional anaesthesia in the elderly patient a current perspective
Purpose of review
The world's population is ageing. Although regional anaesthesia is well established, it seems there is limited evidence to support its use over general anaesthesia in the elderly. This review aims to examine recent publications of regional anaesthesia in relation to this specific patient subgroup.
Recent Findings
There is a paucity of evidence specifically relating to regional anaesthesia in the elderly patient. Studies tend to be small, retrospective and can combine assessment of multiple surgical and anaesthetic techniques in single studies. Surgical stimulus and the associated stress respons...
Source: Current Opinion in Anaesthesiology - January 18, 2021 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Leanne Groban Source Type: research
