1,721,265 research outputs found
Artificial Intelligence for Personalized Perioperative Medicine
No full text: The development of artificial intelligence (AI) is disruptive and unstoppable, also in medicine. Because of the enormous quantity of data recorded during continuous monitoring and the peculiarity of our specialty where stratification and mitigation risk are some of the core aspects, anesthesiology and postoperative intensive care are fertile fields where new technologies find ample room for expansion. Recently, research efforts have focused on the development of a holistic technology that globally embraces the entire perioperative period rather than a fragmented approach where AI is developed to carry out specific tasks. This could potentially revolutionize the perioperative medicine we know today. In fact, AI will be able to expand clinician's ability to interpret, adapt, and ultimately act in a complex reality with facets that are too complex to be managed all at the same time and in a holistic manner. With the support of new tools, as healthcare professionals we have the moral obligation to govern this transition, allowing an ethical and sustainable development of these technologies and avoiding being overwhelmed by them. We should welcome this transhumanist tension which does not aim at the replacement of human capabilities or even at the integration of these but rather at the expansion of a "single intelligence"
Fluid management in cardiac surgery patients: Pitfalls, challenges and solutions
No full textFluid administration is a powerful tool for hemodynamic stabilization as it increases preload and improves cardiac function in fluid-responsive patients. However, there are various types of fluid to choose from. The use of colloids and crystalloids in non-cardiac Intensive Care Units (ICU) has been reported, showing controversial results. Many trials on sepsis in a non-cardiac ICU setting show that colloids, in particular hydroxyethyl starches and gelatins, might have a detrimental effect on kidney function, and on major outcomes such as mortality. Many small randomized clinical trials focusing on coagulation and bleeding show controversial results regarding fluid safety during the perioperative period in cardiac surgery, and in the cardiac ICU. No definitive data are available on the superiority of one fluid compared with another for fluid replacement after cardiac surgery. Only few data are available regarding the impact of fluids on kidney function in the cardiac ICU. On the other hand, there is much evidence showing that fluid administration requires strict protocols and close monitoring. Improved clinical outcomes are evident in protocols for goal-directed therapy. In conclusion, the application of a close monitoring and a pre-defined goal-directed protocol are far more important than the choice of a single fluid. This review examines the available evidence on fluid management in cardiac surgery and in the ICU, and analyzes the key steps of fluid strategy in these settings
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