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icu without walls

Tanel Laisaar, Eero Jakobson, Bruno Sarana, Silver Sarapuu, Jüri Vahtramäe, Mait Raag
OBJECTIVE: Percutaneous tracheostomy is a common procedure but varies considerably in approach. The aim of our study was to evaluate the need for intraoperative bronchoscopy and to compare various surgical techniques. METHODS: During 1 year all percutaneous tracheostomies in three intensive care units were prospectively documented according to a unified protocol. In one unit, bronchoscopy was used routinely and in others only during the study. RESULTS: A total of 111 subjects (77 males) with median age 64 (range, 18-86) years and body mass index 25...
2016: SAGE Open Medicine
K Sudhakar, Y K Areti, L N Kurnutala, G Jibara, S M Lashley, S B Nanduri, P S Chami, M T Kakoory, C A Maynard
Objective: To evaluate the clinical features of angio-oedema (AE) and their correlation with fibre-optic nasolaryngoscopy (FNL) findings. Methods: The charts of adult AE patients for 225 episodes who were admitted as in-patients from January 2002 through December 2012 were reviewed. Results: Of the 51 episodes (22.6%) with laryngeal swelling, 16 had exclusively laryngeal swelling; without oropharyngeal swelling. Swelling of the laryngeal structures on FNL was not significantly associated with a suspected aetiology or history of AE or allergies...
March 9, 2016: West Indian Medical Journal
Shoko Nakano, Junko Nakahira, Toshiyuki Sawai, Noriko Kadono, Toshiaki Minami
BACKGROUND: Robot-assisted laparoscopic prostatectomy is increasingly performed as a minimally invasive option for patients with organ-confined prostate cancer. This technique offers several advantages over other surgical methods. However, concerns have been raised over the effects of the steep head-down tilt necessary during the procedure. We present a case in which head-down positioning and abdominal insufflation masked the signs of an intraoperative hemorrhage. CASE PRESENTATION: A 73-year-old Asian man developed severe hypotension caused by an unexpected hemorrhage during robot-assisted laparoscopic prostatectomy for prostate cancer...
2016: Journal of Medical Case Reports
José Canseco Cavazos, Jorge Palacios-Zertuche, Francisco Reyna-Sepúlveda, Neri Álvarez-Villalobos, Louisiana Alatorre-López, Gerardo Muñoz-Maldonado
BACKGROUND: The incidence of deaths and injuries associated with gunshot wounds deserves special attention, mainly because of its repercussions on hospital resources and the diagnosis and treatment protocols. OBJECTIVE: To perform an analysis on the epidemiological factors associated with gunshot wounds. MATERIAL AND METHODS: An analysis was made of multiple variables of all patients diagnosed with gunshot wounds during the period between 2005 and 2015...
July 12, 2016: Cirugia y Cirujanos
Yoko Nakano, Hiroaki Suzuki, Takero Arai, Yuichi Hashimoto, Yasuhisa Okuda
A 2-year-and-4-month-old female infant, 12 kg in weight and 90 cm in height fell off from a table, which was about 1 m height with a toothbrush in her mouth without her parents noticing. Urgent CT scan showed that it penetrated the left side of her oropharyngeal wall to the bifurcation of her right carotid artery. According to the initial assessment, carotid artery seemed intact and there seemed to be no sign of CNS involvement. She underwent general anesthesia for further investigation and operation. We could detect vocal code with ease by inserting Glidescope between her tongue and the toothbrush...
April 2016: Masui. the Japanese Journal of Anesthesiology
Michel Slama, Christophe Tribouilloy, Julien Maizel
PURPOSE OF REVIEW: Left ventricular (LV) outflow tract (LVOT) obstruction (LVOTO) is not unusual in ICU patients particularly with septic shock. RECENT FINDINGS: LVOT was first described in patients with hypertrophic cardiomyopathy and was defined as LV wall thickness at least 15 mm. LVOT is usually because of systolic anterior motion of the mitral valve. By convention, LVOTO is defined as an instantaneous peak Doppler LVOT pressure gradient at least 30 mmHg at rest or during physiological provocation such as Valsalva maneuver...
June 2016: Current Opinion in Critical Care
M Yaman, U Arslan, O Beton, H E Pamukcu, O Dogdu
OBJECTIVE: Atherosclerosis leads to increased arterial resistance through thickening and stiffening of the arterial wall, a phenomenon largely known as arterial stiffness. M-mode propagation velocity of the descending thoracic aorta, named aortic velocity propagation (AVP) is a novel method for the measurement of the aortic stiffness. We aimed to investigate the difference between early and late values of AVP after successful primary percutaneous coronary intervention (PCI) in ST-elevation myocardial infarction (STEMI) patients...
March 2016: European Review for Medical and Pharmacological Sciences
A Smędra, S Szustowski, J Berent
Myocardial infarction is an infrequent condition in young adults. In most cases, it occurs due to causes other than atherosclerosis of the coronary arteries, including blood hypercoagulability, congenital anomalies of the coronary arteries, their inflammation or spasm induced by amphetamine or cocaine use. Amphetamine and its derivatives, via increasing the levels of epinephrine, serotonin and dopamine in the central nervous system, exert their effect also on the cardiovascular system, causing coronary spasm, enhancing platelet aggregation and inducing tachyarrhythmias...
2015: Archiwum Medycyny Sa̧dowej i Kryminologii
Samir G Sakka
An intra-abdominal hypertension (IAH) defined as a pathological increase in intra-abdominal pressure (IAP) is commonly found on ICU admission or during the ICU stay. Several studies confirmed that an IAH is an independent predictor for mortality of critically ill patients. The abdominal compartment syndrome (ACS) which is defined as a sustained IAP>20 mmHg (with or without an abdominal perfusion pressure [APP]<60mmHg) that is associated with new organ dysfunction or failure has a mortality of up to 60%...
January 2016: Anästhesiologie, Intensivmedizin, Notfallmedizin, Schmerztherapie: AINS
A Abella, V Enciso, I Torrejón, C Hermosa, T Mozo, R Molina, D Janeiro, M Díaz, M Homez, F Gordo, I Salinas
OBJECTIVE: To determine whether extension to holidays and weekends of the protocol for the early proactive detection of severity in hospital ("ICU without walls" project) results in decreased mortality among patients admitted to the ICU during those days. DESIGN: A quasi-experimental before-after study was carried out. SETTING: A level 2 hospital with 210 beds and a polyvalent ICU with 8 beds. PATIENTS OR PARTICIPANTS: The control group involved no "ICU without walls" activity on holidays or weekends and included those patients admitted to the ICU on those days between 1 January 2010 and 30 April 2013...
June 2016: Medicina Intensiva
Mohammed Al-Ghafri, Said Al-Hanshi, Suad Al-Ismaily
Pulmonary pneumatocele is a thin-walled, gas-filled space within the lung that usually occurs in association with bacterial pneumonia and is usually transient. The majority of pneumatoceles resolve spontaneously without active intervention, but in some cases they might lead to pneumothorax with subsequent hemodynamic instability. We report two cases presented to the pediatric intensive care unit at the Royal Hospital, Oman with pneumatoceles. The first was a 14-day-old baby who underwent surgical repair of total anomalous pulmonary venous connection (TAPVC) requiring extracorporeal membrane oxygenation (ECMO) support following surgery...
July 2015: Oman Medical Journal
Veli Citisli, Murat Kocaoglu, Ceyda Necan, Muhammet İbrahimoglu, Özkan Celiker, Eyüp Baykara, Mevci Ozdemir, Feridun Acar, Mehmet Erdal Coskun
The aim of the present report was to present the patient with an anterior cranial base fracture who developed post-traumatic cerebrospinal fluid rhinorrhea, which recovered after onset of meningitis complication. A 26-year-old male patient who had a traffic accident one week ago was sent to our clinic because of his rhinorrhea persisting for 4 days. On cranial computed tomography, fracture of the left frontal skull base and sinus walls, a fracture line on temporal bone, parenchymal bleeding in the vicinity of the frontal sinus, subarachnoidal bleeding and left temporal extradural hematoma were detected...
April 2015: International Journal of Health Sciences
Dominique Belcour, Julien Jabot, Benjamin Grard, Arnaud Roussiaux, Cyril Ferdynus, David Vandroux, Philippe Vignon
OBJECTIVE: Although stress cardiomyopathy has been described in association with epilepsy, its frequency in patients with convulsive status epilepticus remains unknown. Accordingly, we sought to determine the prevalence and risk factors of stress cardiomyopathy in patients admitted to the ICU for convulsive status epilepticus. DESIGN: Prospective, descriptive, single-center study. SETTING: Medical-surgical ICU of a teaching hospital. PATIENTS: Thirty-two consecutive ventilated patients (21 men; age, 50 ± 18 yr; Simplified Acute Physiology Score II, 53 ± 15; Sequential Organ Failure Assessment, 6 ± 2) hospitalized in the ICU for convulsive status epilepticus...
October 2015: Critical Care Medicine
Klemens Horst, Frank Hildebrand, Philipp Kobbe, Roman Pfeifer, Philipp Lichte, Hagen Andruszkow, Rolf Lefering, Hans Christoph Pape
BACKGROUND: The clavicle limits the upper thoracic cage and connects the body and upper extremities. The clavicle is easy to examine and is visible on standard emergency room radiographs. We hypothesized that clavicular fracture in polytrauma patients would indicate the presence of further injuries of the upper extremities, head, neck, and thorax. METHODS: A population-based trauma registry was used. All patients were documented between 2002 and 2013. Inclusion criteria were age ≥16 y and injury severity score (ISS) ≥16...
December 2015: Journal of Surgical Research
S Challita, M Daher, N Roche, M Alifano, M P Revel, A Rabbat
Air in the epidural space is called pneumorachis. The usual mechanism of pneumorachis is air diffusion from the mediastinal tissue layers through the inter-vertebral foramen. Alternatively, air can diffuse directly after spine traumas (e.g., blunt deceleration with vertebral dislocation) or medical procedures. Several mechanisms could explain pneumomediastinum and pneumorachis after cocaine sniffing. Passive apnea and/or cough that occur after sniffing can cause intra alveolar hyper-pressure, which is responsible for alveolar rupture and air diffusion...
2014: Respiratory Medicine Case Reports
Mitsumasa Hata, Kenji Akiyama, Yukihiko Orime, Shinji Wakui, Tetsuya Nakamura, Motomi Shiono
A new device of aortic stent graft made in Japan has been available since July 2014. Here, we describe a novel, unique surgical technique named "less invasive quick open stenting" at a rectal temperature of 28°C without any cerebral perfusion for treating distal arch aneurysms. All 12 patients were discharged from the intensive care unit within 24 hours after surgery without any complications. This technique aids in the exclusion of atherosclerotic plaques on the aortic wall and shortens the duration of circulatory arrest; moreover, it represents a very attractive option to prevent recurrent nerve injury...
June 2016: Thoracic and Cardiovascular Surgeon
E Divarci, B Karapinar, M Yalaz, O Ergun, A Celik
PURPOSE: Intraabdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with high mortality rates in children (40-60%). However, literature lacks comprehensive series in childhood. In this study, we aimed to determine the incidences of IAH and ACS, to identify high risk disorders for the development of IAH/ACS and to decrease ACS-associated mortality by early diagnosis and timely intervention. METHODS: A prospective study was performed between December 2009 and October 2010 in our institution...
March 2016: Journal of Pediatric Surgery
Tyng-Luen Roan, Eng-Kean Yeong, Yueh-Bih Tang
Electrical burns caused by low-voltage batteries are rarely reported. We recently encountered a male patient who suffered from a superficial second-degree burn over his left elbow and back. The total body surface area of the burn was estimated to be 6%. After interviewing the patient, the cause was suspected to be related to the explosion of a music player on the left-side of his waist, carried on his belt while he was painting a bathroom wall. Elevated creatine kinase levels and hematuria indicated rhabdomyolysis and suggested an electrical burn...
February 2015: Journal of the Formosan Medical Association, Taiwan Yi Zhi
R Peters, S Kolderman, B Peters, M Simoens, S Braak
PURPOSE: To evaluate the safety and long-term outcome of percutaneous cholecystostomy (PC) under radiologic guidance for acute calculous cholecystitis (ACC) and acute acalculous cholecystitis (AAC) in all patients undergoing that procedure at our institution. MATERIALS AND METHODS: We performed a retrospective analysis of 111 patients who underwent PC from 2004 to 2012. Patients were divided into two groups: AAC and ACC. For all patients, comorbidity and American Society of Anesthesiologists (ASA) classification were determined...
July 2014: JBR-BTR: Organe de la Société Royale Belge de Radiologie (SRBR)
Shanel B Bhagwandin, Samer Naffouje, George Salti
INTRODUCTION: Peritoneal surface malignancy is increasingly treated with cytoreductive surgery (CRS) plus hyperthermic intraperitoneal chemotherapy (HIPEC). This is associated with potentially high morbidity. We analyzed the incidence of delayed major complications following CRS plus HIPEC. METHODS: Delayed events were chosen as those which occurred after discharge from the hospital following CRS plus HIPEC and prior to 90 days. Major complications included any adverse event requiring intervention or intensive care unit admission...
March 2015: Journal of Surgical Oncology
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