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Surgical Intensive Care Unit

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https://www.readbyqxmd.com/read/28732315/total-and-ionized-magnesium-testing-in-the-surgical-intensive-care-unit-opportunities-for-improved-laboratory-and-pharmacy-utilization
#1
Daniel Dante Yeh, Nalin Chokengarmwong, Yuchiao Chang, Liyang Yu, Colleen Arsenault, Joseph Rudolf, Elizabeth Lee-Lewandrowski, Kent Lewandrowski
PURPOSE: Ionized fraction (iMg) is the physiologically active form of magnesium (Mg); total Mg may not accurately reflect iMg status. Erroneously "low" Mg levels may result in unnecessary repetitive testing. MATERIALS AND METHODS: From 11/2015 to 01/2016, patients ordered for Mg from a pilot ICU also had iMg tested. Weighted kappa statistic was used to assess agreement between Mg categories (low, normal, high). Predictors of unnecessary repeated Mg testing and repletion using data were explored through logistic regression models using GEE techniques to account for repeated measurements in both bivariate and multivariable analyses...
July 11, 2017: Journal of Critical Care
https://www.readbyqxmd.com/read/28728827/the-use-of-perioperative-ketorolac-in-the-surgical-treatment-of-pediatric-spontaneous-pneumothorax
#2
R Michael Dorman, George Ventro, Sarah B Cairo, Kaveh Vali, David H Rothstein
BACKGROUND: We sought to determine the effect of ketorolac on pediatric primary spontaneous pneumothorax recurrence after operation. METHODS: The Pediatric Health Information System database was queried for patients ages 10-16years discharged in the years 2004-2014 with pneumothorax or pleural bleb and a related operative procedure. Deaths and secondary pneumothorax were excluded. Variables included demographics, chronic disease, intensive care unit admission, mechanical ventilation, and lung resection or plication...
June 23, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28724143/potentially-avoidable-surgical-intensive-care-unit-admissions-and-disposition-delays
#3
Navpreet K Dhillon, Ara Ko, Eric J T Smith, Mayumi Kharabi, Joseph Castongia, Michael Nurok, Bruce L Gewertz, Eric J Ley
Importance: High health care costs encourage initiatives that avoid overuse of resources and identify opportunities to promote appropriate care. Objective: To investigate the causes of potentially avoidable surgical intensive care unit (SICU) admissions and disposition delays to determine whether targeted interventions could decrease these stays. Design, Setting, and Participants: This prospective, observational study focused on potentially avoidable SICU days, as determined by observers with input from the rounding intensivists at a 24-bed open SICU at an urban, academic hospital...
July 19, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/28719660/factors-associated-with-life-sustaining-treatment-restriction-in-a-general-intensive-care-unit
#4
Stein Arve Skjaker, Henrik Hoel, Vegard Dahl, Knut Stavem
PURPOSE: Few previous studies have investigated associations between clinical variables available after 24 hours in the intensive care unit (ICU), including the Charlson Comorbidity Index (CCI), and decisions to restrict life-sustaining treatment. The aim of this study was to identify factors associated with the life-sustaining treatment restriction and to explore if CCI contributes to explaining decisions to restrict life-sustaining treatment in the ICU at a university hospital in Norway from 2007 to 2009...
2017: PloS One
https://www.readbyqxmd.com/read/28719134/development-and-implementation-of-a-clinical-pathway-for-cardiac-surgery-in-the-intensive-care-unit-effects-on-protocol-adherence
#5
Marion van der Kolk, Mark van den Boogaard, Corine Ter Brugge-Speelman, Jeroen Hol, Luc Noyez, Kees van Laarhoven, Hans van der Hoeven, Peter Pickkers
RATIONALE, AIMS AND OBJECTIVES: Cardiac surgery (CS) is facilitated by multiple perioperative guidelines and protocols. Use of a clinical pathway (CP) may facilitate the care of these patients. METHODS: This is a pre-post design study in the ICU of a tertiary referral centre. A CP for CS patients in the ICU was developed by ICU-nurses and enabled them to execute proactively predefined actions in accordance with and within the preset boundaries which were part of a variance report...
July 18, 2017: Journal of Evaluation in Clinical Practice
https://www.readbyqxmd.com/read/28717966/association-between-aspirin-use-and-deep-venous-thrombosis-in-mechanically-ventilated-icu-patients
#6
Ena Gupta, Furqan S Siddiqi, Ryan Kunjal, Muhammad Faisal, Farah Al-Saffar, Abubakr A Bajwa, Lisa M Jones, Vandana Seeram, James D Cury, Adil Shujaat
Deep venous thrombosis (DVT) is common in intensive care unit (ICU) patients. It is often silent and may be complicated by pulmonary embolism and death. Thromboprophylaxis with heparin does not always prevent venous thromboembolism (VTE). Aspirin (ASA) reduces the risk of VTE in surgical and high-risk medical patients but it is unknown if ASA may prevent DVT in mechanically ventilated ICU patients. We performed a retrospective chart review of critically ill patients who received mechanical ventilation for >72 h and underwent venous ultrasonography for suspected DVT between Jan 2012 and Dec 2013...
July 17, 2017: Journal of Thrombosis and Thrombolysis
https://www.readbyqxmd.com/read/28717904/a-description-of-deaths-following-emergency-abdominal-surgery
#7
Henrik Wolsted, Ann Merete Møller, Mai-Britt Tolstrup, Morten Vester-Andersen
OBJECTIVE: Emergency major abdominal surgery carries a high mortality rate. The aim of this present study was to characterize a population of deceased abdominal surgical patients, to examine how many died unexpectedly and how many were subject to treatment limitations. MATERIALS AND METHODS: We included adult emergency abdominal surgical patients who died within 30 days postoperatively. We collected data from January 1, 2013, to December 31, 2014, in a Danish tertiary care hospital (Herlev)...
July 17, 2017: World Journal of Surgery
https://www.readbyqxmd.com/read/28717057/glucose-variability-based-on-continuous-glucose-monitoring-assessment-is-associated-with-postoperative-complications-after-cardiovascular-surgery
#8
Hiroki Sato, Michihiro Hosojima, Tomomi Ishikawa, Kenji Aoki, Takeshi Okamoto, Akihiko Saito, Masanori Tsuchida
PURPOSE: This purpose of this prospective study was to use a continuous glucose monitoring (CGM) system to evaluate the suitability of our institution's glucose management protocol after cardiovascular surgery and to clarify the impact of glycemic variability on postoperative complications. METHODS: In all, 76 patients who underwent elective cardiovascular surgery and were monitored perioperatively using a CGM system were evaluated. Postoperative glucose management consisted of continuous intravenous insulin infusion (CIII) in the intensive care unit, and subcutaneous insulin injections (SQII) after oral food intake started...
July 18, 2017: Annals of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28713659/a-descriptive-report-of-early-mobilization-for-critically-ill-ventilated-patients-with-cancer
#9
Amanda Weeks, Claudine Campbell, Prabalini Rajendram, Weiji Shi, Louis Voigt
BACKGROUND: Early mobilization protocols have been successfully implemented to improve function in critically ill patients; however, no study has focused on the oncology population. OBJECTIVES: To investigate the feasibility of early mobilization and describe the rehabilitation interventions and discharge outcomes in a cohort of critically ill patients with cancer. DESIGN: Retrospective review. METHODS: A retrospective analysis of patients with cancer who participated in occupational and physical therapy while on mechanical ventilation utilizing an institutional early mobilization protocol from June 2010 - July 2011, was completed...
July 2017: Rehabilitation Oncology
https://www.readbyqxmd.com/read/28712581/cost-and-contribution-margin-of-transcatheter-versus-surgical-aortic-valve-replacement
#10
Fenton H McCarthy, Danielle C Savino, Chase R Brown, Joseph E Bavaria, Vinay Kini, Danielle D Spragan, Taylor R Dibble, Howard C Herrmann, Saif Anwaruddin, Jay Giri, Wilson Y Szeto, Peter W Groeneveld, Nimesh D Desai
OBJECTIVE: To compare the cost of and payments for transcatheter aortic valve replacement (TAVR), a novel and expensive technology, and surgical aortic valve replacement (SAVR). METHODS: Medicare claims provided hospital charges, payments, and outcomes between January and December 2012. Hospital costs and charges were estimated using hospital-specific cost-to-charge ratios. Costs and payments were examined in propensity score- matched TAVR and SAVR patients. RESULTS: Medicare spent $215,770,200 nationally on 4083 patients who underwent TAVR in 2012...
June 21, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28712104/do-bacteria-isolated-from-icu-patients-eskape-antibiotic-treatment-in-vitro-susceptibility-of-the-enterobacteriaceae-family-to-tigecycline
#11
Katarzyna Talaga-Ćwiertnia, Paweł Krzyściak, Małgorzata Bulanda
BACKGROUND: Enterobacteriaceae are currently causing the majority of healthcare-associated infections (HAI) and simultaneously expressing increasing levels of antibiotic resistance. The purpose of this study is to assess the in vitro sensitivity of MDR strains from the family Enterobacteriaceae to tigecycline in relation to their origin from patients hospitalized in intensive care units (ICUs) and non-ICUs. METHODS: The study involved 156 clinically-significant strains of the Enterobacteriaceae family isolated from patients with cIAIs and/or cSSSIs hospitalized in ICUs and other surgical departments...
July 16, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/28711966/modified-single-patch-technique-versus-two-patch-technique-for-the-repair-of-complete-atrioventricular-septal-defect-a-meta-analysis
#12
Dongxu Li, Qiang Fan, Tomoyuki Iwase, Yasutaka Hirata, Qi An
Technical selection for surgical repair of complete atrioventricular septal defect (CAVSD) still remains controversial. This meta-analysis aimed to compare the modified single-patch (MP) technique with the two-patch (TP) technique for patients with CAVSD. Relevant studies comparing the MP technique with the TP technique were identified through a literature search using MEDLINE, EMBASE, Google Scholar, Cochrane Library, and the China National Knowledge Infrastructure databases. The variables were ventricular septal defect (VSD) size, cardiopulmonary bypass (CBP) time, aortic cross-clamp (ACC) time, intensive care unit stay, hospital stay, and other outcomes involving mortality, left ventricular outflow tract obstruction, atrioventricular valve regurgitation, residual septal shunt, atrioventricular block, and reoperation...
July 15, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28711430/implementation-of-a-national-bundle-care-program-to-reduce-catheter-associated-urinary-tract-infection-in-high-risk-units-of-hospitals-in-taiwan
#13
Chih-Cheng Lai, Chun-Ming Lee, Hsiu-Tzy Chiang, Ching-Tzu Hung, Ying-Chun Chen, Li-Hsiang Su, Zhi-Yuan Shi, Jein-Wei Liu, Chang-Pan Liu, Min-Chi Lu, Yin-Ching Chuang, Wen-Chien Ko, Shu-Hui Tseng, Yen-Hsu Chen, Po-Ren Hsueh
BACKGROUND/PURPOSE: This study was intended to investigate the impact of implementation of catheter-associated urinary tract infection (CA-UTI) bundle care on the incidence of CA-UTI in high-risk units. METHODS: Thirteen high-risk units, including medical (n = 5), surgical (n = 3), cardiac intensive care units (n = 2), respiratory care centers (n = 2), and respiratory care ward (n = 1) were included in this quality-improvement project. This study was divided into pre-intervention phase (from January 1 to July 31) and post-intervention phase (from August 1 to October 31) in 2013...
June 26, 2017: Journal of Microbiology, Immunology, and Infection, Wei Mian Yu Gan Ran za Zhi
https://www.readbyqxmd.com/read/28711371/extubation-to-high-flow-nasal-cannula-in-critically-ill-surgical-patients
#14
Navpreet K Dhillon, Eric J T Smith, Ara Ko, Megan Y Harada, Danielle Polevoi, Richard Liang, Galinos Barmparas, Eric J Ley
BACKGROUND: High-flow nasal cannula (HFNC) is increasingly used to reduce reintubations in patients with respiratory failure. Benefits include providing positive end expiratory pressure, reducing anatomical dead space, and decreasing work of breathing. We sought to compare outcomes of critically ill surgical patients extubated to HFNC versus conventional therapy. METHODS: A retrospective review was conducted in the surgical intensive care unit of an academic center during August 2015 to February 2016...
July 12, 2017: Journal of Surgical Research
https://www.readbyqxmd.com/read/28711332/predictors-of-operating-room-extubation-in-adult-cardiac-surgery
#15
Kathirvel Subramaniam, Diana S DeAndrade, Daniel R Mandell, Andrew D Althouse, Rajan Manmohan, Stephen A Esper, Jeffrey M Varga, Vinay Badhwar
OBJECTIVE: The primary objective of the study was to identify perioperative factors associated with successful immediate extubation in the operating room after adult cardiac surgery. The secondary objective was to derive a simplified predictive scoring system to guide clinicians in operating room extubation. METHODS: All 1518 patients in this retrospective cohort study underwent standardized fast-track cardiac anesthetic protocol during adult cardiac surgery. Perioperative variables between patients who had successful extubation in the operating room versus in the intensive care unit were retrospectively analyzed using both univariate and multivariable logistic regression analyses...
June 13, 2017: Journal of Thoracic and Cardiovascular Surgery
https://www.readbyqxmd.com/read/28711292/perioperative-stroke-after-cerebral-aneurysm-clipping-risk-factors-and-postoperative-impact
#16
Ahmed I Kashkoush, Brian T Jankowitz, Chris Nguyen, Paul A Gardner, Daniel A Wecht, Robert M Friedlander, Yue-Fang Chang, Miguel Habeych, Donald Crammond, Jeffrey Balzer, Parthasarathy D Thirumala
Stroke is a devastating complication after intracranial aneurysm clipping. Understanding the risk factors that prognosticate perioperative stroke may help to identify patients that would benefit from neuroprotective therapy. This study assesses patient-specific independent predictors of perioperative stroke in relation to surgical aneurysm clipping. Additionally, this study evaluates the postoperative complications of stroke. We performed a retrospective chart review of 437 patients with ruptured and unruptured intracranial aneurysms, which underwent surgical clipping from 2006 to 2013...
July 12, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28710563/an-observational-study-examining-the-effects-of-a-surgically-induced-inflammatory-response-on-the-distribution-of-morphine-and-its-metabolites-into-cerebrospinal-fluid
#17
Yan Wang, Kerry B Goralski, Derek J Roberts, Kathryn Landry, Mark E Issa, Lekha Sleno, Lisa C Julien, Jeremy Wood, Richard I Hall
PURPOSE: Morphine is administered intravenously for pain management in the perioperative period. The effect of the inflammatory response to surgery on morphine distribution across the blood-brain barrier (BBB) in humans was investigated. We hypothesized that a graded surgically induced, systemic inflammatory response alters cerebrospinal fluid (CSF) levels of morphine, morphine-3-glucuronide (M3G), and morphine-6-glucuronide (M6G) through a temporary reduction in BBB drug efflux transporter function...
July 14, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28710215/a-study-protocol-for-an-observational-cohort-investigating-cognitive-outcomes-and-wellness-in-survivors-of-critical-illness-the-cogwell-study
#18
M Elizabeth Wilcox, Andrew S Lim, Mary P McAndrews, Richard A Wennberg, Ruxandra L Pinto, Sandra E Black, Karolina D Walczak, Jan O Friedrich, Michael S Taglione, Gordon D Rubenfeld
INTRODUCTION: Up to 9 out of 10 intensive care unit (ICU) survivors will suffer some degree of cognitive impairment at hospital discharge and approximately half will have decrements that persist for years. The mechanisms for this newly acquired brain injury are poorly understood. The purpose of this study is to describe the prevalence of sleep abnormalities and their association with cognitive impairment, examine a well-known genetic risk factor for dementia (Apolipoprotein E ε4) that may allow for genetic risk stratification of ICU survivors at greatest risk of cognitive impairment and determine if electroencephalography (EEG) is an independent predictor of long-term cognitive impairment and possibly a candidate intermediate end point for future clinical trials...
July 13, 2017: BMJ Open
https://www.readbyqxmd.com/read/28708679/transpulmonary-pressure-describes-lung-morphology-during-decremental-positive-end-expiratory-pressure-trials-in-obesity
#19
Jacopo Fumagalli, Lorenzo Berra, Changsheng Zhang, Massimiliano Pirrone, Roberta R De Santis Santiago, Susimeire Gomes, Federico Magni, Glaucia A B Dos Santos, Desmond Bennett, Vinicius Torsani, Daniel Fisher, Caio Morais, Marcelo B P Amato, Robert M Kacmarek
OBJECTIVES: Atelectasis develops in critically ill obese patients when undergoing mechanical ventilation due to increased pleural pressure. The current study aimed to determine the relationship between transpulmonary pressure, lung mechanics, and lung morphology and to quantify the benefits of a decremental positive end-expiratory pressure trial preceded by a recruitment maneuver. DESIGN: Prospective, crossover, nonrandomized interventional study. SETTING: Medical and Surgical Intensive Care Units at Massachusetts General Hospital (Boston, MA) and University Animal Research Laboratory (São Paulo, Brazil)...
August 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28706970/reversibility-of-frailty-after-bridge-to-transplant-ventricular-assist-device-implantation-or-heart-transplantation
#20
Sunita R Jha, Malin K Hannu, Phillip J Newton, Kay Wilhelm, Christopher S Hayward, Andrew Jabbour, Eugene Kotlyar, Anne Keogh, Kumud Dhital, Emily Granger, Mark Connellan, Paul Jansz, Phillip M Spratt, Elyn Montgomery, Angela Smith, Michelle Harkess, Peta Tunicliff, Patricia M Davidson, Peter S Macdonald
BACKGROUND: We recently reported that frailty is independently predictive of increased mortality in patients with advanced heart failure referred for heart transplantation (HTx). The aim of this study was to assess the impact of frailty on short-term outcomes after bridge-to-transplant ventricular assist device (BTT-VAD) implantation and/or HTx and to determine if frailty is reversible after these procedures. METHODS: Between August 2013 and August 2016, 100 of 126 consecutive patients underwent frailty assessment using Fried's Frailty Phenotype before surgical intervention: 40 (21 nonfrail, 19 frail) BTT-VAD and 77 (60 nonfrail, 17 frail) HTx-including 17 of the 40 BTT-VAD supported patients...
July 2017: Transplantation Direct
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