Best Practice & Research-Clinical Anaesthesiology最新文献

{"title":"The role of fibrinogen in postpartum hemorrhage","authors":"Tim Vermeulen MD (Anesthesiology Trainee) ,&nbsp;Marc Van de Velde MD, PhD, EDRA, FESAIC (Professor)","doi":"10.1016/j.bpa.2022.10.002","DOIUrl":"10.1016/j.bpa.2022.10.002","url":null,"abstract":"<div><p><span>Postpartum hemorrhage (PPH) is the leading cause of maternal death worldwide (WHO), with almost 60000 deaths annually. Pregnancy is a prothrombotic state with increased levels of several </span>coagulation factors<span> to protect the parturient from bleeding problems during delivery. Fibrinogen<span> has a significant role in coagulation and bleeding. Studies have pointed out that lower fibrinogen levels before delivery, but also at the initiation of PPH, are predictive of major hemorrhage. Early, the goal-directed fibrinogen concentrate therapy might be very useful in a subgroup of patients with serious PPH. This review aims to summarize the current literature on fibrinogen during PPH.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 399-410"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10346082","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Protocol for postpartum haemorrhage including massive transfusion","authors":"Ove Karlsson MD, PhD (Consultant Anaesthetist)","doi":"10.1016/j.bpa.2022.09.003","DOIUrl":"10.1016/j.bpa.2022.09.003","url":null,"abstract":"<div><p><span><span>Postpartum haemorrhage<span><span> (PPH) is one of the most common causes of maternal mortality worldwide. Management of PPH depends on the severity of bleeding. If the bleeding is severe, aorta compression can reduce bleeding. It should be followed by insertion of two coarse needles for intravenous access and blood sampling for haemoglobin and haemostasis. Further on, monitoring of vital parameters, as well as provision of extra oxygen and warm crystalloids, should be performed. </span>Uterine atony is the most common cause of PPH and local guidelines for uterotonic </span></span>drug selection should be followed. Patients with ongoing bleeding should immediately receive surgical care for bleeding control. During severe ongoing bleeding, haemostasis care includes early </span>tranexamic acid<span><span>, transfusion in ratio 4:4:1 (blood:plasma:platelets), and extra fibrinogen intravenously. If not severe PPH, use goal-directed therapy. During </span>general anaesthesia<span> and uterine atony, stop volatile anaesthesia and change to intravenous anaesthesia.</span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 427-432"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10346080","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk assessment tools to predict postpartum hemorrhage","authors":"Holly B. Ende MD (Assistant Professor of Anesthesiology)","doi":"10.1016/j.bpa.2022.08.003","DOIUrl":"10.1016/j.bpa.2022.08.003","url":null,"abstract":"<div><p>Postpartum hemorrhage<span> (PPH) is a leading cause of maternal morbidity and mortality, and accurate risk assessments may allow providers to anticipate and prevent serious hemorrhage-related adverse events. Multiple category-based tools have been developed by national societies through expert consensus, and these tools assign low, medium, or high risk of hemorrhage based on a review of each patient's risk factors. Validation studies of these tools show varying performance, with a wide range of positive and negative predictive values. Risk prediction models for PPH have been developed and studied, and these models offer the advantage of more nuanced and individualized prediction. However, there are no published studies demonstrating external validation or successful clinical use of such models. Future work should include refinement of these models, study of best practices for implementation, and ultimately linkage of prediction to improved patient outcomes.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 341-348"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10346078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postpartum hemorrhage: The role of simulation","authors":"Rebecca D. Minehart MD, MSHPEd (Assistant Professor) ,&nbsp;Hilary Gallin MD, MBA, Instructor","doi":"10.1016/j.bpa.2022.11.002","DOIUrl":"10.1016/j.bpa.2022.11.002","url":null,"abstract":"<div><p>Postpartum hemorrhage (PPH) persists as a leading cause of maternal death worldwide, and in the United States, most maternal deaths due to hemorrhage are deemed preventable. While essential preparations for hemorrhage include protocols and checklists, implementation science has revealed that it is not enough to merely introduce these tools into units. Simulation affords safe opportunities for practice and produces reliable behavior change, and it does not always need to be highly expensive and resource consuming. We review how simulation can be applied to address a unit's vulnerabilities in identifying, managing, and resolving PPH, as well as considerations for crafting a comprehensive simulation program for your unit.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 433-439"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350233","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of tranexamic acid in the management of postpartum haemorrhage","authors":"Anne-Sophie Bouthors MD,PhD (Redaction and revision of the manuscript, research investigator and coordinator) ,&nbsp;Sixtine Gilliot PhD Student (Draft revision, research team) ,&nbsp;Loïc Sentilhes MD,PhD (Draft revision, research coordinator) ,&nbsp;Benjamin Hennart MD (Research team, draft revision) ,&nbsp;Emmanuelle Jeanpierre MD (Research team, draft revision) ,&nbsp;Catherine Deneux-Tharaux MD,PhD (Draft revision, research team coordinator) ,&nbsp;Gilles Lebuffe MD,PhD (Research team coordinator, draft revision) ,&nbsp;Pascal Odou PhD (Research team coordinator, draft revision)","doi":"10.1016/j.bpa.2022.08.004","DOIUrl":"10.1016/j.bpa.2022.08.004","url":null,"abstract":"<div><p>In the last decades, tranexamic acid<span> (TXA) has emerged as an essential tool in blood loss management in obstetrics<span><span><span>. TXA prophylaxis for postpartum haemorrhage<span> (PPH) has been studied in double-blind, placebo-controlled, randomized clinical trials<span> (RCTs). Given the small observed preventive effect, the systematic use of TXA for vaginal and/or caesarean deliveries remains controversial. The result of a </span></span></span>pharmacokinetic<span><span> modelling suggests that relative to intravenous administration, </span>intramuscular administration may be an equally effective alternative route for preventing PPH and may enable access to this </span></span>drug<span> in low-resource countries. Prophylaxis is currently studied in high-risk populations, such as women with prepartum anaemia or placenta previa.</span></span></span></p><p><span><span>TXA effectively reduces blood loss and PPH-related morbidity and mortality during active PPH, as demonstrated by high-grade evidence from large RCTs. The drug has a good safety profile: in most cases, only mild gastrointestinal or visual adverse events may be observed. TXA use does not increase the risk of serious adverse events, such as venous or arterial thromboembolism, seizures, or </span>acute kidney injury. The TRACES </span><em>in vivo</em><span> analysis of biomarkers of TXA’s antifibrinolytic<span><span> effect have suggested that a dose of at least 1 g is required for the treatment of PPH. The TRACES pharmacokinetic model suggests that because TXA can be lost in the haemorrhaged blood, a second dose should be administered if the PPH continues or if severe </span>coagulopathy<span> occurs. Future pharmacodynamic<span> analyses will focus on the appropriateness of TXA dosing regimens with regard to the intensity of fibrinolysis in catastrophic obstetric events.</span></span></span></span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 411-426"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350230","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Epidemiology and definition of PPH worldwide","authors":"Jan Bláha (Associate Professor),&nbsp;Tereza Bartošová Anaesthetist","doi":"10.1016/j.bpa.2022.11.001","DOIUrl":"10.1016/j.bpa.2022.11.001","url":null,"abstract":"<div><p>Postpartum/peripartum hemorrhage (PPH) is an obstetric emergency<span> complicating 1–10% of all deliveries and is a leading cause of maternal mortality and morbidity worldwide. However, the incidence of PPH differs widely according to the definition and criteria used, the way of measuring postpartum blood loss, and the population being studied with the highest numbers in developing countries. Despite all the significant progress in healthcare, the incidence of PPH is rising due to an incomplete implementation of guidelines, resulting in treatment delays and suboptimal care. A consensus clinical definition of PPH is needed to enable awareness, early recognition, and initiation of appropriate intensive treatment. Unfortunately, the most used definition of PPH based on blood loss ≥500 ml after delivery suffers from inaccuracies in blood loss quantification and is not clinically relevant in most cases, as the amount of blood loss does not fully reflect the severity of bleeding.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 325-339"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10346077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing systems to manage postpartum hemorrhage","authors":"Breyanna M. Dulaney BA (Medical Student),&nbsp;Rania Elkhateb MD (Lecturer in the Department of Anesthesiology),&nbsp;Jill M. Mhyre MD","doi":"10.1016/j.bpa.2022.10.001","DOIUrl":"10.1016/j.bpa.2022.10.001","url":null,"abstract":"<div><p>Systems to optimize the management of postpartum hemorrhage<span><span> must ensure timely diagnosis, rapid hemodynamic and </span>hemostatic resuscitation, and prompt interventions to control the source of bleeding. None of these objectives can be effectively completed by a single clinician, and the management of postpartum hemorrhage requires a carefully coordinated interprofessional team. This article reviews systems designed to standardize hemorrhage diagnosis and response.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 349-357"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10346081","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Point-of-care coagulation testing for postpartum haemorrhage","authors":"Peter Collins MBBS, MD, FRCP, FRPath","doi":"10.1016/j.bpa.2022.08.002","DOIUrl":"10.1016/j.bpa.2022.08.002","url":null,"abstract":"<div><p><span><span><span>The use of viscoelastic haemostatic assays (VHAs) to guide blood product replacement during </span>postpartum haemorrhage is expanding. Rotem and TEG devices can be used to detect and treat clinically significant </span>hypofibrinogenaemia<span>, although evidence to support the role of VHAs for guiding fresh frozen plasma and platelet transfusion is less clear. If Rotem/TEG traces are normal, clinicians should investigate for another cause of bleeding, and haemostatic support is not required. Guidelines support the use of VHAs during postpartum haemorrhage as part of locally agreed algorithms. There is a wide consensus that fibrinogen replacement is needed if the Fibtem A5 is &lt;12 mm and if there is ongoing bleeding. Guidelines recommend against using VHAs to guide </span></span>tranexamic acid<span> infusion, and this drug should be given as soon as bleeding is recognised, irrespective of the Rotem/TEG traces. The cost-effectiveness of VHAs during postpartum haemorrhage needs to be addressed.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 3","pages":"Pages 383-398"},"PeriodicalIF":4.8,"publicationDate":"2022-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10350232","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Operational and strategic decision making in the perioperative setting: Meeting budgetary challenges and quality of care goals","authors":"Corina Bello (Resident Physician) ,&nbsp;Richard D. Urman (Professor & Attending Anaesthesiologist) ,&nbsp;Lukas Andereggen (Attending Neurosurgeon) ,&nbsp;Dietrich Doll (Profesor & Attending Surgeon) ,&nbsp;Markus M. Luedi (Professor & Attending Anaesthesiologist)","doi":"10.1016/j.bpa.2022.04.003","DOIUrl":"10.1016/j.bpa.2022.04.003","url":null,"abstract":"<div><p>Efficient operating room (OR) management is a constant balancing act between optimal OR capacity, allocation of ORs to surgeons, assignment of staff, ordering of materials, and reliable scheduling, while according the highest priority to patient safety. We provide an overview of common concepts in OR management, specifically addressing the areas of strategic, tactical, and operational decision making (DM), and parameters to measure OR efficiency.</p><p>For optimal OR productivity, a surgical suite needs to define its main stakeholders, identify and create strategies to meet their needs, and ensure staff and patient satisfaction. OR planning should be based on real-life data at every stage and should apply newly developed algorithms.</p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 2","pages":"Pages 265-273"},"PeriodicalIF":4.8,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S1521689622000167/pdfft?md5=b734ca6fe102f1213c11acc593ab6a35&pid=1-s2.0-S1521689622000167-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40364933","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Financial management and perioperative leadership in the ambulatory setting journal title: Best practice in clinical research","authors":"Adamu Abdullahi (Neurology Resident) ,&nbsp;Timothy Dean Roberts (Pharmacy Student) ,&nbsp;Charles P. Daniel (Medical Student) ,&nbsp;Alise J. Aucoin (Medical Student) ,&nbsp;Ellen E. Ingram (Medical Student) ,&nbsp;Sarah C. Corley (Medical Student) ,&nbsp;Elyse M. Cornett (Assistant Professor) ,&nbsp;Alan D. Kaye (Professor)","doi":"10.1016/j.bpa.2022.08.001","DOIUrl":"10.1016/j.bpa.2022.08.001","url":null,"abstract":"<div><p><span>A large portion of US healthcare is ambulatory. Strong leadership is vital for the safety and efficiency of perioperative patients in this setting. Good leaders communicate respectfully and openly and ensure effective systems in the delivery of high-level healthcare. In general, to promote patient safety and treatment efficacy, </span>ambulatory care<span> leaders must improve communication. Effective administration is unattainable without leadership and communication in an operating room. When considering outpatient perioperative therapy, it is equally crucial to consider medical costs. Given the unsustainable rate of healthcare spending growth, all attempts to improve our present systems are necessary. Ambulatory care facilities must utilize data regarding resource consumption to be financially viable related to escalating expenses. The present review describes perioperative and financial leadership in the ambulatory setting, effective systems, and relevant clinical strategies.</span></p></div>","PeriodicalId":48541,"journal":{"name":"Best Practice & Research-Clinical Anaesthesiology","volume":"36 2","pages":"Pages 311-322"},"PeriodicalIF":4.8,"publicationDate":"2022-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40366318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}