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procedures in ICU

Diane R M Somlo, Nelson P Repenning, Abeel A Mangi
BACKGROUND: Contemporary reimbursement systems allow hospitals to maintain profitability by offering procedural services. However, increasing procedural volume can be met with structural inefficiencies that in turn cause delays, worse patient outcomes, and increased cost. METHODS: A multidisciplinary team assessed operations and outcomes at the Heart and Vascular Center at Yale New Haven Hospital, a tertiary academic medical center. Data were analyzed retrospectively to assess delays in transferring patients between care environments, patient outcomes, and cost...
June 13, 2018: Annals of Thoracic Surgery
Thomas S Metkus, Alejandro Suarez-Pierre, Todd C Crawford, Jennifer S Lawton, Lee Goeddel, Jeffrey Dodd-O, Monica Mukherjee, Theodore P Abraham, Glenn J Whitman
BACKGROUND: Diastolic dysfunction (DD) identified on echocardiography predicts mortality after cardiac surgery, however the most useful diastolic parameters for assessment and the association of DD with prolonged mechanical ventilation, ICU re-admission, and hospital length of stay are not established. METHODS: We included patients that underwent coronary artery bypass grafting (CABG), aortic valve replacement (AVR) or a combined procedure (CAB-AVR) from 2010 to 2016, and who had preoperative transthoracic echocardiography (TTE) at our institution within 6 months of the operation...
June 15, 2018: Journal of Cardiothoracic Surgery
Adriane da Silva Carvalho, Roger Dos Santos Rosa
OBJECTIVE: to characterize caracterize by Brazilian National Health System (SUS) hospitalizations for bariatric surgeries in residents of the Metropolitan Region of Porto Alegre, RS, Brazil, from 2010 to 2016. METHODS: data analysis of the National Hospital Information System (SIH/SUS); calculation of indicators by sex, age groups, use of Intensive Care Unit and hospitalization expenses; the target population were patients aged 15 years and older. RESULTS: there were 1,249 hospitalizations (178...
June 11, 2018: Epidemiologia e Servicos de Saude: Revista do Sistema Unico de Saude do Brasil
Robert M Rossi, Emily A DeFranco
OBJECTIVE: To quantify the rate of maternal complications associated with a periviable birth in a contemporary population of live births in the state of Ohio. METHODS: We conducted a population-based retrospective cohort study of all live births in Ohio (2006-2015). Maternal, obstetric, and neonatal characteristics were compared between women who delivered in the periviable period (20-25 weeks of gestation) with those who delivered preterm (26-36 weeks of gestation) and at term (greater than 36 weeks of gestation)...
June 6, 2018: Obstetrics and Gynecology
Kumar Vinchurkar, Vishwanath M Pattanshetti, Manoj Togale, Santosh Hazare, Varadraj Gokak
Currently, pancreaticoduodenectomy (PD) is considered a common and feasibly performed surgery for periampullary tumours, but it is still a high-risk surgical procedure with potential morbidity and mortality rates. Previously, it was emphasised for the need of high-volume centres to perform specialised surgery such as PD. The authors have made an attempt to know the relation between low-volume centre and outcomes of PD. The study was conducted in a Tier-II city referral hospital located in Karnataka, India. A total of 37 patients with suspected periampullary neoplasms underwent surgical exploration with curative intent over a period of 4 years, i...
June 2018: Indian Journal of Surgical Oncology
Y Pan, B Jia
Objective: To discuss the experience of early surgical intervention to critical and complex congenital heart diseases (CHD) in neonates. Methods: A retrospective study of clinical records of patients with congenital heart diseases underwent surgical intervention in one single pediatric cardiac center was performed. From January 2009 to December 2017, 841 critical and complex CHD neonates were identified at Department of Cardiovascular Surgery, Children's Hospital of Fudan University, of which 6.5% were premature...
June 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Derek Yecies, Nathaniel Fogel, Michael Edwards, Gerald Grant, Kristen W Yeom, Samuel Cheshier
OBJECT: The need for neurosurgical supervision as well as the general safety and utility of dynamic MRI of the cervical spine in children remains controversial. We present the largest descriptive cohort study of cervical flexion-extension MRIs in a pediatric population to help elucidate the safety and utility of this technique. METHODS: All cervical spine MRIs performed at Lucile Packard Children's Hospital at Stanford from 2009-2015 were retrospectively reviewed...
June 5, 2018: World Neurosurgery
Katarzyna Kotfis, Annachiara Marra, Eugene Wesley Ely
Many patients treated in the intensive care unit (ICU) experience pain, that is a source of suffering and leaves a long-term imprint (chronic pain, post-traumatic stress disorder). Nearly 30% of patients experience pain at rest, the percentage increases to 50% during nursing procedures. Pain in ICU patients can be divided into four categories: continuous ICU treatment-related pain/discomfort, acute illness-related pain, intermittent procedural pain and pre-existing chronic pain present before ICU admission...
June 8, 2018: Anaesthesiology Intensive Therapy
Jan Máca, Matúš Peteja, Petr Reimer, Ondřej Jor, Věra Šeděnková, Lucie Panáčková, Peter Ihnát, Michal Burda, Pavel Ševčík
Background: Major abdominal surgery (MAS) is high-risk intervention usually accompanied by tissue injury leading to a release of signaling danger molecules called alarmins. This study evaluates the surgical injury caused by two fundamental types of gastrointestinal surgical procedures (open surgery and laparoscopy) in relation to the inflammation elicited by alarmins. Patients and methods: Patients undergoing MAS were divided into a mixed laparoscopy group (LPS) and an open surgery group (LPT)...
2018: Therapeutics and Clinical Risk Management
M A Wahab, A Shehta, M Elshoubary, A M Yassen, M Elmorshedi, T Salah, A M Sultan, O Fathy, W R Elsarraf, U Shiha, K Zalata, A N Elghawalby, M Eldesoky, A Monier, R Said, A M Elsabagh, M Ali, A Kandeel, U Abdalla, M Aboelella, M Elsadany, E E Abdel-Khalek, A Marwan, F M ElMorsi, R Adly
BACKGROUND: Living donor liver transplantation (LDLT) is considered a safe alternative to deceased donor liver transplantation (DDLT). In Egypt, DDLT program is still awaited, making LDLT the only hope for patients with end-stage liver disease, mainly due to chronic hepatitis C virus (HCV) infection. The current study is conducted to evaluate our experience of LDLT and discuss the lessons learned from 500 consecutive cases in HCV area. METHODS: We reviewed the data of patients who underwent LDLT at Gastrointestinal Surgery Center, Mansoura University during the period between May 2004 and March 2017...
June 2018: Transplantation Proceedings
Maher El Chaar, Jill Stoltzfus, Maureen Melitics, Leonardo Claros, Ahmad Zeido
INTRODUCTION: The number of bariatric revisional cases has nearly doubled since 2011, and now comprises 13.6% of the total number of cases. The objective of this study is to evaluate the outcomes and safety of the two most common stapling revisional procedures, namely, sleeve and gastric bypass in comparison to primary stapling procedures using the MBSAQIP data registry. METHODS: We reviewed all the sleeve and gastric bypass cases entered between January 1, 2015, and December 31, 2015, in the MBSAQIP data registry...
June 6, 2018: Obesity Surgery
Ermira Biu, Silvana Beraj, Gentian Vyshka, Lordian Nunci, Tatjana Çina
BACKGROUND: Fresh frozen plasma (FFP) is widely used in critically ill patients to correct the deficiency of coagulation factors or increased INR. AIM: In the present study we aimed to evaluate the outcome of the freshly frozen plasma use as prophylaxis in ICU patients before an invasive procedure. METHODS: The study was conducted at Central Anaesthesiology and Intensive Care Service UHCT "Mother Theresa", Tirana. 136 patients were enrolled with coagulopathy with no bleeding before the invasive procedure, from June 2016 to December 2016...
May 20, 2018: Open Access Macedonian Journal of Medical Sciences
Hean Ooi
Objectives: It is not always possible to move critically ill patients to the operating or endoscopy room for a pleuroscopy. Bedside pleuroscopy is indicated for these patients. The aim of this study was to investigate the safety and complications of bedside pleuroscopy in an Intensive Care Unit (ICU). Materials and Methods: The patients who had undergone routine examinations for pleural effusion, with no established diagnosis at the previous admission were included in this analysis...
April 2018: Ci Ji Yi Xue za Zhi, Tzu-chi Medical Journal
Jawad Salman, Gerrit Grannas, Fabio Ius, Wiebke Sommer, Thiery Siemeni, Murat Avsar, Christian Kuehn, Dietmar Boethig, Felix Fleissner, Dmitry Bobylev, Jens Gottlieb, Juergen Klempnauer, Tobias Welte, Axel Haverich, Igor Tudorache, Gregor Warnecke, Frank Lehner
OBJECTIVES: Combined lung and liver transplantation (Lu-LTx) is an established therapy for patients with cystic fibrosis. The initial sequence has primarily been lung first. We changed the sequence to 'liver first' in 2006. The aim of this study is to present outcomes of this procedure. METHODS: The records of combined lung and liver transplant patients treated at our institution between April 1999 and November 2016 were reviewed retrospectively. RESULTS: A total of 27 patients received a combined Lu-LTx at our institute...
June 3, 2018: European Journal of Cardio-thoracic Surgery
Chloe de Grood, Jeanna Parsons Leigh, Sean M Bagshaw, Peter M Dodek, Robert A Fowler, Alan J Forster, Jamie M Boyd, Henry T Stelfox
BACKGROUND: Transfer of patient care from an intensive care unit (ICU) to a hospital ward is often challenging, high risk and inefficient. We assessed patient and provider perspectives on barriers and facilitators to high-quality transfers and recommendations to improve the transfer process. METHODS: We conducted semistructured interviews of participants from a multicentre prospective cohort study of ICU transfers conducted at 10 hospitals across Canada. We purposively sampled 1 patient, 1 family member of a patient, 1 ICU provider, and 1 ward provider at each of the 8 English-speaking sites...
June 4, 2018: CMAJ: Canadian Medical Association Journal, Journal de L'Association Medicale Canadienne
Mario I Perman, Agustín Ciapponi, Juan Va Franco, Cecilia Loudet, Adriana Crivelli, Virginia Garrote, Gastón Perman
BACKGROUND: There are controversies about the amount of calories and the type of nutritional support that should be given to critically-ill people. Several authors advocate the potential benefits of hypocaloric nutrition support, but the evidence is inconclusive. OBJECTIVES: To assess the effects of prescribed hypocaloric nutrition support in comparison with standard nutrition support for critically-ill adults SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL, Cochrane Library), MEDLINE, Embase and LILACS (from inception to 20 June 2017) with a specific strategy for each database...
June 4, 2018: Cochrane Database of Systematic Reviews
Alexa Summe, Laura Foor, Lauren Hoeck, Kristen Campbell, Mark Boyd, Mary Ann Barnes
OBJECTIVES: The purpose of this study was to examine the impact telemedicine in the intensive care unit (ICU) has on the competency, satisfaction, and education of resident physicians. METHODS: Telemedicine in the ICU was implemented in 2014 at a community hospital with 24 family medicine residents. Comfort with the performance of various common procedures; management of major medical diseases in the ICU; and level of comfort, attitudes, and satisfaction in work relationships with various staff members in the ICU were assessed before and 1 year after the telemedicine implementation...
June 2018: Southern Medical Journal
Ingrid Toews, Aneesh Thomas George, John V Peter, Richard Kirubakaran, Luís Eduardo S Fontes, Jabez Paul Barnabas Ezekiel, Joerg J Meerpohl
BACKGROUND: Upper gastrointestinal (GI) bleeding due to stress ulcers contributes to increased morbidity and mortality in people admitted to intensive care units (ICUs). Stress ulceration refers to GI mucosal injury related to the stress of being critically ill. ICU patients with major bleeding as a result of stress ulceration might have mortality rates approaching 48.5% to 65%. However, the incidence of stress-induced GI bleeding in ICUs has decreased, and not all critically ill patients need prophylaxis...
June 4, 2018: Cochrane Database of Systematic Reviews
Verônica Torres Costa E Silva, Renato Antunes Caires, Juliana Silva Bezerra, Elerson C Costalonga, Ana Paula Leandro Oliveira, Fernanda de Oliveira Coelho, Julia T Fukushima, Cilene Muniz Soares, Luciane Oikawa, Ludhmila Abrahão Hajjar, Emmanuel A Burdmann
PURPOSE: This study aimed to evaluate the safety and efficacy of a regional citrate anticoagulation (RCA) protocol for continuous venovenous hemodialysis (CVVHD) in cancer patients with acute kidney injury (AKI) in the intensive care unit (ICU) setting. MATERIAL AND METHODS: One hundred twenty two consecutive ICU cancer patients with AKI treated with citrate-based CVVHD were prospectively evaluated in this prospective observational study. RESULTS: A total of 7198 h of CVVHD therapy (250 filters) were performed...
April 6, 2018: Journal of Critical Care
Camille Hua, Romain Bosc, Emilie Sbidian, Nicolas De Prost, Carolyn Hughes, Patricia Jabre, Olivier Chosidow, Laurence Le Cleach
BACKGROUND: Necrotizing soft tissue infections (NSTIs) are severe and rapidly spreading soft tissue infections of the subcutaneous tissue, fascia, or muscle, which are mostly caused by bacteria. Associated rates of mortality and morbidity are high, with the former estimated at around 23%, and disability, sequelae, and limb loss occurring in 15% of patients. Standard management includes intravenous empiric antimicrobial therapy, early surgical debridement of necrotic tissues, intensive care support, and adjuvant therapies such as intravenous immunoglobulin (IVIG)...
May 31, 2018: Cochrane Database of Systematic Reviews
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