Medicine of the Future in America

Intensive Care and Emergency Medicine: Fluid Administration and Transfusion

The use of blood transfusions has decreased, especially after an important prospective, randomized Canadian study showed that a conservative approach to transfasion may result in lower mortality rates. This may be related to immune effects as the same investigators have shown improved outcomes with leukode-pleted blood (against historical controls). Improved separation and preservation technology now facilitates selective and timely administration of appropriate blood components. Erythropoietin reduces the need for transfusion in long-term patients but has not been associated with changes in outcome.
Albumin administration has been controversial for decades, as it is hard to demonstrate beneficial effects and the costs are high. It had been suggested that albumin administration results in higher mortality rates, but a large study in Australia and New Zealand has demonstrated that albumin and normal saline solution result in equivalent outcomes when used for fluid resuscitation. cialis professional 20 mg

Critical care medicine is driven by the organization of health-care delivery, and this is the area where we have seen the most obvious improvements. Observational studies have shown that a closed ICU with an ICU physician in charge of a multidisciplinary team doing regular rounds is associated with a shorter length of ICU stay and lower mortality. Daily rounds at the bedside can reduce the rate of complications. Prophylactic therapies against GI bleeding in high-risk patients and against deep venous thrombosis can improve outcomes, although the most effective methods of prophylaxis are still unclear.
Markedly improved outcomes have been realized when interventions shown to reduce morbidity and mortality in randomized trials are used consistently. Protocolized care and continuous quality improvement have all resulted in markedly better outcomes, reduced costs, and minimized medical errors. Recent focus on the frequent incidence of preventable medical errors has lead to attempts to improve safety of hospital systems.

This entry was posted in Intensive Care and Emergency Medicine and tagged ards, cardiopulmonary resuscitation, cardiovascular care, critical care, intensive care, invasive monitoring, mechanical ventilation, multiorgan failure, polytrauma, sepsis.
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