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Surgical Intensive Care Unit

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https://www.readbyqxmd.com/read/28431425/the-association-of-frailty-with-outcomes-and-resource-use-after-emergency-general-surgery-a-population-based-cohort-study
#1
Daniel I McIsaac, Husein Moloo, Gregory L Bryson, Carl van Walraven
BACKGROUND: Older patients undergoing emergency general surgery (EGS) experience high rates of postoperative morbidity and mortality. Studies focused primarily on elective surgery indicate that frailty is an important predictor of adverse outcomes in older surgical patients. The population-level effect of frailty on EGS is poorly described. Therefore, our objective was to measure the association of preoperative frailty with outcomes in a population of older patients undergoing EGS. METHODS: We created a population-based cohort study using linked administrative data in Ontario, Canada, that included community-dwelling individuals aged >65 years having EGS...
May 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28430296/effect-of-body-mass-index-on-the-outcome-of-surgical-patients-receiving-extracorporeal-devices-vv-ecmo-pecla-for-respiratory-failure
#2
Justyna Swol, Dirk Buchwald, Justus T Strauch, Thomas A Schildhauer, Christopher Ull
INTRODUCTION: To determine whether obese surgical patients are at a significant disadvantage in terms of outcomes after extracorporeal device (ECD) support, such as veno-venous extracorporeal membrane oxygenation (VV ECMO) or pumpless extracorporeal lung assist (pECLA), for respiratory failure, the relationship between body mass index (BMI) and hospital outcomes was analyzed. METHODS: This retrospective study included data on patients who were supported with an ECD between January 1, 2008 and December 31, 2014...
April 20, 2017: International Journal of Artificial Organs
https://www.readbyqxmd.com/read/28428064/decreased-transport-time-to-the-surgical-intensive-care-unit
#3
Ara Ko, Megan Y Harada, Navpreet K Dhillon, Kavita A Patel, Lydia R Kirillova, Riley C Kolus, Sam Torbati, Eric J Ley
No abstract text is available yet for this article.
April 17, 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28423968/penetrating-brain-injury-with-a-metal-bar-and-a-knife-report-of-two-interesting-cases
#4
Alireza Tabibkhooei, Morteza Taheri, Sadra Rohani, Iran Chanideh, Hessam Rahatlou
Introduction Penetrating brain injury (PBI) is uncommon among the civilian population. Here, we report two interesting cases of PBI. Case presentation The first patient was a 20-year-old male who sustained a penetrating head injury with a metal bar during an accident at work. The patient underwent early surgical intervention, and related meningitis was treated with antibiotics. The patient was discharged 45 days later with no deficit. The second patient was a 34-year-old male who was the victim of a violence attack and was admitted to hospital...
January 1, 2017: Neuroradiology Journal
https://www.readbyqxmd.com/read/28423128/peratrial-device-closure-of-atrial-septal-defect-under-transesophageal-echocardiographic-guidance-without-fluoroscopy-compared-to-conventional-on-pump-surgical-closure
#5
Zhixiang Guo, Chengxin Zhang, Huan Wang, Shenglin Ge
Objective: This study is designed to evaluate the advantages between peratrial device closure under transesophageal echocardiographic guidance and open heart surgery in atrial septal defect. Methods: From November 2011 to September 2014, 28 patients with atrial septal defect were treated. Fourteen patients received peratrial device closure under transesophageal echocardiographic guidance (TEE group) and 14 patients received cardiopulmonary bypass (CPB group). Clinical parameters during intraoperative and postoperative periods were examined...
January 2017: Brazilian Journal of Cardiovascular Surgery
https://www.readbyqxmd.com/read/28422699/hemorrhage-prediction-models-in-surgical-intensive-care-bedside-monitoring-data-adds-information-to-lab-values
#6
Marco De Pasquale, Travis Moss, Sergio Cerutti, James Calland, Douglas Lake, Randall Moorman, Manuela Ferrario
Hemorrhage is a frequent complication in surgery patients; its identification and management have received increasing attention as a target for quality improvement in patient care in the Intensive Care Unit (ICU). The purposes of this work were i) to find an early detection model for hemorrhage by exploring the range of data mining methods that are currently available, and ii) to compare prediction models utilizing continuously measured physiological data from bedside monitors to those using commonly obtained laboratory tests...
April 12, 2017: IEEE Journal of Biomedical and Health Informatics
https://www.readbyqxmd.com/read/28412043/assessment-of-high-priced-systemic-antifungal-prescriptions
#7
C Poulat, Y Nivoix, A Launoy, P Lutun, P Bachellier, S Rohr, M-L Woehl, D Levêque, V Bru, R Herbrecht, B Gourieux
OBJECTIVES: To assess compliance with international guidelines for costly antifungal prescriptions and to compare these results with a first study performed in 2007. METHODS: Retrospective study including all costly antifungal prescriptions made in surgical and medical intensive care units and in a hepatobiliary, pancreatic, and digestive surgery unit. Prescriptions were assessed in terms of indication, dosage, and antifungal de-escalation. RESULTS: Seventy-four treatments were analyzed...
April 12, 2017: Médecine et Maladies Infectieuses
https://www.readbyqxmd.com/read/28411289/evaluating-automated-rules-for-rapid-response-system-alarm-triggers-in-medical-and-surgical-patients
#8
Santiago Romero-Brufau, Bruce W Morlan, Matthew Johnson, Joel Hickman, Lisa L Kirkland, James M Naessens, Jeanne Huddleston
BACKGROUND: The use of rapid response systems (RRS), which were designed to bring clinicians with critical care expertise to the bedside to prevent unnecessary deaths, has increased. RRS rely on accurate detection of acute deterioration events. Early warning scores (EWS) have been used for this purpose but were developed using heterogeneous populations. Predictive performance may differ in medical vs surgical patients. OBJECTIVE: To evaluate the performance of published EWS in medical vs surgical patient populations...
April 2017: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
https://www.readbyqxmd.com/read/28410092/tidal-volume-delivery-during-the-anesthetic-management-of-neonates-is-variable
#9
Thanaa Abouzeid, Elizabeth J Perkins, Prue M Pereira-Fantini, Anushi Rajapaksa, Asha Suka, David G Tingay
OBJECTIVES: To describe expiratory tidal volume (VT) during routine anesthetic management of neonates at a single tertiary neonatal surgical center, as well as the proportion of VT values within the range of 4.0-8.0?mL/kg. STUDY DESIGN: A total of 26 neonates needing surgery under general anesthesia were studied, of whom 18 were intubated postoperatively. VT was measured continuously during normal clinical care using a dedicated neonatal respiratory function monitor (RFM), with clinicians blinded to values...
March 3, 2017: Journal of Pediatrics
https://www.readbyqxmd.com/read/28408715/postoperative-infection-in-developing-world-congenital-heart-surgery-programs-data-from-the-international-quality-improvement-collaborative
#10
Amitabh Chanchal Sen, Debra Forbes Morrow, Rakhi Balachandran, Xinwei Du, Kimberlee Gauvreau, Byalal R Jagannath, Raman Krishna Kumar, Jennifer Koch Kupiec, Monica L Melgar, Nguyen Tran Chau, Gail Potter-Bynoe, Orlando Tamariz-Cruz, Kathy J Jenkins
BACKGROUND: Postoperative infections contribute substantially to morbidity and mortality after congenital heart disease surgery and are often preventable. We sought to identify risk factors for postoperative infection and the impact on outcomes after congenital heart surgery, using data from the International Quality Improvement Collaborative for Congenital Heart Surgery in Developing World Countries. METHODS AND RESULTS: Pediatric cardiac surgical cases performed between 2010 and 2012 at 27 participating sites in 16 developing countries were included...
April 2017: Circulation. Cardiovascular Quality and Outcomes
https://www.readbyqxmd.com/read/28408415/impact-of-international-quality-improvement-collaborative-on-congenital-heart-surgery-in-pakistan
#11
Amina Khan, Ahmed Abdullah, Huzaifa Ahmad, Arjumand Rizvi, Sehrish Batool, Kathy J Jenkins, Kimberlee Gauvreau, Muneer Amanullah, Anwar Haq, Nadeem Aslam, Fauzia Minai, Babar Hasan
BACKGROUND: The International Quality Improvement Collaborative (IQIC) was formed to reduce mortality and morbidity from congenital heart disease (CHD) surgeries in low/middle-income countries. OBJECTIVES: We conducted this study to compare the postoperative outcomes of CHD surgeries at a centre in Pakistan before and after joining IQIC. METHODS: The IQIC provides guidelines targeting key drivers responsible for morbidity and mortality in postoperativepatients with CHD...
April 13, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28400693/ludwig-s-angina-a-nightmare-worsened-by-adverse-drug-reaction-to-antibiotics
#12
Mohamed Hisham, Mundilipalayam N Sivakumar, R S Senthil Kumar, P Nandakumar
A 52-year-old obese gentleman presented to the hospital with complaints of fever and shortness of breath for 10 days. He was admitted in the ward and treated for acute exacerbation of asthma. He was shifted to the Intensive Care Unit (ICU) for persistent fever, neck swelling, airway obstruction and desaturation. Ludwig's angina was suspected and computed tomography of neck confirmed it. A difficult airway was anticipated and preceded with surgical tracheostomy. The patient had hypersensitivity reactions to piperacillin/tazobactam; hence, he was treated with clindamycin and metronidazole...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28400683/factors-associated-with-reintubation-in-an-intensive-care-unit-a-prospective-observational-study
#13
Eric Shih Hsiung Lee, Danny Tse Jiann Lim, Juvel Mabao Taculod, Juliet Tolentino Sahagun, Joerie Pasive Otero, Kaimin Teo, Will Ne-Hooi Loh, Addy Yong Hui Tan
BACKGROUND AND AIMS: The objective of the study was to determine the incidence of failed extubations in our Intensive Care Unit (ICU) and identify associated clinical factors. MATERIALS AND METHODS: A prospective observational study of mechanically ventilated patients who underwent extubation attempts in our (predominantly surgical) ICU was undertaken from July 2012 to August 2013. The primary endpoint was the need for nonelective reintubation within 72 h of extubation...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28400682/unplanned-intensive-care-unit-admission-following-elective-surgical-adverse-events-incidence-patient-characteristics-preventability-and-outcome
#14
Mohammed Meziane, Sidi Driss El Jaouhari, Abdelghafour ElKoundi, Mustapha Bensghir, Hicham Baba, Redouane Ahtil, Khalil Aboulaala, Hicham Balkhi, Charki Haimeur
CONTEXT: Adverse events (AEs) are a persistent and an important reason for Intensive Care Unit (ICU) admission. They lead to death, disability at the time of discharge, unplanned ICU admission (UIA), and prolonged hospital stay. They impose large financial costs on health-care systems. AIMS: This study aimed to determine the incidence, patient characteristics, type, preventability, and outcome of UIA following elective surgical AE. SETTINGS AND DESIGN: This is a single-center prospective study...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28400680/changes-in-b-type-natriuretic-peptide-and-related-hemodynamic-parameters-following-a-fluid-challenge-in-critically-ill-patients-with-severe-sepsis-or-septic-shock
#15
Shahed Omar, Ahmad Ali, Yahya Atiya, Rudo Lufuno Mathivha, Joel M Dulhunty
CONTEXT: Severe sepsis or septic shock. AIMS: The aim of this study is to examine the effect of a fluid challenge on the B-type natriuretic peptide (BNP) and the hemodynamic state. SETTINGS AND DESIGN: This observational study was conducted in an intensivist-led academic, mixed medical-surgical Intensive Care Unit. SUBJECTS AND METHODS: Focused transthoracic echocardiogram, plasma BNP, and hemodynamic measurements were recorded at baseline and following a 500 ml fluid challenge in thirty patients...
March 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28400658/complication-rate-during-multilevel-lumbar-fusion-in-patients-above-60-years
#16
Bijjawara Mahesh, Bidre Upendra, S Vijay, Gc Arun Kumar, Srinivas Reddy
BACKGROUND: Spine surgery in elderly with comorbidities is reported to have higher complication rates and increased cost. However, the surgical outcome is good irrespective of the complications. Hence, it is essential to identify the factors affecting the complication rates in such patients and the measures to reduce them. This retrospective observational study determines the perioperative complications, their incidence and the measures to reduce complications in the elderly with comorbidities, operated by instrumented multilevel lumbar fusion...
March 2017: Indian Journal of Orthopaedics
https://www.readbyqxmd.com/read/28399011/effect-of-a-patient-repositioning-device-in-an-intensive-care-unit-on-hospital-acquired-pressure-injury-occurances-and-cost-a-before-after-study
#17
Melinda Edger
PURPOSE: The principal aim of this study was to determine the hospital-acquired pressure injury (HAPI) rate before and after introduction of a repositioning device, measure staff-perceived level of exertion with device use, and assess return on investment. DESIGN: 1 group, before-and-after study. SUBJECTS AND SETTING: The sample comprised 717 patients cared for in a 17-bed intensive care unit. The study setting was the medical-surgical intensive care unit at Bon Secours Maryview Medical Center located in the mid-Atlantic United States (Portsmouth, Virginia)...
April 7, 2017: Journal of Wound, Ostomy, and Continence Nursing
https://www.readbyqxmd.com/read/28396935/state-of-the-art-in-fluid-and-volume-therapy-a%C3%A2-user-friendly-staged-concept-english-version
#18
M Rehm, N Hulde, T Kammerer, A S Meidert, K Hofmann-Kiefer
Adequate intraoperative infusion therapy is essential for the perioperative outcome of a patient. Both hypo- and hypervolemia can lead to an increased rate of perioperative complications and to a worse outcome. Perioperative infusion therapy should therefore be needs-based. The primary objective is the maintenance of preoperative normovolemia using a rational infusion strategy. Perioperative fluid losses should be differentiated from volume losses due to surgical bleeding or protein losses into the interstitial space...
April 10, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28395369/antibiotics-prescriptions-in-the-neonatal-intensive-care-unit-how-to-overcome-everyday-challenges
#19
D Donà, E Mozzo, V Mardegan, U Trafojer, P Lago, S Salvadori, E Baraldi, C Giaquinto
Antimicrobial prescriptions in neonatal intensive care units (NICUs) represent a point of concern for the emergence of MDROs and for morbidity associated with prolonged antibiotic exposure (e.g., invasive candidiasis, necrotizing enterocolitis, and late-onset sepsis). Antimicrobial stewardship programs (ASPs) have shown to be a valuable tool for the prevention of resistance with the goals of optimizing clinical outcomes while decreasing unnecessary prescribing. The most frequent ASP strategies include the correct collection and interpretation of microbiological specimens, prescription of the narrowest-spectrum antibiotic appropriate for a particular case, and de-escalation or discontinuation of therapy in defined situations...
April 10, 2017: American Journal of Perinatology
https://www.readbyqxmd.com/read/28394022/limited-versus-full-sternotomy-for-aortic-valve-replacement
#20
REVIEW
Bilal H Kirmani, Sion G Jones, S C Malaisrie, Darryl A Chung, Richard Jnn Williams
BACKGROUND: Aortic valve disease is a common condition that is easily treatable with cardiac surgery. This is conventionally performed by opening the sternum longitudinally down the centre ("median sternotomy") and replacing the valve under cardiopulmonary bypass. Median sternotomy is generally well tolerated, but as less invasive options have become available, the efficacy of limited incisions has been called into question. In particular, the effects of reducing the visibility and surgical access has raised safety concerns with regards to the placement of cannulae, venting of the heart, epicardial wire placement, and de-airing of the heart at the end of the procedure...
April 10, 2017: Cochrane Database of Systematic Reviews
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