Acute/Critical Care Surgery

Pierre Demaret, Oliver Karam, Julien Labreuche, Fabrizio Chiusolo, Juan Mayordomo Colunga, Simon Erickson, Marianne E Nellis, Marie-Hélène Perez, Samiran Ray, Marisa Tucci, Ariane Willems, Alain Duhamel, Frédéric Lebrun, Isabelle Loeckx, André Mulder, Stéphane Leteurtre
OBJECTIVE: To describe the management of anemia at PICU discharge by pediatric intensivists. DESIGN: Self-administered, online, scenario-based survey. SETTING: PICUs in Australia/New Zealand, Europe, and North America. SUBJECTS: Pediatric intensivists. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Respondents were asked to report their decisions regarding RBC transfusions, iron, and erythropoietin prescription to children ready to be discharged from PICU, who had been admitted for hemorrhagic shock, cardiac surgery, craniofacial surgery, and polytrauma...
March 25, 2020: Pediatric Critical Care Medicine
Chad G. Ball, Patrick Murphy, Kevin Verhoeff, Omar Albusadi, Matthew Patterson, Sandy Widder, S. Morad Hameed, Neil Parry, Kelly Vogt, John B. Kortbeek, Anthony R. MacLean, Paul T. Engels, Timothy Rice, Rahima Nenshi, Kosar Khwaja, Samuel Minor
Background: Acute care surgery (ACS) and emergency general surgery (EGS) services must provide timely care and intervention for patients who have some of the most challenging needs. Patients treated by ACS services are often critically ill and have both substantial comorbidities and poor physiologic reserve. Despite the widespread implemention of ACS/EGS services across North America, the true postoperative morbidity rates remain largely unknown. Methods: In this prospective study, inpatients at 8 high-volume ACS/EGS centres in geographically diverse locations in Canada who underwent operative interventions were followed for 30 days or until they were discharged...
March 27, 2020: Canadian Journal of Surgery. Journal Canadien de Chirurgie
Heather Torbic, Seth R Bauer, Michael Militello, Sarah Welch, Chiedozie Udeh, Steven Richardson
Background: Albumin 25% has been studied and has demonstrated benefit in a limited number of patient populations. The use of albumin 25% is associated with higher costs compared with crystalloid therapy. The aim of this study was to describe the prescribing practices of albumin 25% at a tertiary-care medical center and identify opportunities for restriction criteria related to its use to help generate cost savings. Methods: This evaluation was a retrospective, noninterventional, descriptive study of albumin 25% use between June 2015 and February 2016...
April 2020: Hospital Pharmacy
Kivanc Atesok, Efstathios Papavassiliou, Michael J Heffernan, Danny Tunmire, Irina Sitnikov, Nobuhiro Tanaka, Sakthivel Rajaram, Jason Pittman, Ziya L Gokaslan, Alexander Vaccaro, Steven Theiss
Study Design: Narrative review. Objectives: Postoperative surgical site infections (SSIs) are among the most common acute complications in spine surgery and have a devastating impact on outcomes. They can lead to increased morbidity and mortality as well as greater economic burden. Hence, preventive strategies to reduce the rate of SSIs after spine surgery have become vitally important. The purpose of this article was to summarize and critically analyze the available evidence related to current strategies in the prevention of SSIs after spine surgery...
April 2020: Global Spine Journal
Rajesh Chawla, Subhal B Dixit, Kapil Gangadhar Zirpe, Dhruva Chaudhry, G C Khilnani, Yatin Mehta, Khalid Ismail Khatib, Bharat G Jagiasi, Gunjan Chanchalani, Rajesh C Mishra, Srinivas Samavedam, Deepak Govil, Sachin Gupta, Shirish Prayag, Suresh Ramasubban, Jayesh Dobariya, Vikas Marwah, Inder Sehgal, Sameer Arvind Jog, Atul Prabhakar Kulkarni
A. ACUTE HYPERCAPNIC RESPIRATORY FAILURE A1. Acute Exacerbation of COPD: Recommendations: NIV should be used in management of acute exacerbation of COPD in patients with acute or acute-on-chronic respiratory acidosis (pH = 7.25-7.35). (1A) NIV should be attempted in patients with acute exacerbation of COPD (pH <7.25 & PaCO2 ≥ 45) before initiating invasive mechanical ventilation (IMV) except in patients requiring immediate intubation. (2A). Lower the pH higher the chance of failure of NIV. (2B) NIV should not to be used routinely in normo- or mildly hyper-capneic patients with acute exacerbation of COPD, without acidosis (pH > 7...
January 2020: Indian Journal of Critical Care Medicine
Simon Clariot, Ophélie Constant, Raphaël Lepeule, Vincent Fihman, Keyvan Razazi, Fabrice Cook, Arié Attias, Jean-Claude Merle, François Hemery, Eric Levesque, Jean-Winoc Decousser, Olivier Langeron, Nicolas Mongardon
PURPOSE: Corynebacterium spp. (C. spp.) is commonly considered as a contaminant in respiratory specimens. No study has ever focused on its clinical relevance in the lower respiratory tract of patients admitted to the intensive care unit (ICU) and requiring mechanical ventilation. The aims were to describe the characteristics of ICU patients with a C. spp. positive deep respiratory specimen, to investigate the impact of C. spp. on the occurrence of pneumonia, and to evaluate the outcomes of these pneumonia...
March 17, 2020: Infection
Ram Kalpatthi, Joseph E Kiss
Hemostatic abnormalities are common among critically ill patients and are associated with a high risk of bleeding. The abnormalities range from isolated thrombocytopenia or prolongation of global coagulation assays to complex disease states, such as thrombotic microangiopathic syndromes, and can be associated with a wide range of conditions, including trauma, surgery, acute disease processes, cardiopulmonary bypass, and exposure to drugs and blood products. Prompt identification of underlying causes is important because treatment strategies vary...
April 2020: Critical Care Clinics
Marine Flechet, Fabian Güiza, Isabelle Scharlaeken, Dirk Vlasselaers, Lars Desmet, Greet Van den Berghe, Geert Meyfroidt
Cerebral oximetry by near-infrared spectroscopy is used frequently in critically ill children but guidelines on its use for decision making in the PICU are lacking. We investigated cerebral near-infrared spectroscopy oximetry in its ability to predict severe acute kidney injury after pediatric cardiac surgery and assessed its additional predictive value to routinely collected data. Design: Prospective observational study. The cerebral oximeter was blinded to clinicians. Setting: Twelve-bed tertiary PICU, University Hospitals Leuven, Belgium, between October 2012 and November 2015...
December 2019: Critical care explorations
Erin Hessey, Sylvie Perreault, Louise Roy, Marc Dorais, Susan Samuel, Véronique Phan, Jean-Philippe Lafrance, Michael Zappitelli
BACKGROUND: To develop a pediatric-specific hypertension algorithm using administrative data and use it to evaluate the association between acute kidney injury (AKI) in the intensive care unit (ICU) and hypertension diagnosis 5 years post-discharge. METHODS: Two-center retrospective cohort study of children (≤ 18 years old) admitted to the pediatric ICU in Montreal, Canada, between 2003 and 2005 and followed until 2010. Patients with a valid healthcare number and without end-stage renal disease were included...
March 11, 2020: Pediatric Nephrology: Journal of the International Pediatric Nephrology Association
Luis G Fernández, Marc R Matthews, Lawton Seal
INTRODUCTION: Management of the open abdomen (OA) has rapidly evolved over the last several decades due to the improved understanding of the underlying pathophysiology of patients with an OA, adoption of damage control surgery, and the use of temporary abdominal closure (TAC) techniques for this patient population. The TAC utilizing negative pressure has been successful for managing patients with an OA with improved time to closure. Recent studies have started to examine the use of TAC in conjunction with negative pressure wound therapy with instillation and dwell time (NPWTi-d) for the management of the OA...
January 23, 2020: Wounds: a Compendium of Clinical Research and Practice
Sergio Aguilera, Leonidas Quintana, Tariq Khan, Roxanna Garcia, Haitham Shoman, Luke Caddell, Rifat Latifi, Kee B Park, Patricia Garcia, Robert Dempsey, Jeffrey V Rosenfeld, Corey Scurlock, Nigel Crisp, Lubna Samad, Montray Smith, Laura Lippa, Rashid Jooma, Russell J Andrews
Trauma/stroke centres optimise acute 24/7/365 surgical/critical care in high-income countries (HICs). Concepts from low-income and middle-income countries (LMICs) offer additional cost-effective healthcare strategies for limited-resource settings when combined with the trauma/stroke centre concept. Mass casualty centres (MCCs) integrate resources for both routine and emergency care-from prevention to acute care to rehabilitation. Integration of the various healthcare systems-governmental, non-governmental and military-is key to avoid both duplication and gaps...
2020: BMJ Global Health
Stephen A Hart, Ronn E Tanel, Alaina K Kipps, Amanda K Hoerst, Margaret A Graupe, Steven C Cassidy, Anthony M Hlavacek, Martha L Clabby, Lauren B Bush, Wenying Zhang, Mousumi M Banerjee, Sara K Pasquali, Michael Gaies, Nicolas Madsen
BACKGROUND: Postoperative length of stay (LOS) is an important quality metric and is known to vary widely across hospitals following congenital heart surgery. Whether this variability is explained by factors associated with the intensive care unit (ICU) or acute care unit (ACU) remains unclear. We evaluated the relationship between ICU and ACU LOS and the impact of ACU characteristics on post-operative LOS. METHODS: Congenital heart surgery hospitalizations within the Pediatric Cardiac Critical Care Consortium (PC4 ) registry (8/2014-2/2018) were included...
February 27, 2020: Annals of Thoracic Surgery
Jennifer M Gurney, Paul E Loos, Mayumi Prins, David W Van Wyck, Randall R McCafferty, Donald W Marion
Increased resource constraints secondary to a smaller medical footprint, prolonged evacuation times, or overwhelming casualty volumes all increase the challenges of effective management of traumatic brain injury (TBI) in the austere environment. Prehospital providers are responsible for the battlefield recognition and initial management of TBI. As such, targeted education is critical to efficient injury recognition, promoting both provider readiness and improved patient outcomes. When austere conditions limit or prevent definitive treatment, a comprehensive understanding of TBI pathophysiology can help inform acute care and enhance prevention of secondary brain injury...
January 7, 2020: Military Medicine
Oscar Jim Michael Coppes, R Jason Yong, Alan D Kaye, Richard D Urman
PURPOSE OF REVIEW: The purpose of the present investigation is to provide a comprehensive review of both patient and procedure specific predictors of acute postoperative pain. RECENT FINDINGS: As the global number of surgeries continues to increase, as well as evidence of worse patient outcomes in those who suffer from poorly controlled postoperative pain, it is becoming more critical for perioperative physicians to have a deep understanding of the risks which might lead to increased pain in the immediate postoperative settings...
February 18, 2020: Current Pain and Headache Reports
Marek Czosnyka, Peter Hutchinson, Peter Smielewski
PURPOSE OF REVIEW: This review summarizes the physiological basis of autoregulation-oriented therapy in critically ill patients, with a particular emphasis on individual targets based on parameters that describe autoregulation of cerebral blood flow. RECENT FINDINGS: The concepts of optimal cerebral perfusion (CPPopt) and arterial pressures (ABPopt), which both take advantage of continuous measures of cerebral autoregulation, recently have been introduced into clinical practice...
April 2020: Current Opinion in Critical Care
Keita Saito, Shigehiko Uchino, Tomoko Fujii, Shinjiro Saito, Masanori Takinami, Shoichi Uezono
BACKGROUND: Acute kidney injury (AKI) is a major comorbidity in critically ill patients. Low-dose atrial natriuretic peptide (ANP) has been shown to effectively prevent acute kidney injury (AKI), especially in cardiovascular surgery patients. However, its treatment effects for AKI in critically ill patients are unclear. METHODS: This single-center, retrospective, observational study included patients with AKI diagnosed within 7 days after intensive care unit (ICU) admission during the period January 2010 to December 2017...
January 30, 2020: BMC Nephrology
Salim S Hayek, David E Leaf, Ayman Samman Tahhan, Mohamad Raad, Shreyak Sharma, Sushrut S Waikar, Sanja Sever, Alex Camacho, Xuexiang Wang, Ranadheer R Dande, Nasrien E Ibrahim, Rebecca M Baron, Mehmet M Altintas, Changli Wei, David Sheikh-Hamad, Jenny S-C Pan, Michael W Holliday, James L Januzzi, Steven D Weisbord, Arshed A Quyyumi, Jochen Reiser
BACKGROUND: Acute kidney injury is common, with a major effect on morbidity and health care utilization. Soluble urokinase plasminogen activator receptor (suPAR) is a signaling glycoprotein thought to be involved in the pathogenesis of kidney disease. We investigated whether a high level of suPAR predisposed patients to acute kidney injury in multiple clinical contexts, and we used experimental models to identify mechanisms by which suPAR acts and to assess it as a therapeutic target...
January 30, 2020: New England Journal of Medicine
J O'Connell, S Keohane, A McGreal-Bellone, P McDonagh, S Naimimohasses, U Kennedy, C Dunne, K Hartery, J Larkin, F MacCarthy, J Meaney, S McKiernan, S Norris, D O'Toole, D Kevans
BACKGROUND AND AIMS: A significant proportion of patients presenting to the Emergency Department with gastrointestinal symptoms that result in cross-sectional imaging receive a radiological diagnosis of colitis. We aimed to review the characteristics, outcomes, and final diagnoses of new emergency department presentations with colitis diagnosed on cross-sectional imaging. METHODS: A radiology database was interrogated to identify patients admitted from the Emergency Department of St James's Hospital whose cross-sectional imaging demonstrated colitis...
January 10, 2020: Irish Journal of Medical Science
Davood Rezazadeh, Roghayeh Anvari Aliabad, Amir Hossein Norooznezhad
Cesarean delivery (CD) has been known as the most common surgery in the United States. This procedure might associate with different complications, the most important of which is surgical site infection (SSI). Among the major SSI categories, incisional type is more common than the others. Regardless of its notable expense, the use of prophylactic wound healing technics (such as negative pressure therapy) has been advised for the patients with high SSI risk. Herein, use of patient's own human amniotic membrane in an autologous form (as a free of charge treatment) would be suggested for prevention of SSI in CD wounds...
December 17, 2019: Medical Hypotheses
Robert Michael O'Connell, Sami Abd Elwahab, Kenneth Mealy
INTRODUCTION: Acute appendicitis is a common surgical emergency in children. The majority of appendicectomies in children are performed by general surgeons, rather than specialist paediatric surgeons. AIM: To assess the impact of hospital specialization, hospital volume, and surgeon volume on outcomes for children undergoing appendicectomy in Ireland. METHODS: NQAIS (National Quality Assurance and Improvement System) data for all appendicectomies performed on children in Ireland between January 2014 and November 2017 was examined...
January 2, 2020: Irish Journal of Medical Science
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