1,721,095 research outputs found

    Perioperative hemodynamic optimization to reduce acute kidney injury and mortality in surgical patients

    No full text
    Acute kidney injury is a serious complication in surgical and critical care patients and carries an increased risk of mortality and additional hospital costs. Hemodynamic optimization to reduce mortality in critically ill patients with or at risk for AKI is supported by high-level evidence. However, several points of debate are still open, including the type of fluid to be used to reach the hemodynamic targets, the inotropic support, the choice of the monitoring tool, as well as of the hemodynamic variables to be targeted, and which subgroup of the high-risk surgical population could benefit most from a goal-directed therapy approach

    Patient-requiested neuraxial analgesia for labor: impact on rates of cesarean and instrumental vaginal delivery

    No full text
    A systematic review, including a meta-analysis, on the timing effects of neuraxial analgesia (NA) on cesarean and instrumental vaginal deliveries in nulliparous women was conducted. Of 20 articles identified, 9 met the inclusion quality criteria (3,320 participants). Cesarean delivery (odds ratio, 1.00; 95% confidence interval, 0.82–1.23) and instrumental vaginal delivery (odds ratio, 1.00; 95% confidence interval, 0.83–1.21) rates were similar in the early NA and control groups. Neonates of women with early NA had a higher umbilical artery pH and received less naloxone. In the early NA group, fewer women were not compliant with assigned treatment and crossed over to the control group. Women receiving early NA for pain relief are not at increased risk of operative delivery, whereas those receiving early parenteral opioid and late epidural analgesia present a higher risk of instrumental vaginal delivery for nonreassuring fetal status, worse indices of neonatal wellness, and a lower quality of maternal analgesia
    corecore