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Acute and Critical Care Surgery

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https://www.readbyqxmd.com/read/29766138/risk-stratification-tools-in-emergency-general-surgery
#1
REVIEW
Joaquim Michael Havens, Alexandra B Columbus, Anupamaa J Seshadri, Carlos V R Brown, Gail T Tominaga, Nathan T Mowery, Marie Crandall
The use of risk stratification tools (RST) aids in clinical triage, decision making and quality assessment in a wide variety of medical fields. Although emergency general surgery (EGS) is characterized by a comorbid, physiologically acute patient population with disparately high rates of perioperative morbidity and mortality, few RST have been explicitly examined in this setting. We examined the available RST with the intent of identifying a tool that comprehensively reflects an EGS patients perioperative risk for death or complication...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29766136/can-necrotizing-soft-tissue-infection-be-reliably-diagnosed-in-the-emergency-department
#2
Sharon M Henry, Kimberly A Davis, Jonathan J Morrison, Thomas M Scalea
Necrotizing soft tissue infections (NSTIs) are associated with a high mortality and require prompt recognition and treatment, consisting of aggressive surgical debridement and critical care support. Diagnosis is a key step, which is generally made in the operating room (OR), but the decision to debride requires guidance. This is frequently made on clinical grounds, but NSTI can be occult in presentation and several other infective processes can mimic NSTI. It is unknown whether the various scoring systems described in the literature can enable clinicians to reliably diagnose NSTI in the emergency department, rather than the OR...
2018: Trauma Surg Acute Care Open
https://www.readbyqxmd.com/read/29766132/red-cell-distribution-width-predicts-out-of-hospital-outcomes-in-critically-ill-emergency-general-surgery-patients
#3
Joaquim Michael Havens, Anupamaa J Seshadri, Ali Salim, Kenneth B Christopher
Introduction: Red cell distribution width (RDW) is associated with mortality and bloodstream infection risk in critically ill patients. We hypothesized that an increase in RDW at hospital discharge in critically ill patients who received emergency general surgery (EGS) would be associated with increased mortality after hospital discharge. Methods: We performed a two-center observational study of patients treated in medical and surgical intensive care units. We studied 1567 patients, who received critical care between 1998 and 2012 who underwent EGS and survived hospitalization...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/29719745/acute-acalculous-cholecystitis-in-the-setting-of-negative-ultrasound-and-computed-tomography-scan-of-the-abdomen
#4
Muhammad Shafiq, Yousaf Zafar
Acute acalculous cholecystitis (AAC) is most commonly seen after surgery in critically ill patients. Early diagnosis and treatment is the key in the management of AAC. Ultrasound is the commonly used first modality for right upper quadrant (RUQ) pain with sensitivity equal to or greater than 80% for AAC. Computed tomography (CT) scan is reported to have a sensitivity close to 90% and if both the ultrasound and CT scan are combined, it further increases the sensitivity for the diagnosis of AAC. It is unlikely for AAC to be present in the setting of both negative ultrasound and CT scan of the abdomen...
February 28, 2018: Curēus
https://www.readbyqxmd.com/read/29713734/advances-in-critical-care-management-of-patients-undergoing-cardiac-surgery
#5
REVIEW
Anders Aneman, Nicholas Brechot, Daniel Brodie, Frances Colreavy, John Fraser, Charles Gomersall, Peter McCanny, Peter Hasse Moller-Sorensen, Jukka Takala, Kamen Valchanov, Michael Vallely
Cardiac surgery has been evolving to include minimally invasive, hybrid and transcatheter techniques. Increasing patient age and medical complexity means that critical care management needs to adapt and evolve. Recent advances have occurred in several areas, including ventilation, haemodynamics and mechanical circulatory support, bleeding and coagulation, acute kidney injury, and neurological management. This narrative review describes standard care, recent advances, and future areas of research in the critical care management of patients undergoing cardiac surgery...
April 30, 2018: Intensive Care Medicine
https://www.readbyqxmd.com/read/29712611/the-development-of-extracorporeal-membrane-oxygenation
#6
Don K Nakayama
Evolving from the development of heart-lung machines for open-heart surgery, extracorporeal membrane oxygenation has reemerged as a rescue modality for patients with acute respiratory failure that cannot be supported by conventional modes of ventilation. The history of extracorporeal membrane oxygenation begins with the discovery of heparin, fundamental to the success of extracorporeal circulation and membrane lungs. Engineers and scientists created suitable artificial membranes that allowed gas exchange while keeping gas and blood phases separate...
April 1, 2018: American Surgeon
https://www.readbyqxmd.com/read/29707505/acute-airway-management
#7
Nikhil Panda, Dean M Donahue
Acute airway management has challenged clinicians for nearly four millennia. History underscores the discoveries of surgeons and anesthesiologists, whose advances in technology and surgical technique have transformed management algorithms from primarily surgical tracheostomy, to transoral endotracheal intubation under direct laryngoscopy. Despite this progress and a better understanding of airway anatomy, physiology and pathogenesis of disease, the acute airway, whether obstructed, traumatically disrupted, or externally compressed, remains a life-threatening challenge...
March 2018: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/29701421/rapid-pacing-for-thoracic-endovascular-aortic-repair-a-case-report
#8
Hugo Silva, Andreia Fernandes, João Rodrigues, Daniel Brandão, Manuela Vieira, Catarina Celestino
INTRODUCTION: Endovascular aortic interventions are suitable alternatives to open surgery, being less invasive and having lower mortality and complications. Accurate positioning of the stent graft is a critical point because of systolic thrush. Techniques used to prevent it include pharmacological (antihypertensive drugs, nitroglycerin, adenosine) and mechanical methods (temporary caval occlusion by balloon). Rapid Right Ventricular Pacing (RRVP) is an emerging alternative with good patient tolerance and low level of complications...
July 2017: Revista Portuguesa de Cirurgia Cardio-torácica e Vascular
https://www.readbyqxmd.com/read/29685796/fluids-and-organ-dysfunction-a-narrative-review-of-the-literature-and-discussion-of-5-controversial-topics
#9
Adam J Kingeter, Meredith A Kingeter, Andrew D Shaw
Evidence-based clinical decision making is at the forefront of modern cardiothoracic anesthesia practice. Therefore, as a field, cardiac anesthesiologist should strive to ensure that the available evidence is of the highest possible quality. In this narrative review, 5 important topics that the authors believe require additional investigation in cardiothoracic anesthesia and critical care related to fluid therapy and organ dysfunction are outlined briefly. In particular, the authors believe that the areas of pulmonary artery catheter use, restrictive versus liberal transfusion strategies, cardiopulmonary bypass prime composition, colloid use in resuscitation and its effects on acute kidney injury, and management of acute kidney injury after cardiac surgery hold many unanswered questions and opportunities for continued improvement in the specialty of cardiac anesthesia...
March 13, 2018: Journal of Cardiothoracic and Vascular Anesthesia
https://www.readbyqxmd.com/read/29660009/critical-care-in-the-military-health-system-a-24-h-point-prevalence-study
#10
Raymond Fisher, Christopher J Colombo, Cristin A Mount, Elizabeth A Mann-Salinas, Adam W Bostick, Konrad Davis, James K Aden, Kevin K Chung, Mary S McCarthy, Jeremy C Pamplin
Background: Healthcare expenditures are a significant economic cost with critical care services constituting one of its largest components. The Military Health System (MHS) is the largest, global healthcare system of its kind. In this project, we sought to describe critical care services and the patients who receive them in the MHS. Methods: We surveyed 26 military treatment facilities (MTFs) representing 38 critical care services or intensive care units (ICUs)...
April 11, 2018: Military Medicine
https://www.readbyqxmd.com/read/29629201/anesthesia-and-fast-track-in-video-assisted-thoracic-surgery-vats-from-evidence-to-practice
#11
REVIEW
Marzia Umari, Stefano Falini, Matteo Segat, Michele Zuliani, Marco Crisman, Lucia Comuzzi, Francesco Pagos, Stefano Lovadina, Umberto Lucangelo
In thoracic surgery, the introduction of video-assisted thoracoscopic techniques has allowed the development of fast-track protocols, with shorter hospital lengths of stay and improved outcomes. The perioperative management needs to be optimized accordingly, with the goal of reducing postoperative complications and speeding recovery times. Premedication performed in the operative room should be wisely administered because often linked to late discharge from the post-anesthesia care unit (PACU). Inhalatory anesthesia, when possible, should be preferred based on protective effects on postoperative lung inflammation...
March 2018: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/29621027/cardiac-output-monitoring-how-to-choose-the-optimal-method-for-the-individual-patient
#12
Bernd Saugel, Jean-Louis Vincent
PURPOSE OF REVIEW: To review the different methods available for the assessment of cardiac output (CO) and describe their specific indications in intensive care and perioperative medicine. RECENT FINDINGS: In critically ill patients, persistent circulatory shock after initial resuscitation is an indication for the assessment of CO to monitor the response to fluids and vasoactive agents. In patients with circulatory shock associated with right ventricular dysfunction, pulmonary artery hypertension, or acute respiratory distress syndrome, invasive CO monitoring using indicator dilution methods is indicated...
June 2018: Current Opinion in Critical Care
https://www.readbyqxmd.com/read/29619627/new-advances-in-acute-postoperative-pain-management
#13
REVIEW
Sukanya Mitra, Daniel Carlyle, Gopal Kodumudi, Vijay Kodumudi, Nalini Vadivelu
PURPOSE OF REVIEW: Postoperative pain remains one of the most common challenges following inpatient and outpatient surgeries. With our advances in modern medicine, pain following surgical procedures still remains a challenge, though significant accomplishments have been made over the past few decades. This article highlights some of the promising new advances and approaches in postoperative pain management. RECENT FINDINGS: Over the last decade, Enhanced Recovery after Surgery (ERAS) pathways and protocols are becoming the benchmark standards for enhancing postoperative recovery...
April 4, 2018: Current Pain and Headache Reports
https://www.readbyqxmd.com/read/29617154/n-terminal-pro-brain-natriuretic-peptide-and-high-sensitivity-troponin-t-exhibit-additive-prognostic-value-for-the-outcome-of-critically-ill-patients
#14
Max Lenz, Konstantin A Krychtiuk, Georg Goliasch, Klaus Distelmaier, Johann Wojta, Gottfried Heinz, Walter S Speidl
BACKGROUND: Patients treated at medical intensive care units suffer from various pathologies and often present with elevated troponin T (TnT) and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Both markers may reflect different forms of cardiac involvement in critical illness. Therefore, the aim of our study was to examine the synergistic prognostic potential of NT-proBNP and high-sensitivity TnT (hs)TnT in unselected critically ill patients. METHODS: We included all consecutive patients admitted to our intensive care unit within one year, excluding those suffering from acute myocardial infarction or undergoing cardiac surgery and measured NT-proBNP and TnT plasma levels on the day of admission and 72 hours thereafter...
April 1, 2018: European Heart Journal. Acute Cardiovascular Care
https://www.readbyqxmd.com/read/29615192/acute-kidney-injury-predicts-mortality-in-emergency-general-surgery-patients
#15
Alexandra Briggs, Joaquim M Havens, Ali Salim, Kenneth B Christopher
BACKGROUND: Patients undergoing Emergency General Surgery (EGS) have increased risk of complications and death. The risk of AKI in patients undergoing EGS, along with associated outcomes, is unknown. METHODS: This two-institution observational study included adults admitted to intensive care units between 1997 and 2012. EGS was defined by 7 procedures occurring within 48 hours of ICU admission. The main outcome studied was AKI within 5 days, along with 90-day mortality...
March 14, 2018: American Journal of Surgery
https://www.readbyqxmd.com/read/29613899/traumatic-spinal-cord-injury
#16
Alejandro A Rabinstein
PURPOSE OF REVIEW: This article provides an update on the acute and subacute management and prognostication of patients with traumatic spinal cord injury. RECENT FINDINGS: Immobilization of the spine and spine clearance should be individualized depending on the ability to perform a reliable neurologic examination, the presence of neck pain, and the imaging findings. Early surgery (within 24 hours) to achieve definitive cord decompression and spine stabilization may be beneficial...
April 2018: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/29609546/high-frequency-power-of-heart-rate-variability-can-predict-the-outcome-of-thoracic-surgical-patients-with-acute-respiratory-distress-syndrome-on-admission-to-the-intensive-care-unit-a-prospective-single-centric-case-controlled-study
#17
I-Chen Chen, Chew-Teng Kor, Ching-Hsiung Lin, Jane Kuo, Jang-Zern Tsai, Wen-Je Ko, Cheng-Deng Kuo
BACKGROUND: The morbidity and mortality of acute respiratory distress syndrome (ARDS) remains high, and the strategic focus of ARDS research has shifted toward identifying patients at high risk of mortality early in the course of illness. This study intended to identify the heart rate variability (HRV) measure that can predict the outcome of patients with ARDS on admission to the surgical intensive care unit (SICU). METHODS: Patients who had lung or esophageal cancer surgery were included either in the ARDS group (n = 21) if they developed ARDS after surgery or in the control group (n = 11) if they did not...
April 2, 2018: BMC Anesthesiology
https://www.readbyqxmd.com/read/29608545/adherence-to-20-emergency-general-surgery-best-practices-results-of-a-national-survey
#18
Angela M Ingraham, M Didem Ayturk, Catarina I Kiefe, Heena P Santry
OBJECTIVE: To examine national adherence to emergency general surgery (EGS) best practices. BACKGROUND: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adherence to clinical guidelines. We previously established best practices for EGS using RAND Appropriateness Methodology and pilot data...
March 30, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29608394/surrogate-decision-makers-perspectives-on-family-members-prognosis-after-intracerebral-hemorrhage
#19
Darin B Zahuranec, Renee R Anspach, Meghan E Roney, Andrea Fuhrel-Forbis, Daniel M Connochie, Emily P Chen, Bradford B Thompson, Panayiotis N Varelas, Lewis B Morgenstern, Angela Fagerlin
BACKGROUND: Surrogate communication with providers about prognosis in the setting of acute critical illness can impact both patient treatment decisions and surrogate outcomes. OBJECTIVES: To examine surrogate decision maker perspectives on provider prognostic communication after intracerebral hemorrhage (ICH). DESIGN: Semistructured interviews were conducted and analyzed qualitatively for key themes. SETTING/SUBJECTS: Surrogate decision makers for individuals admitted with ICH were enrolled from five acute care hospitals...
April 2, 2018: Journal of Palliative Medicine
https://www.readbyqxmd.com/read/29602175/effect-of-anemia-on-prognosis-in-patients-on-extracorporeal-membrane-oxygenation
#20
Chang-Chyi Jenq, Feng-Chun Tsai, Tsung-Yu Tsai, Sue-Yun Hsieh, Yi-Wen Lai, Ya-Chung Tian, Ming-Yang Chang, Chan-Yu Lin, Ji-Tseng Fang, Chih-Wei Yang, Yung-Chang Chen
Anemia is a component of the pathological triangle in cardiorenal anemia syndrome and is a risk factor for mortality in acute respiratory distress syndrome. This study assessed the predictive value of anemia for outcomes in critically ill patients receiving extracorporeal membrane oxygenation (ECMO) support. This retrospective study analyzed patients who received ECMO support at the cardiovascular surgery intensive care unit in the study institute between July 2003 and March 2012. Patient data, such as demographic information, etiologies of ECMO implementation, clinical parameters, and in-hospital and 6-month mortality rates, were statistically analyzed...
March 30, 2018: Artificial Organs
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