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https://www.readbyqxmd.com/read/28220023/early-palliative-care-reduces-end-of-life-intensive-care-unit-icu-use-but-not-icu-course-in-patients-with-advanced-cancer
#1
Andrew M Romano, Kristine E Gade, Gradon Nielsen, Robert Havard, James H Harrison, Josh Barclay, George J Stukenborg, Paul W Read, Leslie J Blackhall, Patrick M Dillon
BACKGROUND: Early palliative care for advanced cancer patients improves quality of life and survival, but less is known about its effect on intensive care unit (ICU) use at the end of life. This analysis assessed the effect of a comprehensive early palliative care program on ICU use and other outcomes among patients with advanced cancer. PATIENTS AND METHODS: A retrospective cohort of patients with advanced cancer enrolled in an early palliative care program (n = 275) was compared with a concurrent control group of patients receiving standard care (n = 195) during the same time period by using multivariable logistic regression analysis...
February 20, 2017: Oncologist
https://www.readbyqxmd.com/read/28219597/combined-heart-and-kidney-transplantation-a-23-year-experience
#2
M Awad, L S C Czer, F Esmailian, S Jordan, M A De Robertis, J Mirocha, J Patel, D H Chang, M Kittleson, D Ramzy, F Arabia, J S Chung, J L Cohen, A Trento, J A Kobashigawa
BACKGROUND: We report clinical experience with combined heart and kidney transplantation (HKTx) over a 23-year time period. METHODS: From June 1992 to August 2015, we performed 83 combined HKTx procedures at our institution. We compared the more recent cohort of 53 HKTx recipients (group 2, March 2009 to August 2015) with the initial 30 previously reported HKTx recipients (group 1, June 1992 to February 2009). Pre-operative patient characteristics, peri-operative factors, and post-operative outcomes including survival were examined...
March 2017: Transplantation Proceedings
https://www.readbyqxmd.com/read/28203537/robotic-cardiac-surgery-in-brazil
#3
Robinson Poffo, Alisson P Toschi, Renato B Pope, Paola K Montanhesi, Ricardo S Santos, Alexandre Teruya, Dina M Hatanaka, Gabriel F Rusca, Claudio H Fischer, Marcelo C Vieira, Marcia R Makdisse
BACKGROUND: Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci(®) robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. METHODS: From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery...
January 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28198754/relationship-between-adverse-tracheal-intubation-associated-events-and-picu-outcomes
#4
Margaret M Parker, Gabrielle Nuthall, Calvin Brown, Katherine Biagas, Natalie Napolitano, Lee A Polikoff, Dennis Simon, Michael Miksa, Eleanor Gradidge, Jan Hau Lee, Ashwin S Krishna, David Tellez, Geoffrey L Bird, Kyle J Rehder, David A Turner, Michelle Adu-Darko, Sholeen T Nett, Ashley T Derbyshire, Keith Meyer, John Giuliano, Erin B Owen, Janice E Sullivan, Keiko Tarquinio, Pradip Kamat, Ronald C Sanders, Matthew Pinto, G Kris Bysani, Guillaume Emeriaud, Yuki Nagai, Melissa A McCarthy, Karen H Walson, Paula Vanderford, Anthony Lee, Jesse Bain, Peter Skippen, Ryan Breuer, Sarah Tallent, Vinay Nadkarni, Akira Nishisaki
OBJECTIVE: Tracheal intubation in PICUs is a common procedure often associated with adverse events. The aim of this study is to evaluate the association between immediate events such as tracheal intubation associated events or desaturation and ICU outcomes: length of stay, duration of mechanical ventilation, and mortality. STUDY DESIGN: Prospective cohort study with 35 PICUs using a multicenter tracheal intubation quality improvement database (National Emergency Airway Registry for Children: NEAR4KIDS) from January 2013 to June 2015...
February 14, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28197051/benefits-of-and-untoward-events-during-intrahospital-transport-of-pediatric-intensive-care-unit-patients
#5
M M Harish, Suhail Sarwar Siddiqui, Natesh R Prabu, Harish K Chaudhari, Jigeeshu V Divatia, Atul Prabhakar Kulkarni
BACKGROUND AND AIMS: The transport of critically ill patients for procedures or imaging outside the Intensive Care Unit (ICU) is potentially hazardous; hence, the transport process must be organized and efficient. The literature about benefits of and untoward events (UEs) during intrahospital transport of pediatric critically ill patient is scarce. We, therefore, audited the UEs during and benefits of intrahospital transport of critically ill pediatric patients in our ICU. SUBJECTS AND METHODS: Eighty critically ill pediatric (<18 years) cancer patients, transported from the ICU for either diagnostic or therapeutic procedure over a period of 6 months, were included in the study...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28197046/outcome-of-noncardiac-surgical-patients-admitted-to-a-multidisciplinary-intensive-care-unit
#6
Pradeep Kumar, M K Renuka, M S Kalaiselvan, A S Arunkumar
CONTEXT: Surgical procedures carry significant morbidity and mortality depending on the type of surgery and patients. There is a dearth of evidence from India on the outcome of surgical patients admitted to an Intensive Care Unit (ICU). AIMS: We aimed to describe the incidence and risk factors of postoperative complications and mortality in noncardiac surgical patients admitted to the ICU. SETTINGS AND DESIGN: This was a prospective observational study on all perioperative patients admitted to a multidisciplinary ICU for 18 months...
January 2017: Indian Journal of Critical Care Medicine
https://www.readbyqxmd.com/read/28196469/extracorporeal-membrane-oxygenation-for-avian-influenza-a-h7n9-patient-with-acute-respiratory-distress-syndrome-a-case-report-and-short-literature-review
#7
Qi Nie, Ding-Yu Zhang, Wen-Juan Wu, Chao-Lin Huang, Zheng-Yi Ni
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is performed as an acceptable life-saving bridging procedure in patients with severe acute respiratory distress syndrome (ARDS).To patients with avian influenza A (H7N9)-associated ARDS, ECMO could be adopted as a feasible therapeutic solution. We present our successful experience with ECMO utilized in a respiratory failure patient with H7N9 infection. CASE PRESENTATION: A 44 years-old female with H7N9-induced ARDS was admitted to intensive care unit (ICU) and was treated with veno-venous ECMO for six days, antiviral therapy, prolonged corticosteroid infusion and other therapies...
February 14, 2017: BMC Pulmonary Medicine
https://www.readbyqxmd.com/read/28195969/acute-mesenteric-ischemia-among-postcardiac-surgery-patients-presenting-with-multiple-organ-failure
#8
Alexis Guillaume, Sébastien Pili-Floury, Sidney Chocron, Eric Delabrousse, Bénédicte De Parseval, Stephane Koch, Emmanuel Samain, Gilles Capellier, Gaël Piton
BACKGROUND: Acute mesenteric ischemia (AMI) is a rare but severe complication after cardiac surgery. However, AMI is likely to be more frequent in the subgroup of patients presenting with multiple organ failure after a cardiac surgery. The primary objective of this study was to identify AMI risk factors among patients requiring intensive care unit (ICU) admission after cardiac surgery. METHODS: Retrospective observational study of all the patients requiring admission to two ICUs in a large university hospital after a cardiac surgery procedure...
March 2017: Shock
https://www.readbyqxmd.com/read/28195682/access-to-palliative-care-services-during-the-terminal-hospital-episode-reduces-intervention-rates-and-hospital-costs-a-database-study-of-19707-elderly-patients-dying-in-hospital-2011-2015
#9
Anthony W Ireland
BACKGROUND: The burden of healthcare costs for persons approaching death is of increasing concern. This study examines cost savings associated with access to palliative care (PC) during the hospital episode ending in death for a large sample of elderly patients. METHODS: A retrospective cohort study of administrative data for Department of Veterans' Affairs clients identified patient demographics, hospital characteristics, utilisation data and component costs for the hospital terminal episode for patients aged ≥ 70 years who died in hospital between July 2011 and June 2015...
February 14, 2017: Internal Medicine Journal
https://www.readbyqxmd.com/read/28194479/-airway-management-in-intensive-care-units-in-rhineland-palatinate-evolution-over-five-years
#10
T Piepho, T Härer, L Ellermann, R R Noppens
BACKGROUND: Securing the airway in severely ill patients is associated with a high rate of complications. So far, no information exists about the equipment readily available for airway management in German intensive care units (ICUs). It is also unknown if the range of material has improved over time. OBJECTIVES: In the present trial the availability of equipment for airway management in ICUs in Rhineland-Palatinate was evaluated at two different times. MATERIALS AND METHODS: Using a structured questionnaire, all ICUs in the state were contacted in the years 2010 and 2015...
February 13, 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/28190429/the-scope-of-neurology-of-critical-illness
#11
E F M Wijdicks
Critical illness increases the probability of a neurologic complication. There are many reasons to consult a neurologist in a critically ill patient and most often it is altered alertness with no intuitive plausible explanation. Other common clinical neurologic problems facing the intensive care specialist and consulting neurologist in everyday decisions are coma following prolonged cardiovascular surgery, newly perceived motor asymmetry, seizures or other abnormal movements, and generalized muscle weakness...
2017: Handbook of Clinical Neurology
https://www.readbyqxmd.com/read/28186429/financial-impact-of-the-robotic-approach-in-liver-surgery-a-comparative-study-of-clinical-outcomes-and-costs-between-the-robotic-and-open-technique-in-a-single-institution
#12
Despoina Daskalaki, Raquel Gonzalez-Heredia, Marc Brown, Francesco M Bianco, Ivo Tzvetanov, Myriam Davis, Jihun Kim, Enrico Benedetti, Pier C Giulianotti
BACKGROUND: One of the perceived major drawbacks of minimally invasive techniques has always been its cost. This is especially true for the robotic approach and is one of the main reasons that has prevented its wider acceptance among hospitals and surgeons. The aim of our study was to evaluate the clinical outcomes and economic impact of robotic and open liver surgery in a single institution. METHODS: Sixty-eight robotic and 55 open hepatectomies were performed at our institution between January 1, 2009 and December 31, 2013...
February 10, 2017: Journal of Laparoendoscopic & Advanced Surgical Techniques. Part A
https://www.readbyqxmd.com/read/28185721/approaches-and-adjuncts-used-by-physiotherapists-when-suctioning-adult-patients-who-are-intubated-and-ventilated-in-intensive-care-units-in-australia-and-new-zealand-a-cross-sectional-survey
#13
Charissa S L Tan, Meg Harrold, Kylie Hill
BACKGROUND: Suctioning is an integral component of care for patients who are intubated and ventilated in an intensive care unit (ICU). There appears to be no published data of physiotherapy suctioning practices in Australia or New Zealand. OBJECTIVE: To describe suctioning practices and the factors which have shaped these practices, of experienced physiotherapists working with adults who are intubated and ventilated in an ICU across Australia and New Zealand. Areas of investigation focused on: (i) suctioning approach (i...
February 6, 2017: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/28179009/benefits-of-ultra-fast-track-anesthesia-in-left-ventricular-assist-device-implantation-a-retrospective-propensity-score-matched-cohort-study-of-a-four-year-single-center-experience
#14
Rashad Zayat, Ares K Menon, Andreas Goetzenich, Gereon Schaelte, Ruediger Autschbach, Christian Stoppe, Tim-Philipp Simon, Lachmandath Tewarie, Ajay Moza
BACKGROUND: The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications...
February 8, 2017: Journal of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28173939/outcome-and-management-of-endoscopic-retrograde-cholangiopancreatography-perforations-a-community-perspective
#15
Mallory S Bray, Andrew J Borgert, Milan E Folkers, Shanu N Kothari
BACKGROUND: Endoscopic retrograde cholangiopancreatography (ERCP) carries a small but significant risk of perforation. Recent data suggest that select patients can be managed non-operatively. We sought to evaluate the management of ERCP perforations at our community medical center. METHODS: ERCPs performed from 2004 to 2015 were reviewed. RESULTS: Twenty-one of 2423 patients who underwent ERCP had a perforation (0.9%). ERCP procedures included balloon sweep with/without sphincterotomy and pancreatic duct stent (71%), common bile duct brushing (10%), and pancreatic duct stenting (5%)...
January 30, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28167226/outcomes-icu-utilization-and-length-of-stay-in-chronically-ill-black-and-white-children-on-medicaid-hospitalized-for-surgery
#16
Jeffrey H Silber, Paul R Rosenbaum, Shawna Calhoun, Joseph G Reiter, Alexander S Hill, Orit Even-Shoshan, William J Greeley
BACKGROUND: With increasing Medicaid coverage, it has become especially important to determine if racial differences exist within the Medicaid system. We asked if disparities exist in hospital practice and patient outcomes between matched black and white Medicaid children with chronic conditions undergoing surgery. STUDY DESIGN: A matched cohort study, matching 6,398 pairs within states on detailed patient characteristics, using data from 25 states contributing adequate Medicaid Analytic eXtract (MAX) claims for dmissions of children with chronic conditions undergoing the same surgical procedures between January 1, 2009 and November 30, 2010 for ages 1-18 years...
February 3, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28159650/impact-of-the-new-kidney-allocation-system-on-perioperative-outcomes-and-costs-in-kidney-transplantation
#17
David J Taber, Derek DuBay, John W McGillicuddy, Satish Nadig, Charles F Bratton, Kenneth D Chavin, Prabhakar K Baliga
BACKGROUND: In December 2014, a new kidney allocation system (KAS) was implemented nationwide with the goal of improving longevity matching, increasing access to sensitized patients, and improving racial/ethnic disparities. STUDY DESIGN: National cohort study of US kidney transplantation programs, analyzing hospital-level outcomes (October 2012 to June 2016) using University HealthSystem Consortium data. In-hospital outcomes and costs were analyzed for trends over time using interrupted time series analysis with segmented regression...
January 31, 2017: Journal of the American College of Surgeons
https://www.readbyqxmd.com/read/28156609/icu-deaths-in-patients-with-advanced-cancer-criteria-to-decrease-potentially-inappropriate-admissions-and-analysis-of-advance-planning-discussions
#18
Alva B Weir
: 47 Background: A significant number of advanced cancer admissions to intensive care unit (ICU) are inappropriate, as they do not prolonged survival. No clear consensus criteria for reasonable admissions of advanced cancer patients have been developed. METHODS: We established four criteria for ICU admissions in advanced cancer patients: post procedure complication, recent cancer diagnosis, good performance status and life expectancy of > 6 months. We reviewed charts of all patients who died in the ICU at a university-affiliated hospital between 2005-2010...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28156590/healthcare-utilization-among-cancer-patients-prior-to-hospice
#19
Richard F Riedel, Christel N Rushing, Anthony N Galanos
: 135 Background: The integration of palliative medicine in oncologic care has become increasingly recognized and supported. We have previously reported improved health system and quality of care outcomes for solid tumor patients admitted to our novel, fully-integrated palliative care (PC) and medical oncology inpatient service at Duke University Medical Center (DUMC). In this study, we explored healthcare utilization in patients specifically discharged to hospice pre- and post-PC integration...
October 9, 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
https://www.readbyqxmd.com/read/28152750/impact-of-a-best-practice-alert-on-transfusion-practices-for-solid-tumor-oncology-patients
#20
Kelley Wachsberg, Charlotta Weaver, Lyndsey Dombrowski, Madeleine Ma, Jungwha Lee, Kevin O'Leary
: 57 Background: Recent evidence supports a restrictive transfusion strategy in the majority of hospitalized patients, though transfusion practices for oncology patients remain highly variable. We evaluated whether use of a best practice alert for solid tumor oncology inpatients would result in more restrictive transfusion practices and impact patient outcomes. METHODS: We conducted a retrospective, historical control analysis at a large academic hospital in Chicago, IL...
March 2016: Journal of Clinical Oncology: Official Journal of the American Society of Clinical Oncology
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