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Surgical Intensive Care Unit

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https://www.readbyqxmd.com/read/28527564/prospective-comparison-of-perioperative-antibiotic-management-protocols-in-oncological-head-and-neck-surgery
#1
Alexander K Bartella, Mohammad Kamal, Jan Teichmann, Anita Kloss-Brandstätter, Timm Steiner, Frank Hölzle, Bernd Lethaus
OBJECTIVES: The adequate perioperative antibiotic prophylaxis in head and neck cancer surgery is an important and easy applicable tool to decrease nosocomial morbidity and mortality by reducing the rate of infections. In the study a strictly perioperative antibiosis is compared with an extended postoperative prophylactic antibiosis. We aim to clarify the value of postoperative prophylactic antibiosis for the recovery and clinical course of patients. MATERIAL AND METHODS: In this prospective study 75 consecutive patients, who underwent major oncological head and neck surgery were included and divided in three groups, each containing 25 patients...
April 20, 2017: Journal of Cranio-maxillo-facial Surgery
https://www.readbyqxmd.com/read/28523889/collagenase-for-wound-debridement-in-the-neonatal-intensive-care-unit-a-retrospective-case-series
#2
Elizabeth Huett, Whitney Bartley, Darla Morris, Della Reasbeck, Beth McKitrick-Bandy, Charlotte Yates
BACKGROUND/OBJECTIVES: The use of collagenase for enzymatic wound debridement has been studied extensively and has been established as the standard of care for nonhealing and necrotic wounds in individuals for whom surgical intervention is not an option. Collagenase has been shown to be effective in adults but has been studied in a limited capacity in infants and neonates. The purpose of this study was to investigate the use of collagenase in the neonatal intensive care unit (NICU). METHODS: Retrospective chart review of infants and neonates admitted to the NICU at Arkansas Children's Hospital with nonhealing wounds for which collagenase was used for wound healing over a 1-year time period...
May 2017: Pediatric Dermatology
https://www.readbyqxmd.com/read/28523130/the-development-of-uniportal-video-assisted-thoracoscopic-surgery-in-s%C3%A3-o-paulo-from-diagnosis-to-lobectomy
#3
Alexandre de Oliveira, Thais Amarante P P Couto
BACKGROUND: The use of uniportal video-assisted thoracoscopic surgery (VATS) has been increasing worldwide. Our main goal was to describe the evolution of uniportal surgery in the biggest private hospital in Latin America that is located in São Paulo, Brazil. METHODS: This descriptive and retrospective study included patients who underwent uniportal VATS in the thoracic surgical department of Beneficencia Portuguesa Hospital, after being referred to our team to undergo the aforementioned procedure within the period from February 2012 to March 2016...
April 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28521598/malnutrition-critical-illness-survivors-and-postdischarge-outcomes-a-cohort-study
#4
Kris M Mogensen, Clare M Horkan, Steven W Purtle, Takuhiro Moromizato, James D Rawn, Malcolm K Robinson, Kenneth B Christopher
BACKGROUND: We hypothesized that preexisting malnutrition in patients who survived critical care would be associated with adverse outcomes following hospital discharge. METHODS: We performed an observational cohort study in 1 academic medical center in Boston. We studied 23,575 patients, aged ≥18 years, who received critical care between 2004 and 2011 and survived hospitalization. RESULTS: The exposure of interest was malnutrition determined at intensive care unit (ICU) admission by a registered dietitian using clinical judgment and on data related to unintentional weight loss, inadequate nutrient intake, and wasting of muscle mass and/or subcutaneous fat...
May 1, 2017: JPEN. Journal of Parenteral and Enteral Nutrition
https://www.readbyqxmd.com/read/28520538/treatment-strategies-for-paradoxical-hypertension-following-surgical-correction-of-coarctation-of-the-aorta-in-children
#5
Peter P Roeleveld, Eline G Zwijsen
BACKGROUND: Paradoxical hypertension after repair of coarctation of the aorta is a well-known phenomenon. The pathogenesis involves the activation of the sympathetic nervous system (first phase) and renin-angiotensin system (second phase). Only a limited number of different treatment strategies have been published in the literature, without any comparative studies. METHODS: Our aim was to describe the current international practice variation surrounding pharmacological treatment currently being employed to treat paradoxical hypertension following the repair of coarctation of the aorta in children...
May 2017: World Journal for Pediatric & Congenital Heart Surgery
https://www.readbyqxmd.com/read/28515741/respiratory-functional-status-after-conventional-and-minimally-invasive-aortic-valve-replacement-surgery-a-propensity-score-analysis
#6
Jarosław Stoliński, Robert Musiał, Dariusz Plicner, Kamil Fijorek, Michał Mędrzycki, Janusz Andres, Bogusław Kapelak
INTRODUCTION: Reports describing respiratory function of patients after conventional or minimally invasive cardiac surgery are infrequent. AIM: To compare pulmonary functional status after conventional (AVR) and after minimally invasive, through right anterior minithoracotomy, aortic valve replacement (RT-AVR). MATERIAL AND METHODS: This was an observational analysis of 212 patients scheduled for RT-AVR and 212 for AVR between January 2011 and December 2014 selected using propensity score matching...
March 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28511483/a-study-of-morbidity-and-cost-of-peripheral-venous-cannulation-in-neonates-admitted-to-paediatric-surgical-intensive-care-unit
#7
Sushama Raghunath Tandale, Nandini Dave, Madhu Garasia, Shalil Patil, Sandesh Parelkar
INTRODUCTION: Peripheral venous access in sick neonates is indicated for administration of fluids, drugs or nutrients. AIM: We conducted an audit of peripheral venous access in neonates admitted to paediatric surgical intensive care unit to study the morbidity, time spent on cannulation and cost with its use. MATERIALS AND METHODS: One hundred consecutive neonates requiring hospital admission to paediatric surgical intensive care unit in a period of one year were included in the study...
March 2017: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28509706/length-of-stay-mortality-cost-and-perceptions-of-care-associated-with-transition-from-an-open-to-closed-staffing-model-in-the-cardiac-intensive-care-unit
#8
Jason N Katz, Anton Lishmanov, Sean van Diepen, Dongqing Yu, Haipeng Shen, Eric Pauley, Jatin Bhatia, Adam Buntaine, Arun Das, Cristie Dangerfield, Brooke McLaughlin, George A Stouffer, Prashant Kaul
BACKGROUND: Organizational models in the intensive care unit (ICU) have classically been described as either closed or open, depending on the presence or absence of a dedicated ICU team. Although a closed model has been shown to improve patient outcomes in medical and surgical ICUs, the merits of various care models have not been previously explored in the cardiac ICU (CICU) setting. METHODS: From November 2012 to March 2014, data were prospectively collected on all admissions before and after transition from an open to closed CICU at our institution...
June 2017: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/28504994/preoperative-low-dose-aspirin-exposure-and-outcomes-after-emergency-neurosurgery-for-traumatic-intracranial-hemorrhage-in-elderly-patients
#9
Alex T Lee, Arni Gagnidze, Sharon R Pan, Pimwan Sookplung, Bala Nair, Shu-Fang Newman, Alon Ben-Ari, Ahmed Zaky, Kevin Cain, Monica S Vavilala, Irene Rozet
BACKGROUND: Antiplatelet medications are usually discontinued before elective neurosurgery, but this is not an option for emergent neurosurgery. We performed a retrospective cohort study to examine whether preoperative aspirin use was associated with worse outcomes after emergency neurosurgery in elderly patients. METHODS: We analyzed all cases of emergency neurosurgical procedures for traumatic intracranial hemorrhage from 2008 to 2012 at a level 1 trauma center...
May 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28504992/trends-in-perioperative-practice-and-resource-utilization-in-patients-with-obstructive-sleep-apnea-undergoing-joint-arthroplasty
#10
Crispiana Cozowicz, Jashvant Poeran, Ashley Olson, Madhu Mazumdar, Eva E Mörwald, Stavros G Memtsoudis
BACKGROUND: Emerging evidence associating obstructive sleep apnea (OSA) with adverse perioperative outcomes has recently heightened the level of awareness among perioperative physicians. In particular, estimates projecting the high prevalence of this condition in the surgical population highlight the necessity of the development and adherence to "best clinical practices." In this context, a number of expert panels have generated recommendations in an effort to provide guidance for perioperative decision-making...
May 11, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28504109/severe-traumatic-brain-injury-targeted-management-in-the-intensive-care-unit
#11
REVIEW
Nino Stocchetti, Marco Carbonara, Giuseppe Citerio, Ari Ercole, Markus B Skrifvars, Peter Smielewski, Tommaso Zoerle, David K Menon
Severe traumatic brain injury (TBI) is currently managed in the intensive care unit with a combined medical-surgical approach. Treatment aims to prevent additional brain damage and to optimise conditions for brain recovery. TBI is typically considered and treated as one pathological entity, although in fact it is a syndrome comprising a range of lesions that can require different therapies and physiological goals. Owing to advances in monitoring and imaging, there is now the potential to identify specific mechanisms of brain damage and to better target treatment to individuals or subsets of patients...
June 2017: Lancet Neurology
https://www.readbyqxmd.com/read/28503124/factor-xiii-deficiency-and-thrombocytopenia-are-frequent-modulators-of-postoperative-clot-firmness-in-a-surgical-intensive-care-unit
#12
Sarah von Rappard, Corina Hinnen, Roger Lussmann, Manuela Rechsteiner, Wolfgang Korte
OBJECTIVE: Fibrinogen and factor XIII (FXIII) have been shown to critically influence clot firmness in the intraoperative setting and thus likely influence intraoperative bleeding. We were interested to identify potential modulators of postoperative clot firmness in a tertiary care hospital surgical intensive care unit setting, independent of their clinical course during surgery. METHODS: 272 day-shift consecutive patients were evaluated for whole blood clot firmness evaluated by the ROTEM® EXTEM thrombelastometric assay and various potential modulators of clot firmness upon arrival at the surgical intensive care unit (SICU)...
April 2017: Transfusion Medicine and Hemotherapy
https://www.readbyqxmd.com/read/28502236/family-presence-in-the-adult-icu-during-bedside-procedures
#13
Marnie Jakab, Alex Z Day, Alan Kraguljac, Maedean Brown, Sangeeta Mehta
PURPOSE: To understand perspectives of family members of adult patients admitted to the medical-surgical intensive care unit (ICU) regarding their presence during procedures. METHODS: Respondents completed a questionnaire about procedures the patient had undergone, their desire to be present, and their experience. Procedures of interest were endotracheal intubation; chest compressions; vascular catheter insertion; and gastric, chest, and rectal tubes. Impact of Events Scale-Revised (IES-R) was completed at the time of questionnaire completion and again 1 month later to evaluate the psychological impact of witnessing a procedure...
January 1, 2017: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/28501293/gender-differences-in-physician-service-provision-using-medicare-claims-data
#14
Michael A Mahr, Sharonne N Hayes, Tait D Shanafelt, Jeff A Sloan, Jay C Erie
OBJECTIVE: To determine differences in the provision of Medicare services based on physician gender in the United States. PATIENTS AND METHODS: Participants included all 2013 Medicare fee-for-service physicians and their patients, a population that is predominantly older than 65 years. The 2013 Medicare Provider Utilization and Payment Data for services rendered between January 1, 2013, and December 31, 2013, were combined with the 2015 Physician Compare National Downloadable files and 2015 Berenson-Eggers Type of Service classification files...
May 10, 2017: Mayo Clinic Proceedings
https://www.readbyqxmd.com/read/28498944/assessment-of-standard-laboratory-tests-and-rotational-thromboelastometry-for-the-prediction-of-postoperative-bleeding-in-liver-transplantation
#15
T M Dötsch, D Dirkmann, D Bezinover, M Hartmann, J W Treckmann, A Paul, F H Saner
Background.: Perioperative bleeding remains a major challenge in liver transplantation. We aimed to compare standard laboratory tests with thromboelastometry (ROTEM ® ) with regard to their ability to predict postoperative non-surgical bleeding. Methods.: Data from 243 adult liver transplant recipients from January 2012 to May 2014 were evaluated retrospectively. Upon admission to the intensive care unit, coagulation status was assessed using standard laboratory tests [prothrombin time (PT), activated partial thromboplastin time (aPTT), fibrinogen concentration, and platelet count] and ROTEM ® whole blood coagulation assays...
May 12, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/28495809/comparison-of-enteral-versus-intravenous-potassium-supplementation-in-hypokalaemia-in-paediatric-patients-in-intensive-care-post-cardiac-surgery-open-label-randomised-equivalence-trial-eips
#16
Naveed Ur Rehman Siddiqu, Quratulain Merchant, Babar S Hasan, Arjumand Rizvi, Muneer Amanullah, Amina Rehmat, Anwarul Ul Haq
OBJECTIVES: The primary objective was to compare the efficacy of enteral potassium replacement (EPR) and intravenous potassium replacement (IVPR) as first-line therapy. Secondary objectives included comparison of adverse effects and number of doses required to resolve the episode of hypokalaemia. TRIAL DESIGN: The EIPS trial is designed as a randomised, equivalence trial between two treatment arms. STUDY SETTING: The study was conducted at the paediatric cardiac intensive care unit (PCICU) at Aga Khan University Hospital, Karachi...
May 10, 2017: BMJ Open
https://www.readbyqxmd.com/read/28495690/intensive-care-in-thoracic-oncology
#17
Anne-Pascale Meert, Bogdan Grigoriu, Marc Licker, Paul E Van Schil, Thierry Berghmans
The admission of lung cancer patients to intensive care is related to postprocedural/postoperative care and medical complications due to cancer or its treatment, but is also related to acute organ failure not directly related to cancer.Despite careful preoperative risk management and the use of modern surgical and anaesthetic techniques, thoracic surgery remains associated with high morbidity, related to the extent of resection and specific comorbidities. Fast-tracking processes with timely recognition and treatment of complications favourably influence patient outcome...
May 2017: European Respiratory Journal: Official Journal of the European Society for Clinical Respiratory Physiology
https://www.readbyqxmd.com/read/28494887/preoperative-risk-stratification-of-critically-ill-patients
#18
Curtis C Copeland, Andrew Young, Tristan Grogan, Eilon Gabel, Anahat Dhillon, Vadim Gudzenko
STUDY OBJECTIVE: Risk assessment historically emphasized cardiac morbidity and mortality in elective, outpatient, non-cardiac surgery. However, critically ill patients increasingly present for therapeutic interventions. Our study investigated the relationship of American Society of Anesthesiologists (ASA) class, revised cardiac risk index (RCRI), and sequential organ failure assessment (SOFA) score with survival to discharge in critically ill patients with respiratory failure. DESIGN: Retrospective cohort analysis over a 21-month period...
June 2017: Journal of Clinical Anesthesia
https://www.readbyqxmd.com/read/28492463/impact-of-an-alcohol-withdrawal-treatment-pathway-on-hospital-length-of-stay-a-retrospective-observational-study-comparing-pre-and-post-pathway-implementation
#19
Andrew J Muzyk, Rachel E Rogers, Gary Dighe, Jessica Hartung, Robert C Musser, Mary J Stillwagon, Sarah Rivelli
OBJECTIVE: To determine if the implementation of a hospital-specific alcohol withdrawal treatment pathway used in a medical-surgical patient population decreased hospital length of stay (LOS) compared with the standard of care. METHODS: This retrospective observational study, conducted in a large academic tertiary care hospital, involved 582 subjects who met criteria for study inclusion, with 275 subjects in the 2010 cohort and 307 in the 2012 cohort. The Alcohol Withdrawal Project Team was formed with the goal of creating a standardized approach to the recognition and treatment of alcohol withdrawal at Duke University Hospital...
May 2017: Journal of Psychiatric Practice
https://www.readbyqxmd.com/read/28489476/benefits-of-thoracic-epidural-analgesia-in-patients-undergoing-an-open-posterior-component-separation-for-abdominal-herniorrhaphy
#20
Daryl S Henshaw, Christopher J Edwards, Austin R Sellers, Gregory B Russell, Robert S Weller
An open posterior component separation (PCS) is a commonly utilized surgical approach for repair of complex abdominal wall defects and hernias. Although this approach may improve surgical outcomes, significant postoperative pain can be expected given the required laparotomy and extensive abdominal wall manipulation. Both systemic opioids and thoracic epidural analgesia (TEA) are viable postoperative analgesic options, and both are commonly utilized. Although the benefits of TEA have been investigated following a variety of surgeries, there is a paucity of literature related to its efficacy for this particular surgery...
May 10, 2017: Journal of Pain & Palliative Care Pharmacotherapy
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