Acute/Critical Care Surgery

Myung Hun Jang, Myung-Jun Shin, Yong Beom Shin
Some patients admitted to the intensive care unit (ICU) because of an acute illness, complicated surgery, or multiple traumas develop muscle weakness affecting the limbs and respiratory muscles during acute care in the ICU. This condition is referred to as ICU-acquired weakness (ICUAW), and can be evoked by critical illness polyneuropathy (CIP), critical illness myopathy (CIM), or critical illness polyneuromyopathy (CIPNM). ICUAW is diagnosed using the Medical Research Council (MRC) sum score based on bedside manual muscle testing in cooperative patients...
February 2019: Acute and critical care
Hiromasa Irie, Hiroshi Okamoto, Shigehiko Uchino, Hideki Endo, Masatoshi Uchida, Tatsuya Kawasaki, Junji Kumasawa, Takashi Tagami, Hidenobu Shigemitsu, Eiji Hashiba, Yoshitaka Aoki, Hiroshi Kurosawa, Junji Hatakeyama, Nao Ichihara, Satoru Hashimoto, Masaji Nishimura
PURPOSE: The Japanese Intensive care PAtient Database (JIPAD) was established to construct a high-quality Japanese intensive care unit (ICU) database. MATERIALS AND METHODS: A data collection structure for consecutive ICU admissions in adults (≥16 years) and children (≤15 years) has been established in Japan since 2014. We herein report a current summary of the data in JIPAD for admissions between April 2015 and March 2017. RESULTS: There were 21,617 ICU admissions from 21 ICUs (217 beds) including 8416 (38...
October 25, 2019: Journal of Critical Care
Shreyus S Kulkarni, Alexandra Briggs, Olivia A Sacks, Matthew R Rosengart, Douglas B White, Amber E Barnato, Andrew B Peitzman, Deepika Mohan
BACKGROUND: 30% of elderly patients who require emergency general surgery (EGS) die in the year after the operation. Preoperative discussions can determine whether patients receive preference-sensitive care. Theoretically, surgeons frame their conversations after systematically assessing the risks and benefits of management options based on the clinical characteristics of each case. However, little is known about how surgeons actually deliberate about those options. OBJECTIVE: To identify variables that influence surgeons' assessment of management options for critically-ill EGS patients...
November 8, 2019: Annals of Surgery
Dennis Y Kim, Matt Lissauer, Niels Martin, Karen Brasel
BACKGROUND: There has been an unprecedented increase in critical care research recently and there is a need for an organized and systematic approach to surgical critical care research planning. The purpose of this paper was to establish a surgical critical care research agenda via a systematic review of the literature and needs assessment. METHODS: A systematic review of the literature was performed to identify high-impact critical care articles since 1999 on the basis of citation data...
October 31, 2019: Journal of Trauma and Acute Care Surgery
Christopher R Marcellino, Avital Perry, Christopher S Graffeo
Ecthyma gangrenosum is a rare physical exam finding pathognomonic for severe bacteremia and typically associated with pseudomonal sepsis. The characteristic skin lesions appear as ring-shaped hemorrhagic pustules that evolve into necrotic ulcers. In the present case, a 62-year-old woman with a pulmonary adenocarcinoma treated with surgical resection and adjuvant chemotherapy developed three symptomatic brain masses. The lesions were presumed metastatic and initially treated with stereotactic radiosurgery; however, follow-up imaging identified treatment failure of a cerebellar lesion, and the patient was subsequently taken to surgery on an elective basis for suboccipital craniotomy and tumor resection...
August 31, 2019: Curēus
Sara Ottolenghi, Giovanni Sabbatini, Andrea Brizzolari, Michele Samaja, Davide Chiumello
Oxygen administration is particularly relevant in patients undergoing surgery under general anesthesia and in those who suffer from acute or critical illness. Nevertheless, excess O2, or hyperoxia, is also known to be harmful. Toxicity arises from the enhanced formation of Reactive Oxygen Species (ROS) that, exceeding the antioxidant defense, may generate oxidative stress. Oxidative stress markers are used to quantify ROS toxicity in clinical and non-clinical settings and represent a promising tool to assess the optimal FiO2 in anesthesia and critical care setting...
October 28, 2019: Minerva Anestesiologica
Brian W Johnston, Ruaraidh Hill, Rui Duarte, Chung Shen Chean, Danny F McAuley, Bronagh Blackwood, Nathan Pace, Ingeborg D Welters
BACKGROUND: New onset atrial fibrillation is the most commonly encountered arrhythmia in critically unwell patients with a reported incidence of 4% to 29%. The occurrence of new onset atrial fibrillation may precipitate acute heart failure and lead to thromboembolic complications as well as being associated with increased in-hospital and in intensive care unit (ICU) mortality. Despite being common, much of our current knowledge regarding the treatment of new onset atrial fibrillation comes from patients with chronic atrial fibrillation or post cardiac surgery...
October 28, 2019: Systematic Reviews
Binila Chacko, John Victor Peter, Kandasamy Subramani
There has seen an increase in anticoagulant consumption worldwide over the past few decades. With this widespread utilization of anticoagulants, clinicians are increasingly likely to encounter situations where anticoagulants would need to be withheld. This includes emergency and elective procedures or surgeries as well as major or minor bleeding as a direct result of over anticoagulation or consequent to other intercurrent illnesses such as sepsis or trauma with multiorgan failure, where the anticoagulant may contribute to coagulation abnormalities...
September 2019: Indian Journal of Critical Care Medicine
Lucia Chinnappa-Quinn, Michael Bennett, Steve Robert Makkar, Nicole A Kochan, John D Crawford, Perminder S Sachdev
PURPOSE OF REVIEW: Cognitive decline is frequently reported after hospitalisation in the contexts of surgery, delirium and critical care. The question not adequately addressed is whether all types of acute hospitalisations increase the risk of cognitive decline. As acute hospitalisations are common in the elderly, who are also vulnerable to cognitive decline, this possible association is of significant concern. RECENT FINDINGS: This review summarises cognitive outcomes from recent observational studies investigating acute hospitalisation (emergent and elective) in older age adults...
October 24, 2019: Current Opinion in Psychiatry
Elizabeth Carpenter, Zayan Mahmooth, David Elwood, Edward Lin, Marianne Foster, Carla Haack, Jyotirmay Sharma, Ankit Patel, Juan Sarmiento, John Sweeney, Wendy Greene
No abstract text is available yet for this article.
September 1, 2019: American Surgeon
Miguel L Varela, Pedro Teixeira, Marta Ponte, Daniel Caeiro, Adelaide Dias, Alberto Rodrigues, Pedro Braga
Introduction Balloon aortic valvuloplasty (BAV), introduced in 1986, quickly lost its wide adoption due to the high incidence of restenosis after the procedure and due to improved skills in transcatheter aortic valve implantation (TAVI). It has seen a re-emergence in the last few years as bailout therapy in critical care patients presenting with cardiogenic shock (CS) and severe aortic stenosis (AS), who are temporarily unable to tolerate such a procedure as TAVI or surgery for valve replacement. Methods We did a retrospective analysis of every BAV performed between January 1, 2008, and November 11, 2018, in our hospital and identified those admitted to the cardiac intensive care unit (CICU) due to cardiogenic shock with severe aortic stenosis, as defined in the European Society of Cardiology Guidelines...
August 17, 2019: Curēus
Nicholas E Ingraham, Christopher J Tignanelli, Jeremiah Menk, Jeffrey G Chipman
Background: Chronic critical illness (CCI) is a new and increasing entity that accounts for substantial cost despite its low incidence. We hypothesized that patients with end-stage liver failure undergoing liver transplant would be at high risk for developing CCI. With limited liver donors it is essential to understand pre- and peritransplant predictors of CCI. Methods: To accomplish this we performed a retrospective cohort study at a large academic transplant center of all adult liver transplant patients from 2011 to 2017...
October 16, 2019: Surgical Infections
Tetsuya Nakazato, Bailey Su, Stephanie Novak, Shanley B Deal, Kristine Kuchta, Michael Ujiki
INTRODUCTION: We hypothesized that practicing surgeons would successfully achieve a better and more frequent Critical View of Safety (CVS) during laparoscopic cholecystectomy (LC) after participation in a structured Safe CVS Curriculum. METHODS: All surgeons performing LC at a regional health system had four LC cases recorded: twice before and twice after a curriculum focused on the CVS, which was led by a member of the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Safe LC Task Force...
October 11, 2019: Surgical Endoscopy
Jay Giri, Akhilesh K Sista, Ido Weinberg, Clive Kearon, Dharam J Kumbhani, Nimesh D Desai, Gregory Piazza, Mark T Gladwin, Saurav Chatterjee, Taisei Kobayashi, Christopher Kabrhel, Geoffrey D Barnes
Pulmonary embolism (PE) represents the third leading cause of cardiovascular mortality. The technological landscape for management of acute intermediate- and high-risk PE is rapidly evolving. Two interventional devices using pharmacomechanical means to recanalize the pulmonary arteries have recently been cleared by the US Food and Drug Administration for marketing, and several others are in various stages of development. The purpose of this document is to clarify the current state of endovascular interventional therapy for acute PE and to provide considerations for evidence development for new devices that will define which patients with PE would derive the greatest net benefit from their use in various clinical settings...
October 4, 2019: Circulation
Kedar G Sharbidre, Samuel J Galgano, Desiree E Morgan
Post-traumatic pancreatitis can develop secondary to blunt or penetrating abdominal trauma, post-endoscopic retrograde cholangiopancreatography, or following pancreatic surgery. Clinical findings are often nonspecific, and imaging findings can be subtle on presentation. Early diagnosis of pancreatic duct injury is critical and informs management strategy; imaging plays important role in diagnosis of ductal injury and identification of delayed complications such as retroperitoneal fluid collections, pancreatic fistula, ductal strictures, and recurrent pancreatitis...
October 1, 2019: Abdominal Radiology
Oliver Grottke, Shuba Mallaiah, Keyvan Karkouti, Fuat Saner, Thorsten Haas
Adequate plasma levels of fibrinogen are essential for clot formation, and in severe bleeding, fibrinogen reaches a critically low plasma concentration earlier than other coagulation factors. Although the critical minimum concentration of fibrinogen to maintain hemostasis is a matter of debate, many patients with coagulopathic bleeding require fibrinogen supplementation. Among the treatment options for fibrinogen supplementation, fibrinogen concentrate may be viewed by some as preferable to fresh frozen plasma or cryoprecipitate...
October 1, 2019: Seminars in Thrombosis and Hemostasis
Nikolay Bugaev, Bishwajit Bhattacharya, William C Chiu, John J Como, Michael W Cripps, Paula Ferrada, Rondi B Gelbard, Stephen Gondek, George Kasotakis, Dennis Kim, Caleb Mentzer, Bryce R H Robinson, Edgardo S Salcedo, D Dante Yeh
BACKGROUND: Acute noninfectious diarrhea is a common phenomenon in intensive care unit patients. Multiple treatments are suggested but the most effective management is unknown. A working group of the Eastern Association for the Surgery of Trauma, aimed to evaluate the effectiveness of loperamide, diphenoxylate/atropine, and elemental diet on acute noninfectious diarrhea in critically ill adults and to develop recommendations applicable to daily clinical practice. METHODS: The literature search identified 11 randomized controlled trials (RCT) appropriate for inclusion...
October 2019: Journal of Trauma and Acute Care Surgery
Emily Fletcher, Erica Seabold, Karen Herzing, Ronald Markert, Alyssa Gans, Akpofure Peter Ekeh
Background: The Acute Care Surgery (ACS) model developed during the last decade fuses critical care, trauma, and emergency general surgery. ACS teams commonly perform laparoscopic cholecystectomy (LC) for acute biliary disease. This study reviewed LCs performed by an ACS service focusing on risk factors for complications in the emergent setting. Methods: All patients who underwent LC on an ACS service during a 26-month period were identified. Demographic, perioperative, and complication data were collected and analyzed with Fisher's exact test, χ2 test, and Mann-Whitney U Test...
2019: Trauma Surgery & Acute Care Open
Gernot Beutel, Michael Kiehl, Joachim Stemmler, Alexander Shimabukuro-Vornhagen, Thomas Staudinger
In Europe, up to 25 % of the ICU patients suffer from malignant diseases. Recent studies have shown that the short term prognosis of critically ill cancer patients is determined by the severity of the acute complication leading to ICU admission, but not by the underlying malignancy. Long-term prognosis of cancer patients surviving the ICU however is given by the underlying disease and comparable to cancer patients never admitted to the ICU. In particular, survival rates of tumor patients admitted after surgery are equal to those from surgical non-tumor patients...
September 2019: Deutsche Medizinische Wochenschrift
Alexandra C Rowell, Wade G Stedman, Pierre F Janin, Naomi Diel, Michael R Ward, Sharon M Kay, Anthony Delaney, Gemma A Figtree
AIMS: Recent reports have shown a high incidence of silent left ventricular apical ballooning (LVAB) in the intensive care unit (ICU) setting with potential implications for safe use of inotropes and vasopressors. We examined the incidence, predictors, and associated outcomes of LVAB in patients in a contemporary tertiary Australian ICU. METHODS AND RESULTS: In a prospective cohort study, patients were screened within 24 h of admission to the ICU and enrolled if they were deemed critically unwell based on mechanical ventilation, administration of >5 mg/min of noradrenaline, or need for renal replacement therapy...
September 26, 2019: ESC Heart Failure
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