Surgical rib fixation in traumatic rib fractures: is it warranted?
Purpose of review
Traumatic chest wall injuries and rib fractures remain a prevalent injury. Despite many advances, these injuries result in high morbidity and mortality. Surgical stabilization of rib fractures (SSRF) is increasing in utilization with expanding indications. Recent studies have demonstrated that many patients may benefit from surgical intervention.
Recent findings
Over the past 20 years the indications and timing of SSRF has evolved. Once reserved mainly for the most extreme of injuries, expanding indications demonstrate that even minimally injured patients may benefit from intervention regarding...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research
When is it safe to resume anticoagulation in traumatic brain injury?
Purpose of review
When to resume or initiate anticoagulation therapy following traumatic brain injury (TBI) is controversial. This summary describes the latest evidence to guide best practice.
Recent findings
Following trauma, prophylactic, and therapeutic anticoagulation (TAC) have been widely encouraged to prevent major comorbidities such as pulmonary embolism and deep venous thrombosis. Increased rebleeding risk and potentially catastrophic outcome from initiation of anticoagulation treatment in TBI are mainly influenced by institutional guidelines or physician preference in the absence of level I or II recom...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research
Predicting mortality in elderly trauma patients: a review of the current literature
Purpose of review
Advances in medical care allow patients to live longer, translating into a larger geriatric patient population. Adverse outcomes increase with older age, regardless of injury severity. Age, comorbidities, and physiologic deterioration have been associated with the increased mortality seen in geriatric trauma patients. As such, outcome prediction models are critical to guide clinical decision making and goals of care discussions for this population. The purpose of this review was to evaluate the various outcome prediction models for geriatric trauma patients.
Recent findings
There are several pr...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research
The impact of coronavirus 2019 on trauma
Purpose of review
The relationship between trauma and the ongoing global coronavirus 2019 (COVID-19) pandemic is still largely unclear. This comprehensive review of recent studies examining overall trauma volumes, mechanisms of injury, and outcomes after trauma during the COVID-19 pandemic was performed to better understand the impact of the pandemic on trauma patients.
Recent findings
In the early stages of the pandemic, the overall volumes of patients seen in many major trauma centers had decreased; however, these rates largely returned to historical baselines after the cessation of stay-at-home orders. An inc...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research
Healthcare disparities in trauma: why they exist and what we can do
Purpose of review
This review will explore the underlying causes of healthcare disparities among trauma patients and offer considerations for reducing inequities to improve trauma care.
Recent findings
Newly recognized racial disparities exist with respect to triaging trauma patients and in acute pain management. Social Determinants of Health offers a model to understand disparity in trauma care.
Summary
Race, ethnicity, socioeconomic status, and access to healthcare drive outcome disparity among trauma patients. These disparities include reduced healthcare services, inadequate pain management, reduced po...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research
Whole blood use in trauma resuscitation: targeting prehospital transfusion
Purpose of review
Trauma resuscitation management has evolved over the years with a more nuanced understanding of the injured patient's physiologic state of shock. The purpose of this review is to discuss the role of whole blood administration in the prehospital setting in the resuscitation of the trauma patient.
Recent findings
In traumatically injured patients, whole blood administration initiated in the prehospital setting may improve early shock severity, coagulopathy, and survival when used over traditional resuscitation fluids such as crystalloid administration or component therapy.
Summary
The timi...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research
Editorial: Trauma and transfusion during a global pandemic
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: TRAUMA AND TRANSFUSION: Edited by Catherine M. Kuza Source Type: research
Airway management in the critically ill patient with COVID-19
Purpose of review
Critically ill Coronavirus disease 2019 (COVID-19) patients needing endotracheal intubation are on the verge of rapid decompensation. The aims of this review were to assess the risks, the preoxygenation, the device and the hemodynamic management of a patient with COVID-19.
Recent findings
The proceduralist performing endotracheal intubation with the entire team are at an increased risk for exposure to COVID-19. Appropriate personal protective equipment and other measures remain essential. For preoxygenation, noninvasive ventilation allows higher oxygen saturation during intubation in severely h...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Avery Tung Source Type: research
Airway misadventures in adult critical care: a concise narrative review of managing lost or compromised artificial airways
Purpose of review
Loss or compromise of artificial airways in critically ill adults can lead to serious adverse events, including death. In contrast to primary emergency airway management, the optimal management of such scenarios may not be well defined or appreciated.
Recent findings
Endotracheal tube cuff leaks may compromise both oxygenation and ventilation, and supraglottic cuff position must first be recognized and distinguished from other reasons for gas leakage during positive pressure ventilation. Although definitive management involves tube exchange, if direct visualization is possible temporizing measu...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Avery Tung Source Type: research
Extubation of the potentially difficult airway in the intensive care unit
Purpose of review
Extubation in the intensive care unit (ICU) is associated with a failure rate requiring reintubation in 10–20% patients further associated with significant morbidity and mortality. This review serves to highlight recent advancements and guidance on approaching extubation for patients at risk for difficult or failed extubation (DFE).
Recent findings
Recent literature including closed claim analysis, meta-analyses, and national society guidelines demonstrate that extubation in the ICU remains an at-risk time for patients. Identifiable strategies aimed at optimizing respiratory mechanics, patien...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Avery Tung Source Type: research
The physiologically difficult airway: an emerging concept
Purpose of review
The physiologically difficult airway is one in which physiologic alterations in the patient increase the risk for cardiorespiratory and other complications during tracheal intubation and transition to positive pressure ventilation. This review will summarize the recent literature around the emerging concept of the physiologically difficult airway, describe its relevance and various patient types in which this entity is observed.
Recent findings
Physiologic derangements during airway management occur due acute illness, pre-existing disease, effects of anesthetic agents, and positive pressure ven...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Avery Tung Source Type: research
Challenges and outcomes in airway management outside the operating room
Purpose of review
Airway management outside the operating room poses unique challenges that every clinician should recognize. These include anatomic, physiologic, and logistic challenges, each of which can contribute to complications and lead to poor outcomes. Recognizing these challenges and highlighting known outcome data may better prepare the team, making this otherwise daunting procedure safer and potentially improving patient outcomes.
Recent findings
Newer intubating techniques and devices have made navigating anatomic airway challenges easier. However, physiological challenges during emergency airway man...
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: INTENSIVE CARE AND RESUSCITATION: Edited by Avery Tung Source Type: research
Editorial introductions
No abstract available (Source: Current Opinion in Anaesthesiology)
Source: Current Opinion in Anaesthesiology - March 16, 2022 Category: Anesthesiology Tags: EDITORIAL INTRODUCTIONS Source Type: research
Mechanical circulatory support devices in geriatric patients: more than just age
Purpose of review
The use of mechanical circulatory support (MCS) devices, such as left ventricular assist device and extracorporeal membrane oxygenation in the elderly have been rapidly increasing in various clinical settings over the past two decades. This review briefly summarizes recent literature on the role and outcomes of such mechanical circulatory support devices use in the elderly.
Recent findings
Elderly patients are receiving increasing number of LVADs with improved survival and quality-of-life outcomes, despite multiple comorbidities. ECMO is a viable option in elderly patients but they have a highe...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Shamsuddin Akhtar Source Type: research
Preoperative evaluation of geriatric patients undergoing liver transplantation
Purpose of review
As the population of the world is aging the number of geriatric patients undergoing liver transplantation (LT) is also increasing. They pose a unique challenge for the caregivers, as they have age-related physiological changes, multiple comorbidities and cirrhosis-related pathologies.
Recent findings
Twenty-two percent of patients who undergo LT are older than 65 years. Many patients suffer from nonalcoholic steatohepatitis (NASH), hepatocellular carcinoma and hepatitis-C virus. Incidence of NASH tends to increase with age, obesity, diabetes and metabolic syndrome. Elderly patients require comp...
Source: Current Opinion in Anaesthesiology - January 3, 2022 Category: Anesthesiology Tags: GERIATRIC ANESTHESIA: Edited by Shamsuddin Akhtar Source Type: research
