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tracheostomy decision

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https://www.readbyqxmd.com/read/28506407/intraoperative-neuromonitoring-in-thyroid-surgery-is-the-two-staged-thyroidectomy-justified
#1
Pietro Giorgio Calò, Fabio Medas, Giovanni Conzo, Francesco Podda, Gian Luigi Canu, Claudio Gambardella, Giuseppe Pisano, Enrico Erdas, Angelo Nicolosi
BACKGROUND: The aim of this study was to evaluate the diagnostic accuracy of intraoperative neuromonitoring (IONM) in predicting postoperative nerve function during thyroid surgery and its consequent ability to assist the surgeon in intraoperative decision making. MATERIALS AND METHODS: A total of 2365 consecutive patients were submitted to thyroidectomy by the same surgical team. Group A included 1356 patients (2712 nerves at risk) in whom IONM was utilized, and Group B included 1009 patients (2018 nerves at risk) in whom IONM was not utilized...
May 2017: International Journal of Surgery
https://www.readbyqxmd.com/read/28484927/ethical-and-legal-considerations-in-the-management-of-an-unbefriended-patient-in-a-vegetative-state
#2
Alexandra Lloyd-Smith Sequeira, Ariane Lewis
BACKGROUND: Patients without surrogates are referred to as "unbefriended." Because these patients do not have representatives to assist with medical decision-making, patient autonomy and self-determination, fundamental concepts of American healthcare, are jeopardized. METHODS: We present a case of an unbefriended patient in a vegetative state and discuss the ethical and legal complications associated with management of unbefriended patients. RESULTS: An unbefriended patient was admitted to our hospital with a cardiac arrest in the setting of an intracerebral hemorrhage...
May 8, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28479121/ethical-considerations-and-palliative-care-in-patients-with-amyotrophic-lateral-sclerosis-a-review
#3
REVIEW
V Danel-Brunaud, L Touzet, L Chevalier, C Moreau, D Devos, S Vandolaeghe, L Defebvre
Amyotrophic lateral sclerosis (ALS) is not a curable disease, but it is treatable. By definition, much of the care provided to ALS patients is palliative, even though active life-sustaining strategies are available to prolong survival. Healthcare professionals must develop communication skills that help patients cope with the inexorable progression of the disease and the inevitability of death. Symptomatic treatments as well as respiratory insufficiency and nutritional life-sustaining therapies must be regularly evaluated as the disease progresses, without losing sight of the burden placed on the patient's non-professional caregivers...
May 4, 2017: Revue Neurologique
https://www.readbyqxmd.com/read/28467581/can-we-make-an-early-do-not-resuscitate-decision-in-severe-burn-patients
#4
Yücel Yüce, Hakan Ahmet Acar, Kutlu Hakan Erkal, Erhan Tuncay
BACKGROUND: The present study was conducted to examine topic of issuing early do-not-resuscitate (DNR) order at first diagnosis of patients with severe burn injuries in light of current law in Turkey and the medical literature. DNR requires withholding cardiopulmonary resuscitation in event of respiratory or cardiac arrest and allowing natural death to occur. It is frequently enacted for terminal cancer patients and elderly patients with irreversible neurological disorders. METHODS: Between January 2009 and December 2014, 29 patients (3...
March 2017: Ulusal Travma Ve Acil Cerrahi Dergisi, Turkish Journal of Trauma & Emergency Surgery: TJTES
https://www.readbyqxmd.com/read/28457142/decision-making-for-tracheostomy-in-amyotrophic-lateral-sclerosis-als-a-retrospective-study
#5
Piero Ceriana, Sara Surbone, Daniele Segagni, Annia Schreiber, Annalisa Carlucci
BACKGROUND: ALS patients should discuss the issue of tracheostomy before the onset of terminal respiratory failure. While the process of shared decision-making is desirable, there are few data on the practical application of this real-life situation. AIM OF THE STUDY: To determine how a decision-making process is actually carried out, we analysed the episodes of acute respiratory failure preceding tracheostomy. METHODS: We studied the charts of a group of ALS patients after tracheostomy...
April 29, 2017: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration
https://www.readbyqxmd.com/read/28447274/classification-and-regression-tree-model-for-predicting-tracheostomy-in-patients-with-traumatic-cervical-spinal-cord-injury
#6
Dae-Sang Lee, Chi-Min Park, Keumhee Chough Carriere, Joonghyun Ahn
PURPOSE: In patients with cervical spinal cord injury (CSCI), respiratory compromise and the need for tracheostomy are common. The purpose of this study was to identify common risk factors for tracheostomy following traumatic CSCI and develop a decision tree for tracheostomy in traumatic CSCI patients without pulmonary function test. METHODS: Data of 105 trauma patients with CSCI admitted in our institution from April, 2008 to February, 2014 were retrospectively analyzed...
April 26, 2017: European Spine Journal
https://www.readbyqxmd.com/read/28425577/postoperative-hemorrhage-and-hospital-revisit-after-transoral-robotic-surgery
#7
Joseph Zenga, Jasmina Suko, Dorina Kallogjeri, Patrik Pipkorn, Brian Nussenbaum, Ryan S Jackson
OBJECTIVES/HYPOTHESIS: To investigate the incidence and complications related to postoperative hemorrhage (POH) after transoral robotic surgery (TORS). STUDY DESIGN: Retrospective review of the State Inpatient Database (SID), the State Ambulatory Surgery Database (SASD), and the State Emergency Department Database (SEDD) from the Healthcare Cost and Utilization Project. METHODS: Patients were identified from the SID, SASD, and SEDD for the states of Florida, New York, and California from 2005 to 2013 who had an International Classification of Diseases, Ninth Edition code for a surgical procedure on the upper aerodigestive tract associated with a code for robotic-assisted surgery...
April 20, 2017: Laryngoscope
https://www.readbyqxmd.com/read/28419746/factors-for-postoperative-complications-following-pressure-ulcer-operation-stepwise-multiple-logistic-regression-analysis
#8
Hyun Ho Han, Jun Gul Ko, Jong Won Rhie
Patients with pressure ulcers are generally older, have a long hospital stay and often have a variety of comorbidities. The decision to perform surgery for pressure ulcer management can be difficult because of concerns about the risk of postoperative complications. The aim of this study was to analyse the relationship between comorbid conditions and surgical outcomes in order to guide patient selection for pressure ulcer surgery. In 57 patients, data on age, defect size, operating time, hospital stay, body mass index, surgical site, mobility state, cardiac ischaemic history, diabetes, renal failure, ventilator dependency, tracheostomy state, use of haemodilution therapy and cancer were evaluated using stepwise multiple logistic regression analysis to determine the relationships between variables...
April 17, 2017: International Wound Journal
https://www.readbyqxmd.com/read/28395275/tracheostomy-extubation-reintubation-airway-management-decisions-in-intubated-stroke-patients
#9
Corinna Steidl, Julian Boesel, Sonja Suntrup-Krueger, Silvia Schoenenberger, Faisal Al-Suwaidan, Tobias Warnecke, Jens Minnerup, Rainer Dziewas
BACKGROUND: Both delayed and premature extubation increase complication rate, the need for tracheostomy (TT), the duration of intensive care unit stay, and mortality. In this study, we therefore investigated factors associated with primary TT and predictors for extubation failure (EF) in a sample of severely affected ventilated stroke patients. METHODS: One hundred eighty five intubated stroke patients were prospectively analyzed in this observational study. Patients not meeting predefined clinical and respiratory extubation criteria received a TT...
April 11, 2017: Cerebrovascular Diseases
https://www.readbyqxmd.com/read/28157753/discussing-life-sustaining-therapy-with-surrogate-decision-makers
#10
David Y Hwang
Clinicians caring for patients with severe stroke in intensive care units often grapple with requests from surrogate decision makers for life-prolonging treatment that members of the care team may believe to be futile. An example is a surrogate decision maker's request to place a tracheostomy and feeding tube in a patient who, in the clinical judgment of the neurocritical care team, is very unlikely to recover interactive capacity. This article presents a case, discusses definitions of medical futility, and summarizes recommended steps for mediating conflict regarding potentially inappropriate treatment...
February 2017: Continuum: Lifelong Learning in Neurology
https://www.readbyqxmd.com/read/28075489/cough-augmentation-techniques-for-extubation-or-weaning-critically-ill-patients-from-mechanical-ventilation
#11
REVIEW
Louise Rose, Neill Kj Adhikari, David Leasa, Dean A Fergusson, Douglas McKim
BACKGROUND: There are various reasons why weaning and extubation failure occur, but ineffective cough and secretion retention can play a significant role. Cough augmentation techniques, such as lung volume recruitment or manually- and mechanically-assisted cough, are used to prevent and manage respiratory complications associated with chronic conditions, particularly neuromuscular disease, and may improve short- and long-term outcomes for people with acute respiratory failure. However, the role of cough augmentation to facilitate extubation and prevent post-extubation respiratory failure is unclear...
January 11, 2017: Cochrane Database of Systematic Reviews
https://www.readbyqxmd.com/read/28066609/association-between-post-sternotomy-tracheostomy-and-deep-sternal-wound-infection-a-retrospective-analysis
#12
Yi-Chin Tsai, Kevin Phan, Andrie Stroebel, Livia Williams, Lisa Nicotra, Lesley Drake, Elizabeth Ryan, James McGree, Peter Tesar, Kiran Shekar
BACKGROUND: Tracheostomy has traditionally been used as a means of facilitated mechanical ventilation in patients requiring respiratory management following cardiac surgery. However in the clinical setting, the advantages of tracheostomy has been questioned by concerns surrounding evidence of its association with increased risk of deep sternal wound infections (DSWI). The present study sought to evaluate retrospectively our experience with post-sternotomy tracheostomy among cardiac surgery patients and association with DSWI...
November 2016: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28040717/predictors-of-the-use-of-specific-critical-care-therapies-in-patients-with-metastatic-cancer
#13
Kah Poh Loh, Ankit Kansagra, Meng-Shiou Shieh, Penelope Pekow, Peter Lindenauer, Mihaela Stefan, Tara Lagu
OBJECTIVE: Understanding which factors are associated with the use of critical care therapies (CCTs) can help with clinical decision-making and goals of care discussion. The goal of this study was to describe the predictors of CCT use (eg, mechanical ventilation, tracheostomy, percutaneous endoscopic gastrostomy tube, total parenteral nutrition, acute use of dialysis) in hospitalized patients with metastatic cancer. METHODS: We used the 2010 California State Inpatient Databases sponsored by the Agency for Healthcare Research and Quality to identify all hospitalizations with a diagnosis of metastatic cancer (patients aged ≥18 years)...
January 2017: Journal of the National Comprehensive Cancer Network: JNCCN
https://www.readbyqxmd.com/read/27984449/operative-treatment-of-rib-fractures-in-flail-chest-injuries-a-meta-analysis-and-cost-effectiveness-analysis
#14
Eric Swart, Joseph Laratta, Gerard Slobogean, Samir Mehta
OBJECTIVES: Flail chest is a common injury sustained by patients who experience high-energy blunt chest trauma and results in severe respiratory compromise because of altered mechanics of respiration. There has been increased interest in operative fixation of these injuries with the intention of restoring the mechanical integrity of the chest wall, and several studies have shown that ventilation requirements and pulmonary complications may be decreased with operative intervention. The purpose of this study was to evaluate fixation of rib fractures in flail chest injuries using cost-effectiveness analysis, supported by systematic review and meta-analysis...
February 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/27976928/post-acute-care-referral-and-inpatient-rehabilitation-admission-criteria-for-persons-with-brain-injury-across-two-canadian-provinces
#15
Bonnie Swaine, Nora Cullen, Frédéric Messier, Mark Bayley, André Lavoie, Shawn Marshall, Marie-Josée Sirois, Alexis Turgeon-Fournier, Julie Lamoureux, Priscilla Lam Wai Shun
PURPOSE: Investigate health care providers' perceptions of referral and admission criteria to brain injury inpatient rehabilitation in two Canadian provinces. METHODS: Health care providers (n = 345) from brain injury programs (13 acute care and 16 rehabilitation facilities) participated in a cross-sectional web-based survey. The participants rated the likelihood of patients (traumatic brain injury and cerebral hypoxia) to be referred/admitted to rehabilitation and the influence of 19 additional factors (e...
December 15, 2016: Disability and Rehabilitation
https://www.readbyqxmd.com/read/27864126/the-use-of-life-sustaining-procedures-in-the-last-month-of-life-is-associated-with-more-depressive-symptoms-in-surviving-spouses
#16
Katherine A Ornstein, Melissa D Aldridge, Melissa M Garrido, Rebecca Gorges, Evan Bollens-Lund, Albert L Siu, Kenneth M Langa, Amy S Kelley
CONTEXT: Family caregivers of individuals with serious illness who undergo intensive life-sustaining medical procedures at the end of life may be at risk of negative consequences including depression. OBJECTIVES: The objective of this study was to determine the association between patients' use of life-sustaining procedures at the end of life and depressive symptoms in their surviving spouses. METHODS: We used data from the Health and Retirement Study, a longitudinal survey of U...
February 2017: Journal of Pain and Symptom Management
https://www.readbyqxmd.com/read/27806150/patterns-of-care-in-hospitalized-vascular-surgery-patients-at-end-of-life
#17
Dale G Wilson, Sheena K Harris, Heidi Peck, Kyle Hart, Enjae Jung, Amir F Azarbal, Erica L Mitchell, Gregory J Landry, Gregory L Moneta
Importance: There is limited literature reporting circumstances surrounding end-of-life care in vascular surgery patients. Objective: To identify factors driving end-of-life decisions in vascular surgery patients. Design, Setting, and Participants: In this cohort study, medical records were reviewed for all vascular surgery patients at a tertiary care university hospital who died during their hospitalization from 2005 to 2014. Main Outcomes and Measures: Patient, family, and hospitalization variables potentially important to influencing end-of-life decisions...
February 1, 2017: JAMA Surgery
https://www.readbyqxmd.com/read/27685758/physician-driven-variation-in-the-care-of-children-with-spinal-muscular-atrophy-type-1
#18
Maryam Oskoui, Pamela Ng, Stephen Liben, David Zielinski
BACKGROUND: Increasing numbers of families are requesting active supportive management for their child with spinal muscular atrophy type 1 (SMA1), leading to longer survival and greater prevalence of affected children. Strong opinions exist among physicians for and against the provision of care measures prolonging life. OBJECTIVE: To describe current practice in the care of SMA1 in Canada, and explore the factors underlying inter-physician variability. METHODS: A cross-sectional survey of Canadian hospital-based pediatric neurologists and pediatric respirologists was performed in 2015...
May 2017: Pediatric Pulmonology
https://www.readbyqxmd.com/read/27676204/time-to-decannulation-and-associated-risk-factors-in-the-post-acute-rehabilitation-of-critically-ill-patients-with-intensive-care-unit-acquired-weakness-a-cohort-study
#19
Simone Thomas, Wolfgang Sauter, Ulrike Starrost, Marcus Pohl, Jan Mehrholz
BACKGROUND: Treatment of critical illness on intensive-care-units (ICU) results often in persistent invasive endotracheal intubation which might delay rehabilitation and increases the risk of mortality. Recent longitudinal studies have described the recovery of critically ill people, but the detailed time course of decannulation in patients with chronic critical illness with ICU- acquired muscle weakness (ICUAW) is not well known. AIM: The aim of our study was therefore to describe the decannulation times and associated risk factors in patients who are chronic critically ill with ICU acquired weakness...
September 27, 2016: European Journal of Physical and Rehabilitation Medicine
https://www.readbyqxmd.com/read/27646881/comparison-of-sedation-strategies-for-critically-ill-patients-a-protocol-for-a-systematic-review-incorporating-network-meta-analyses
#20
Brian Hutton, Lisa D Burry, Salmaan Kanji, Sangeeta Mehta, Melanie Guenette, Claudio M Martin, Dean A Fergusson, Neill K Adhikari, Ingrid Egerod, David Williamson, Sharon Straus, David Moher, E Wesley Ely, Louise Rose
BACKGROUND: Sedatives and analgesics are administered to provide sedation and manage agitation and pain in most critically ill mechanically ventilated patients. Various sedation administration strategies including protocolized sedation and daily sedation interruption are used to mitigate drug pharmacokinetic limitations and minimize oversedation, thereby shortening the duration of mechanical ventilation. At present, it is unclear which strategy is most effective, as few have been directly compared...
2016: Systematic Reviews
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