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https://www.readbyqxmd.com/read/30098772/perioperative-considerations-in-free-flap-surgery-a-review-of-pressors-and-anticoagulation
#1
Mark K Wax, James Azzi
Given the high stakes for microvascular reconstruction, the majority of reconstructive surgeons have developed paradigms for pre, intra, and postoperative management that have proven to result in individual high success rates. Much has been done to identify and avoid perioperative factors that could potentially increase flap failure rates. Two example of this practice has been the generalized use of anticoagulation in free tissue transfer and the prohibition against vasopressor use in patients that are undergoing free tissue transfer...
August 2018: Oral Oncology
https://www.readbyqxmd.com/read/30098743/special-considerations-for-the-septic-patient-going-to-the-operating-room
#2
REVIEW
Juanita L Derouen
Perioperative care of the septic patient presents unique challenges for the nurse. Understanding the physiology of sepsis is important for the nurse to anticipate the physiologic changes associated with the disorder and to prioritize the patient's needs. Ensuring adequate intravenous access by peripheral or central venous access as well as anticipating potential invasive monitoring lines allows the nurse to quickly administer antibiotic therapy, initiate fluid resuscitation, and prepare for potential vasopressor use...
September 2018: Critical Care Nursing Clinics of North America
https://www.readbyqxmd.com/read/30092434/predicting-factors-associated-with-postoperative-hypotension-following-carotid-artery-stenting
#3
Gustavo Rubio, John K Karwowski, Hilene DeAmorim, Lee J Goldstein, Arash Bornak
INTRODUCTION: and objective: Prolonged hemodynamic instability after carotid artery stenting (CAS) has been associated with increased incidence of stroke and other major adverse events. The objective of this study is to determine the factors associated with hypotension following CAS. In particular, this study evaluates whether involvement of the carotid bifurcation/bulb and degree of calcification can predict postoperative hypotension. METHODS: A retrospective review of 90 CAS performed in 88 patients at a single tertiary center was performed...
August 6, 2018: Annals of Vascular Surgery
https://www.readbyqxmd.com/read/30084038/exposure-to-stress-dose-steroids-and-lethal-septic-shock-after-in-hospital-cardiac-arrest-individual-patient-data-reanalysis-of-two-prior-randomized-clinical-trials-that-evaluated-the-vasopressin-steroids-epinephrine-combination-versus-epinephrine-alone
#4
Spyros D Mentzelopoulos, Iosifina Koliantzaki, Marios Karvouniaris, Charikleia Vrettou, Nicolas Mongardon, George Karlis, Demosthenes Makris, Epaminondas Zakynthinos, Sotirios Sourlas, Stavros Aloizos, Theodoros Xanthos, Spyros G Zakynthinos
PURPOSE: Low-dose steroids may reduce the mortality of severely ill patients with septic shock. We sought to determine whether exposure to stress-dose steroids during and/or after cardiopulmonary resuscitation is associated with reduced risk of death due to postresuscitation septic shock. METHODS: We analyzed pooled, individual patient data from two prior, randomized clinical trials (RCTs). RCTs evaluated vasopressin, steroids, and epinephrine (VSE) during resuscitation and stress-dose steroids after resuscitation in vasopressor-requiring, in-hospital cardiac arrest...
August 7, 2018: Cardiovascular Drugs and Therapy
https://www.readbyqxmd.com/read/30080727/a-randomized-controlled-trial-comparing-epidural-analgesia-versus-continuous-local-anesthetic-infiltration-via-abdominal-wound-catheter-in-open-liver-resection
#5
Richard Bell, Deesa Ward, Julie Jeffery, Giles J Toogood, JPeter A Lodge, Krishna Rao, Sharmeen Lotia, Ernest Hidalgo
AIM: To compare outcomes following open liver resection (OLR) between patients receiving thoracic epidural (EP) versus abdominal wound catheters plus patient-controlled analgesia (AWC-PCA). METHOD: Patients were randomized 1:1 to either EP or AWC-PCA within an enhanced recovery protocol. Primary outcome was length of stay (LOS), other variables included functional recovery, pain scores, peak flow, vasopressor and fluid requirements, and postoperative complications...
August 3, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/30079751/intensive-care-outcomes-and-mortality-prediction-at-a-national-referral-hospital-in-western-kenya
#6
Hussain S Lalani, Wangari Waweru-Siika, Thomas Mwogi, Protus Kituyi, Joseph R Egger, Lawrence P Park, Peter S Kussin
RATIONALE: The burden of critical care is greatest in resource-limited settings (RLS). Intensive care unit (ICU) outcomes at public hospitals in Kenya are unknown. This study is timely given the Ministry of Health initiative to expand ICU capacity. OBJECTIVES: Identify factors associated with mortality at Moi Teaching and Referral Hospital; validate the Mortality Probability Admission Model-II0 (MPM-II0). METHODS: A retrospective cohort of 450 patients from January 1, 2013 to April 5, 2015 was evaluated using demographics, presenting diagnoses, interventions, mortality, and cost data...
August 4, 2018: Annals of the American Thoracic Society
https://www.readbyqxmd.com/read/30079572/prolonged-vasopressor-support-during-hip-fracture-surgery-is-a-risk-factor-for-enhanced-mortality
#7
Johan Kristansson, Fredrik Olsen, Eva Hagberg, Robert Dutkiewicz, Bengt Nellgård
BACKGROUND: Hip fracture is a common injury in the elderly population and is associated with high morbidity and mortality. Intraoperative hypotension is commonly noted, and is often treated with vasopressors (VP), however, to what extent is unknown. We set out to examine retrospectively how many hip fracture-patients received VP perioperatively and further to investigate if VP treatment is connected to increased mortality. METHOD: Data on VP treatment were captured from medical and anaesthesia journals, and if so, data were investigated to find potential confounders...
August 5, 2018: Acta Anaesthesiologica Scandinavica
https://www.readbyqxmd.com/read/30078659/performance-of-the-curb-65-score-in-predicting-critical-care-interventions-in-patients-admitted-with-community-acquired-pneumonia
#8
Annette Ilg, Ari Moskowitz, Varun Konanki, Parth V Patel, Maureen Chase, Anne V Grossestreuer, Michael W Donnino
STUDY OBJECTIVE: Confusion, uremia, elevated respiratory rate, hypotension, and aged 65 years or older (CURB-65) is a clinical prediction rule intended to stratify patients with pneumonia by expected mortality. We assess the predictive performance of CURB-65 for the proximal endpoint of receipt of critical care intervention in emergency department (ED) patients admitted with community-acquired pneumonia. METHODS: We performed a retrospective analysis of electronic health records from a single tertiary center for ED patients admitted as inpatients with a primary diagnosis of pneumonia from 2010 to 2014...
August 2, 2018: Annals of Emergency Medicine
https://www.readbyqxmd.com/read/30076624/clinical-consequences-of-cardiomyopathy-in-children-with-biliary-atresia-requiring-liver-transplantation
#9
Noelle M Gorgis, Curtis Kennedy, Fong Lam, Kathleen Thompson, Jorge Coss-Bu, Ayse Akcan Arikan, Trung Nguyen, Kathleen Hosek, Tamir Miloh, Saul J Karpen, Daniel J Penny, John Goss, Moreshwar S Desai
Cirrhotic Cardiomyopathy (CCM), a comorbidity of end-stage cirrhotic liver disease, remains uncharacterized in children, largely due to a lack of an established pediatric definition. The aim of this retrospective cohort analysis is to derive objective 2-dimensional echocardiographic (2DE) criteria to define CCM associated with biliary atresia (BA), or BA-CCM, and correlate presence of BA-CCM with liver transplant (LT) outcomes in this population. Using receiver operating characteristic (ROC) curve analysis, optimal cutoff values for left ventricular (LV) geometric parameters that were highly sensitive and specific for the primary outcomes: a composite of serious adverse events (CSAE) and peri-transplant death were determined...
August 3, 2018: Hepatology: Official Journal of the American Association for the Study of Liver Diseases
https://www.readbyqxmd.com/read/30076547/characteristics-and-outcome-of-patients-with-newly-diagnosed-advanced-or-metastatic-lung-cancer-admitted-to-intensive-care-units-icus
#10
C Barth, M Soares, A C Toffart, J F Timsit, G Burghi, C Irrazabal, N Pattison, E Tobar, B F Almeida, U V Silva, L C Azevedo, A Rabbat, C Lamer, A Parrot, V C Souza-Dantas, F Wallet, F Blot, G Bourdin, C Piras, J Delemazure, M Durand, J Salluh, E Azoulay, Virginie Lemiale
BACKGROUND: Although patients with advanced or metastatic lung cancer have poor prognosis, admission to the ICU for management of life-threatening complications has increased over the years. Patients with newly diagnosed lung cancer appear as good candidates for ICU admission, but more robust information to assist decisions is lacking. The aim of our study was to evaluate the prognosis of newly diagnosed unresectable lung cancer patients. METHODS: A retrospective multicentric study analyzed the outcome of patients admitted to the ICU with a newly diagnosed lung cancer (diagnosis within the month) between 2010 and 2013...
August 4, 2018: Annals of Intensive Care
https://www.readbyqxmd.com/read/30073871/why-not-life-and-limb-vasopressor-use-in-intensive-care-unit-patients-the-cause-of-acute-limb-ischemia
#11
Anastassia Newbury, Katharine D Harper, Arianna Trionfo, Frederick V Ramsey, Joseph J Thoder
BACKGROUND: Acute limb ischemia (ALI) of the upper extremity is a rare yet severe condition in intensive care unit (ICU) patients that generally leads to amputation. The aim of this study is to determine risk factors for development of upper extremity limb ischemia in ICU patients requiring vasopressor support. METHODS: This is a retrospective study conducted from 2010 to 2015. Patients who received vasopressors during ICU admission were considered for the study...
August 3, 2018: Hand: Official Journal of the American Association for Hand Surgery
https://www.readbyqxmd.com/read/30065844/the-impact-of-smoking-on-patient-outcomes-in-severe-sepsis-and-septic-shock
#12
Fahad Alroumi, Ahmed Abdul Azim, Rachel Kergo, Yuxiu Lei, James Dargin
Background: To assess, in the setting of severe sepsis and septic shock, whether current smokers have worse outcomes compared to non-smokers. Methods: This is a retrospective analysis of immunocompetent adult patients with severe sepsis and septic shock at a tertiary medical center. The primary outcome was the effect of active smoking on hospital mortality. Chi-square test and logistic regression were used to assess categorical outcomes. Wilcoxon rank-sum was utilized to test the differences in continuous outcomes among the varied smoking histories...
2018: Journal of Intensive Care
https://www.readbyqxmd.com/read/30056632/a-literature-review-and-meta-analysis-of-outcomes-in-microsurgical-reconstruction-using-vasopressors
#13
REVIEW
Rebecca Knackstedt, James Gatherwright, Raffi Gurunluoglu
INTRODUCTION: There is a hesitancy to utilize vasopressors in microsurgical reconstruction due to fear of vessel spasm and subsequent flap compromise. Although there are large literature reviews analyzing vasopressor usage in head and neck reconstruction, this has not been extrapolated to all regions of the body. The goal of this study was to perform a meta-analysis examining vasopressor usage and risk of complications in microsurgical reconstruction for all recipient sites. MATERIALS AND METHODS: A meta-analysis was conducted for articles discussing the utilization of vasopressors in microsurgical reconstruction...
July 29, 2018: Microsurgery
https://www.readbyqxmd.com/read/30054093/ultra-fast-track-extubation-vs-conventional-extubation-after-cardiac-surgery-in-a-cardiovascular-reference-centre-in-colombia-a-longitudinal-study
#14
A Guerrero Gómez, N González Jaramillo, J A Castro Pérez
INTRODUCTION: The fast track / ultra-fast-track protocols are techniques used to optimise the patient care process and a quick recovery after cardiac surgery. They are one of the mainstays of efficient practice. With their use, the length of hospital and intensive care unit (ICU) stays are reduced, with a direct impact on costs and the quality of the health service. OBJECTIVE: To compare the length of stay in the ICU, length of hospital stay, and post-operative mortality in ultra-fast-track extubated (uFTE) patients and those with conventional extubation (CE) after cardiac surgery...
July 24, 2018: Revista Española de Anestesiología y Reanimación
https://www.readbyqxmd.com/read/30049018/impact-of-crystalloid-or-albumin-priming-of-the-heart-lung-machine-on-inhospital-outcome-after-coronary-artery-bypass-surgery
#15
Pia Weiler, Marwan Hamiko, Fritz Mellert, Wilhelm Roell, Martina Roell, Cecilia Welz, Georg Daniel Duerr
BACKGROUND:  Crystalloid priming is a cost-effective, free from immunological reactions, and independent from human plasma delivery. However, there is some debate on the negative impact of low plasma colloid pressure and higher incidence of systemic inflammatory response syndrome (SIRS). The aim of the study was to rule out any adverse effects of crystalloid priming on the postoperative outcome. METHODS:  We investigated 520 consecutive patients, including emergencies, who had isolated on-pump coronary artery bypass grafting in 2009 by retrospective analysis in our clinic...
July 26, 2018: Thoracic and Cardiovascular Surgeon
https://www.readbyqxmd.com/read/30047044/barriers-and-facilitators-of-intensivists-adherence-to-hyperinsulinemia-euglycemia-therapy-in-the-treatment-of-calcium-channel-blocker-poisoning
#16
Eric Brassard, Patrick Archambault, Guillaume Lacombe, Maude St-Onge
INTRODUCTION: Adherence to poison center (PC) recommendations for the management of calcium channel blocker (CCB) poisoning is inconsistent. This study aimed to identify behaviors that determine adherence to hyperinsulinemia-euglycemia therapy (HIET) for CCB poisoning. METHODS: Semistructured interviews were conducted involving a convenience sample of 18 intensivists. Interview responses were analyzed using the theoretical domains framework (TDF) to identify relevant domains influencing physician adherence to HIET...
July 25, 2018: Journal of Medical Toxicology: Official Journal of the American College of Medical Toxicology
https://www.readbyqxmd.com/read/30046422/establishing-an-anaesthetist-delivered-propofol-sedation-service-for-advanced-endoscopic-procedures-implementing-the-rca-bsg-guidelines
#17
Ian Smith, Damien Durkin, Kaw Wai Lau, Srisha Hebbar
Background: Following recommendations from the Royal College of Anaesthetists and the British Society of Gastroenterology, we report our results of propofol sedation for complex endoscopic procedures delivered by a single consultant anaesthetist over a 5-year period. Methods: A weekly session was provided in the endoscopy department for procedures that were complex or could previously not be completed successfully. Deep sedation was provided by intermittent propofol bolus doses, supplemented with fentanyl where necessary, titrated to clinical effect...
July 2018: Frontline Gastroenterology
https://www.readbyqxmd.com/read/30031784/the-impact-of-diastolic-blood-pressure-values-on-the-neurological-outcome-of-cardiac-arrest-patients
#18
Filippo Annoni, Antonio Maria Dell'Anna, Federico Franchi, Jacques Creteur, Sabino Scolletta, Jean-Louis Vincent, Fabio Silvio Taccone
AIM: Which haemodynamic variable is the best predictor of neurological outcome remains unclear. We investigated the association of several haemodynamic variables with neurological outcome in CA patients. METHODS: Retrospective analysis of adult comatose survivors of CA admitted to the intensive care unit (ICU) of a University Hospital. Exclusion criteria were early death due to withdrawal of care, missing haemodynamic data and use of intra-aortic balloon pump or extracorporeal membrane oxygenation...
July 19, 2018: Resuscitation
https://www.readbyqxmd.com/read/30023436/blunt-rupture-of-the-thoracic-duct-after-severe-thoracic-trauma
#19
Samuel R Brown, Carlos Fernandez, Robert Bertellotti, Juan Antonio Asensio
A 53-year-old man was admitted to our trauma center after sustaining thoracoabdominal injuries, secondary to a rear-end motor vehicle collision. As he stepped out of his vehicle, he was struck by a tractor trailer at 55 mph. The following were the initial vital signs on his arrival: heart rate 140 beats/min, blood pressure 142/80 mm Hg, respiratory rate 28 breaths/min, temperature 36.8°C, and oxygen saturation 93%. The Glasgow Coma Scale score was 15 and the Injury Severity Score was 59. He was evaluated and resuscitated per the advanced trauma life support protocols...
2018: Trauma surgery & acute care open
https://www.readbyqxmd.com/read/30014234/biochemically-diagnosed-hypothyroidism-and-postoperative-complications-after-cardiac-surgery-a-retrospective-cohort-analysis
#20
Ryu Komatsu, Nika Karimi, Nicole M Zimmerman, Daniel I Sessler, C A Bashour, Edward G Soltesz, Alparslan Turan
PURPOSE: To determine whether hypothyroidism is associated with cardiovascular complications and surgical wound infections after cardiac surgery. METHODS: Patients were categorized as: (1) hypothyroid [patients with increased TSH concentrations (≧ 5.5 mIU/L) within 6 months prior to surgery]; (2) corrected hypothyroid [diagnosis of hypothyroidism any time before surgery or on preoperative thyroid supplementation and normal TSH concentration (0.4 [Formula: see text] TSH [Formula: see text] 5...
July 16, 2018: Journal of Anesthesia
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