Current Opinion in Anesthesiology最新文献_第8页

Guidelines in trauma-related bleeding and coagulopathy: an update. 创伤相关出血和凝血病指南：更新版。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-22 DOI: 10.1097/ACO.0000000000001346

Jannis Christoffel, Marc Maegele

{"title":"Guidelines in trauma-related bleeding and coagulopathy: an update.","authors":"Jannis Christoffel, Marc Maegele","doi":"10.1097/ACO.0000000000001346","DOIUrl":"10.1097/ACO.0000000000001346","url":null,"abstract":"Purpose of review: The diagnosis and treatment of patients with severe traumatic bleeding and subsequent trauma-induced coagulopathy (TIC) is still inconsistent, although the implementation of standardized algorithms/treatment pathways was repeatedly linked to improved outcome. Various evidence-based guidelines for these patients now exist, three of which have recently been updated.Recent findings: A synopsis of the three recently updated guidelines for diagnosis and treatment of seriously bleeding trauma patients with TIC is presented: (i) AWMF S3 guideline 'Polytrauma/Seriously Injured Patient Treatment' under the auspices of the German Society for Trauma Surgery; (ii) guideline of the European Society of Anesthesiology and Intensive Care (ESAIC) on the management of perioperative bleeding; and (iii) European guideline on the management of major bleeding and coagulopathy after trauma in its 6th edition (EU-Trauma).Summary: Treatment of trauma-related bleeding begins at the scene with local compression, use of tourniquets and pelvic binders and rapid transport to a certified trauma centre. After arrival at the hospital, measures to record, monitor and support coagulation function should be initiated immediately. Surgical bleeding control is carried out according to 'damage control' principles. Modern coagulation management includes individualized treatment based on target values derived from point-of-care viscoelastic test procedures.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934004","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}

引用次数: 0

Stress hyperglycaemia following trauma - a survival benefit or an outcome detriment? 创伤后的应激性高血糖--对生存有利还是对结果不利？

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-19 DOI: 10.1097/ACO.0000000000001350

Christopher Rugg, Stefan Schmid, Johannes Zipperle, Janett Kreutziger

{"title":"Stress hyperglycaemia following trauma - a survival benefit or an outcome detriment?","authors":"Christopher Rugg, Stefan Schmid, Johannes Zipperle, Janett Kreutziger","doi":"10.1097/ACO.0000000000001350","DOIUrl":"10.1097/ACO.0000000000001350","url":null,"abstract":"Purpose of review: Stress hyperglycaemia occur often in critically injured patients. To gain new consideration about it, this review compile current as well as known immunological and biochemical findings about causes and emergence.Recent findings: Glucose is the preferred energy substrate for fending immune cells, reparative tissue and the cardiovascular system following trauma. To fulfil these energy needs, the liver is metabolically reprogrammed to rebuild glucose from lactate and glucogenic amino acids (hepatic insulin resistance) at the expenses of muscles mass and - to a less extent - fat tissue (proteolysis, lipolysis, peripheral insulin resistance). This inevitably leads to stress hyperglycaemia, which is evolutionary preserved and seems to be an essential and beneficial survival response. It is initiated by damage-associated molecular patterns (DAMPs) and pathogen-associated molecular patterns (PAMPs), intensified by immune cells itself and mainly ruled by tumour necrosis factor (TNF)α and catecholamines with lactate and hypoxia inducible factor (HIF)-1α as intracellular signals and lactate as an energy shuttle. Important biochemical mechanisms involved in this response are the Warburg effect as an efficient metabolic shortcut and the extended Cori cycle.Summary: Stress hyperglycaemia is beneficial in an acute life-threatening situation, but further research is necessary, to prevent trauma patients from the detrimental effects of persisting hyperglycaemia.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934014","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}

引用次数: 0

How much does it cost to be fit for operation? The economics of prehabilitation. 适合手术需要多少钱？康复前的经济学。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-02-07 DOI: 10.1097/ACO.0000000000001359

Iulia Crişan, Ksenija Slankamenac, Federico Bilotta

引用次数: 0

Implementation of guidelines in clinical practice; barriers and strategies. 在临床实践中实施指南；障碍与策略。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-17 DOI: 10.1097/ACO.0000000000001344

Stefan De Hert, Waynice Neiva de Paula-Garcia

{"title":"Implementation of guidelines in clinical practice; barriers and strategies.","authors":"Stefan De Hert, Waynice Neiva de Paula-Garcia","doi":"10.1097/ACO.0000000000001344","DOIUrl":"10.1097/ACO.0000000000001344","url":null,"abstract":"Purpose of review: Published clinical practice guidelines frequently have difficulties for implementation of the recommendations and adherence in daily clinical practice. The present review summarizes the current knowledge on the barriers encountered when implementing clinical practice guideline and the strategies proposed to address these barriers.Recent findings: Studies on strategies for implementation of clinical guidelines are scarce. Evidence indicates that a multidisciplinary policy is necessary in order to address the barriers at various levels. Continuous education and motivation of the stakeholders, together with structural adaptations are key elements in the process.Summary: The barriers for implementation of guidelines involve different levels, including the healthcare system, organizational, societal and cultural specificities, and individual attitudes. All of these should be addressed with policy-driven strategies. Such strategies could include optimization of resources allocations, and establishing well coordinated multidisciplinary networks, finally, future studies should also evaluate the effectiveness of the potential strategies.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934006","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}

引用次数: 0

Thrombosis prophylaxis following trauma. 外伤后的血栓预防。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-23 DOI: 10.1097/ACO.0000000000001351

Johannes Bösch, Mirjam Bachler, Dietmar Fries

{"title":"Thrombosis prophylaxis following trauma.","authors":"Johannes Bösch, Mirjam Bachler, Dietmar Fries","doi":"10.1097/ACO.0000000000001351","DOIUrl":"10.1097/ACO.0000000000001351","url":null,"abstract":"Purpose of review: This review explores the persistent occurrence of venous thromboembolic events (VTE) in major trauma patients despite standard thrombosis prophylaxis with low-molecular-weight heparin (LMWH) or unfractionated heparin (UFH). It investigates the inadequacies of standard pharmacologic prophylaxis and proposes alternative approaches not covered in current trauma guidelines.Recent findings: Recent studies highlight the effectiveness of monitoring and adjusting subcutaneous LMWH doses based on anti-Xa levels for the purpose of reducing VTE in trauma patients. The need for dose adaptation arises due to factors like fluctuating organ function, varying antithrombin levels, interaction with plasma proteins, and altered bioavailability influenced by oedema or vasopressor use. Additionally, promising alternatives such as intravenous LMWH, UFH, and argatroban have shown success in intensive care settings.Summary: The standard dosing of subcutaneous LMWH is often insufficient for effective thrombosis prophylaxis in trauma patients. A more personalised approach, adjusting doses based on specific effect levels like anti-Xa or choosing an alternative mode of anticoagulation, could reduce the risk of insufficient prophylaxis and subsequent VTE.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934016","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}

引用次数: 0

Dosing of tranexamic acid in trauma. 氨甲环酸在创伤中的剂量。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-24 DOI: 10.1097/ACO.0000000000001357

David Faraoni, Christian Fenger-Eriksen

{"title":"Dosing of tranexamic acid in trauma.","authors":"David Faraoni, Christian Fenger-Eriksen","doi":"10.1097/ACO.0000000000001357","DOIUrl":"10.1097/ACO.0000000000001357","url":null,"abstract":"Purpose of review: Tranexamic acid is routinely used as part of the management of traumatic bleeding. The dose recommendation in trauma was extrapolated from other clinical settings and the results of pragmatic randomized trials rather than pharmaco-kinetic and -dynamic evaluations. The review addresses current evidence on dosing of tranexamic acid in traumatized patients with a focus on efficacy, safety and risk-benefit profile.Recent findings: A majority, but not all, of existing randomized clinical trials reports a reduction in mortality and/or blood loss with tranexamic acid administration. Increasing dose above the general recommendation (1 g bolus + 1 g infusion/8 h intravenously) has not been shown to further increase efficacy and could potentially increase side effects.Summary: The benefit of tranexamic acid as adjuvant therapy in the management of bleeding trauma patients on mortality and transfusion requirements is clear and well documented, being most effective if given early and to patients with clinical signs of hemorrhagic shock. Recent reports suggest that in some patients presenting with a shutdown of their fibrinolytic pathway the administration of tranexamic acid could be associated with an increased risk of thromboembolic events and poor outcomes. A more personalized approach based on bedside assessment of fibrinolytic activation and pharmacokinetic-based dose regimen should be developed moving forward.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934003","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}

引用次数: 0

Massive transfusion in trauma. 创伤中的大量输血。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-19 DOI: 10.1097/ACO.0000000000001347

Heiko Lier, Björn Hossfeld

{"title":"Massive transfusion in trauma.","authors":"Heiko Lier, Björn Hossfeld","doi":"10.1097/ACO.0000000000001347","DOIUrl":"10.1097/ACO.0000000000001347","url":null,"abstract":"Purpose of review: The purpose of this review is to provide an overview of currently recommended treatment approaches for traumatic hemorrhage shock, with a special focus on massive transfusion.Recent findings: Severe trauma patients require massive transfusion, but consensual international definitions for traumatic hemorrhage shock and massive transfusion are missing. Current literature defines a massive transfusion as transfusion of a minimum of 3-4 packed red blood cells within 1 h. Using standard laboratory and/or viscoelastic tests, earliest diagnosis and treatment should focus on trauma-induced coagulopathy and substitution of substantiated deficiencies.Summary: To initiate therapy immediately massive transfusion protocols are helpful focusing on early hemorrhage control using hemostatic dressing and tourniquets, correction of metabolic derangements to decrease coagulopathy and substitution according to viscoelastic assays and blood gases analysis with tranexamic acid, fibrinogen concentrate, red blood cells, plasma and platelets are recommended. Alternatively, the use of whole blood is possible. If needed, further support using prothrombin complex, factor XIII or desmopressin is suggested.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934011","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}

引用次数: 0

Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again). 拓宽范围，迎难而上，麻醉医师有机会（再次）在医疗质量和患者安全方面发挥带头作用。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-02-07 DOI: 10.1097/ACO.0000000000001358

Wolfgang Buhre, Linde Maas

{"title":"Broadening the scope and rising to the occasion, an opportunity for anaesthesiologists to take the lead in healthcare quality & patient safety (again).","authors":"Wolfgang Buhre, Linde Maas","doi":"10.1097/ACO.0000000000001358","DOIUrl":"10.1097/ACO.0000000000001358","url":null,"abstract":"Purpose of review: The landscape of healthcare is characterized by high demands and scarce human and financial resources. This calls for action in improving healthcare quality. This review shows how anaesthesiologists are the designated medical specialist to share their affinity and knowledge in quality and safety, throughout the hospital and across the care continuum.Recent findings: Recent studies show excellent frameworks and examples of anaesthesiologist leading the way in patient safety and quality of care.Summary: Anaesthesiologist are early adapters of patient safety. In the last decades anaesthesia has become linked with patient safety and the quality of care. With the recent transition from peroperative to perioperative care; new opportunities are emerging, expanding our professional scope. Unfortunately, the anaesthesiologist is not often positioned in a leading role in quality of care and patient safety. After a brief rise during the COVID-19 pandemic, in which anaesthesiologists were visible in the frontline in many countries, we have unfortunately disappeared from the spotlight. This review shows numerous ideas, examples, and a framework how a leading position can be realized.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139933999","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}

引用次数: 0

Direct oral anticoagulants in trauma patients. 创伤患者的直接口服抗凝剂。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-01-25 DOI: 10.1097/ACO.0000000000001356

Herbert Schöchl, Oliver Grottke, Felix C F Schmitt

{"title":"Direct oral anticoagulants in trauma patients.","authors":"Herbert Schöchl, Oliver Grottke, Felix C F Schmitt","doi":"10.1097/ACO.0000000000001356","DOIUrl":"10.1097/ACO.0000000000001356","url":null,"abstract":"Purpose of review: Direct oral anticoagulants (DOACs) are increasingly prescribed for prevention of thromboembolic events. Thus, trauma care providers are facing a steadily raising number of injured patients on DOACs.Recent findings: Despite a predictable pharmacokinetic profile, the resulting plasma levels of trauma patients upon admission and bleeding risks remain uncertain. Therefore, recent guidelines recommend the measurement of DOAC plasma concentrations in injured patients. Alternatively, DOAC specific visco-elastic tests assays can be applied to identify DOAC patients at bleeding risk.Bleeding complications in trauma patients on DOACs are generally higher compared to nonanticoagulated subjects, but comparable to vitamin K antagonists (VKAs). In particular, a traumatic brain injury does not carry an increased risk of intracranial bleeding due to a DOAK intake compared to VKAs. Current studies demonstrated that up to 14% of patients with a hip fracture are on DOACs prior to surgery. However, the majority can be operated safely within a 24h time window without an increased bleeding rate.Specific antagonists facilitate rapid reversal of patients on DOACs. Idarucizumab for dabigatran, and andexanet alfa for apixaban and rivaroxaban have been approved for life threatening bleeding. Alternatively, prothrombin complex concentrate can be used. Dialysis is a potential treatment option for dabigatran and haemoabsorption with special filters can be applied in patients on FXa-inhibitors.Summary: Current guidelines recommend the measurement of DOAC plasma levels in trauma patients. Compared to VKAs, DOACs do not carry a higher bleeding risk. DOAC specific antagonists facilitate the individual bleeding management.","PeriodicalId":50609,"journal":{"name":"Current Opinion in Anesthesiology","volume":null,"pages":null},"PeriodicalIF":2.5,"publicationDate":"2024-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139934002","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}

引用次数: 0

Prehospital transfusion of allogeneic blood products. 院前输注异体血制品。

IF 2.5 3区医学

Current Opinion in Anesthesiology Pub Date : 2024-04-01 Epub Date: 2024-02-02 DOI: 10.1097/ACO.0000000000001353

Cristina Alomar-Dominguez, Johannes Bösch, Dietmar Fries

引用次数: 0