- Elucidation of HLA classes and their role in the complex (with mHAgs, etc) mechanisms of graft rejection have posited different approaches for immunosuppression to maintain graft survival in a recipient.
- Multiple agent approach for complex immunomodulation of recipient immune system, including agents cyclosporine, tacrolimus, belatacept, basiliximab, sirolimus, everolimus, MPA, and alemtuxumab.
- Detailed 2017 Renal Association guidelines delineate strategies, first-line and second-line choices for induction and maintenance immunosuppressive therapies in kidney transplant recipients. Furthermore, this guideline details the approach to management of rejection [see Table 13].
Latest Updates
End of Life Care and Withdrawal of Life Support
- Enhanced understanding of differences in palliative care between surgical and medical intensive care units
- Improved specificity of bedside signs and indications for imminent death
- Review of studies in the surgical patient population suggesting palliative care consultation improves end-of-life outcomes without increasing mortality
- Preoperative detection of frailty with subsequent palliative care consultation may result in decreased perioperative mortality
End of Life Care and Withdrawal of Life Support
- Enhanced understanding of differences in palliative care between surgical and medical intensive care units
- Improved specificity of bedside signs and indications for imminent death
- Review of studies in the surgical patient population suggesting palliative care consultation improves end-of-life outcomes without increasing mortality
- Preoperative detection of frailty with subsequent palliative care consultation may result in decreased perioperative mortality
- Evolving CDC recommendations for containment and management of outbreaks that may be linked to bioterrorism. These should be referred to by physicians for the most up-to-date protocols.
- Tecovirimat is a novel agent that was FDA-approved in 2018 for the treatment of smallpox.
- Potential for ribavirin as an antiviral agent in the management of hemorrhagic fever viruses. The efficacy is not well delineated, and further investigation as to this modality is required.
Coma, Cognitive Impairment, and Seizures
- When treating an unresponsive patient, targeted therapy is advised instead of routine use of the “coma cocktail” (empirical treatment with dextrose, naloxone, thiamine, and sometimes flumazenil).
- Avoidance of hypotension and maintenance of normoglycemia and normothermia are critical to the management of intracranial hypertension.
- Differing levels of awareness were noted among patients found to be in a minimally conscious state (MCS); subsequently, this condition was further subdivided into two categories, MCS plus (MCS+) and MCS minus (MCS-), based on the ability to follow commands versus just visual pursuit. Permanent vegetative state is no longer used.
Coma, Cognitive Impairment, and Seizures
- When treating an unresponsive patient, targeted therapy is advised instead of routine use of the “coma cocktail” (empirical treatment with dextrose, naloxone, thiamine, and sometimes flumazenil).
- Avoidance of hypotension and maintenance of normoglycemia and normothermia are critical to the management of intracranial hypertension.
- Differing levels of awareness were noted among patients found to be in a minimally conscious state (MCS); subsequently, this condition was further subdivided into two categories, MCS plus (MCS+) and MCS minus (MCS-), based on the ability to follow commands versus just visual pursuit. Permanent vegetative state is no longer used.
Coma, Cognitive Impairment, and Seizures
- When treating an unresponsive patient, targeted therapy is advised instead of routine use of the “coma cocktail” (empirical treatment with dextrose, naloxone, thiamine, and sometimes flumazenil).
- Avoidance of hypotension and maintenance of normoglycemia and normothermia are critical to the management of intracranial hypertension.
- Differing levels of awareness were noted among patients found to be in a minimally conscious state (MCS); subsequently, this condition was further subdivided into two categories, MCS plus (MCS+) and MCS minus (MCS-), based on the ability to follow commands versus just visual pursuit. Permanent vegetative state is no longer used.
- Control of asthma symptoms may reduce the risk of obstetric complications
- Certain known comorbidities may contribute to more severe asthma exacerbation in pregnancy and should be evaluated.
- For most pregnant patients with asthma, general guidelines for asthma severity evaluation and treatment can be followed, as they would be for non-pregnant patients.
- Safety data on use of biologic agents such as humanized IgG1 monoclonal anti-immunoglobulin E antibody is increasing.
