scholarly journals The effect of short term peripheral parenteral nutrition on treatment outcomes and mortality in critically ill pediatric canine patients

2021 ◽  
Vol 74 (1) ◽  
Author(s):  
Cesar Augusto Flores Dueñas ◽  
Soila Maribel Gaxiola Camacho ◽  
Martin Francisco Montaño Gómez ◽  
Rafael Villa Angulo ◽  
Idalia Enríquez Verdugo ◽  
...  
Keyword(s):  
Weight Loss ◽  
Adverse Effects ◽  
Parenteral Nutrition ◽  
Hospital Stay ◽  
Critically Ill ◽  
Energy Requirement ◽  
Length Of Hospital Stay ◽  
Short Term ◽  
Clinical Complications ◽  
Significant Difference

Abstract Background Peripheral parenteral nutrition (PPN) is increasingly considered as an alternative to central parenteral nutrition (CPN) given the higher cost and more frequent clinical complications associated with the latter. However, the assessment of potential risks and benefits of PPN in critically ill pediatric canine patients has not been extensively performed. In this study, we aimed to explore the effect of short-term, hypocaloric PPN on weight loss, length of hospital stay, the incidence of complications, adverse effects, and mortality in critically ill pediatric canine patients. Results Between August 2015 and August 2018, a total of 59 critically ill pediatric canine patients aged from 1 to 6 months admitted at the Veterinary Sciences Research Institute of the Autonomous University of Baja California were included in this non-randomized clinical trial. Canine pediatric patients were initially allocated to 3 groups: 11 in group 1 receiving parenteral nutrition (PN) supplementation equivalent to 40% of the resting energy requirement (RER), 12 in group 2 receiving supplementation of 50% of the RER, and 36 in group 3 receiving no PN supplementation. After establishing that there was no significant difference between 40 and 50% of PN supplementation, these groups were not separated for downstream analysis. Similar lengths of hospital stays were noted among study subjects who received PN supplementation and those who did not (4.3 ± 1.5 vs. 5.0 ± 1.5, days, p = 0.097). No metabolic-, sepsis- or phlebitis-related complications were observed in any animal in the PPN supplemented group. Higher mortality (19.4% vs. 0%, p = 0.036), and a greater percentage of weight loss (9.24% vs. 0%, p <  0.001) were observed in patients who received no supplementation. Conclusion Even though short-term, hypocaloric PPN did not reduce the length of hospital stay, it was associated with lower mortality and resulted in mitigation of weight loss. In contrast to previous studies evaluating central and peripheral parenteral nutrition protocols, we observed a lower frequency of metabolic, septic, and phlebitis complications using a 40–50% parenteral nutrition treatment. The parenteral nutrition therapeutic intervention used in our study may reduce PN-related adverse effects and promote a favorable disease outcome in critically ill canine patients. Larger studies will be needed to confirm these observations.

scholarly journals Feasibility of short term drainage for diagnostic thoracoscopy

2016 ◽  
Vol 71 (2) ◽  
Author(s):  
D.P. Breen ◽  
S. Mallawathantri ◽  
A. Fraticelli ◽  
L. Greillier ◽  
P. Astoul
Keyword(s):  
Hospital Stay ◽  
Length Of Hospital Stay ◽  
Economic Benefits ◽  
Optimal Time ◽  
Chest Drain ◽  
Complication Rates ◽  
Short Term ◽  
Drainage Time ◽  
Drain Removal ◽  
Significant Difference

Background and Aim. Thoracoscopy is a diagnostic tool superior to other available techniques for the assessment of pleural effusions. There are numerous publications that describe the technique in detail but there is very little published on the optimal time of chest drain removal post procedure. Our aim was to retrospectively study all cases of diagnostic thoracoscopy and to ascertain the time of chest drain removal, length of hospital stay and associated complications. Methods. All patients who underwent thoracoscopy during a 6-year period were identified from a computerised database. Patients who received talc for pleurodesis were excluded as they required longer drainage time. A review of the remaining patients’ charts and radiology was performed to ascertain the predefined outcomes. Results. 124 patients had a diagnostic thoracoscopy. The time to chest drain removal was documented as less than four hours, four to 24 hours, 24 to 48 hours and greater than 48 hours in 66 (53.2%), 29 (23.4%), 12 (9.7%) and 17 (13.7%) of patients respectively. The median length of stay for all patients was one day (interquartile range, 1-4 days). There was a statistically significant difference in overall length of hospital stay between the early (48 hours) chest drain removal groups, p=0.0028. The overall complication rate was 15.9%. There was no statistical difference in complication rates between the two groups. Conclusion. This retrospective series demonstrates that early chest drain removal post diagnostic thoracoscopy is possible and safe. This is likely to confer economic benefits.

O148 SHORT-TERM RESULTS OF A RANDOMIZED CONTROLLED TRIAL OF STANDARD VS. PROLONGED TIME TO SURGERY AFTER NEOADJUVANT CHEMORADIATION FOR CANCER

2019 ◽  
Vol 32 (Supplement_2) ◽  
Author(s):  
K Nilsson ◽  
F Klevebro ◽  
E Szabo ◽  
I Halldestam ◽  
E Johnsson ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Postoperative Mortality ◽  
Length Of Hospital Stay ◽  
Postoperative Outcomes ◽  
Standard Group ◽  
Median Length ◽  
Short Term ◽  
Time To Surgery ◽  
Prolonged Time ◽  
Significant Difference

Abstract Aim The aim of this study was to clarify if prolonged time to surgery (TTS) improves postoperative outcomes in the curative intended treatment of an junctional cancer. Background & Methods sophagectomy is conventionally performed 4-6 weeks after completed neoadjuvant chemoradiotherapy (nCRT). However, studies have shown that prolonged TTS might be favourable. A randomized multicentre clinical trial was performed with allocation to 4-6 or 10-12 weeks between finished nCRT and surgery. All patients received nCRT according to CROSS. Primary outcome of thstudy was postoperative. Smortality, need for intensive care, and length of hospital stay. Results The study randomized 248 patients, 202have to date undergone esophagectomy 98 patients were allocated to prolonged TTS, and the groups were well matched concerning baseline characteristics. Postoperative complications were reported in 106 patients (52.5%).There was no difference in postoperative Clavien-Dindo score.In the standardgroup 17 (16.4%) patients had anastomotic leak compared to 19 (19.4%) in the prolongedgroup (P=0.572). Conduit necrosis was reported in 9 (4.5%) patients, esophago-bronchial fistula in 1 (0.5%) patient,chyle leak in 5 (2.5%) neumoni in 54 (26.7%) patients and respiratory insufficiency in 36 (17.8%) patients without significant difference . In the standard group 5 (4.8%) patients had postoperative mortality due to a complication, compared to 2 (2.0%) patients in the prolonged group (P=0.446). Median length of hospital stay was 14 days in the standard group and 17.5 days in the prolonged group (P=0.040). Conclusion In this we found no significant differences in postoperative mortality comparing standard to prolonged TTS after nCRT. Although, an observandum is that the median length of hospital stay was significantly longer in the prolonged group. We need to compare response and survival to properly evaluate prolonged TTS, but these results suggest that timing is not cardinal in short-term postoperative outcomes.

scholarly journals Clinical rationale for the treatment tactics of term patients diagnosed with transient neonatal tachypnoea without parenteral nutrition

2021 ◽  
Vol 20 (5) ◽  
pp. 29-34
Author(s):  
N. V. Kalyakova ◽  
E. V. Shestak ◽  
D. S. Dodrov
Keyword(s):  
Parenteral Nutrition ◽  
Hospital Stay ◽  
Average Length ◽  
Total Duration ◽  
Length Of Hospital Stay ◽  
Venous Access ◽  
Rapid Expansion ◽  
Control Group ◽  
Vacuum Extraction ◽  
Significant Difference

Introduction. To analyze the efficacy and safety of treatment tactics for term patients diagnosed with TTN in an ICU without venous access and parenteral nutrition.Materials and methods. The study gives a retrospective analysis of the medical records of 241 ICU patients from January 2020 to March 2021. 83 children meet general criteria for inclusion in the study.Results and Discussion. While comparing the study group and the control group, no significant difference was detected in the incidence of risk factors during pregnancy and childbirth, such as gestational diabetes, ARVI during pregnancy, chorioamnionitis, preeclampsia, and the frequency of a prolonged anhydrous period, the frequency of induced labor, delivery by caesarean section, fetal distress and the use of vacuum extraction. Despite the same initial level of severity of respiratory disorders, when the child was admitted to the ICU, the duration of CPAP therapy was significantly higher in the control group: 7.5 (5.5-12) versus 5 (4-6) hours p = 5×10-5. The average length of hospital stay in the ICU and the total length of hospital stay was significantly higher in the control group (p = 4×10-11 and p = 0.006, respectively), as well as the need for treatment in the Neonatal Pathology unit conditions (p = 0.001).Conclusion. Analyzing the tactics of treating term patients diagnosed with TTN, the study proved that children without venous access require less time for respiratory therapy with CPAP in the NICU, the total duration of hospitalization in the NICU is significantly lower, as well as the need for additional treatment in the Neonatal Pathology unit. The study revealed that the early onset of enteral nutrition and the rapid expansion of the feeding portion, provided with child’s stable health condition, enable to avoid the installation of venous access and the prescription of parenteral nutrition at the ICU stage.

Effect of Chewing Gum on Bowel Motility in Women Undergoing Post-Operative Cesarean Section

2018 ◽  
Vol 3 (06) ◽  
Author(s):  
Dr.Randa Mohammed AboBaker
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Demographic Data ◽  
Length Of Hospital Stay ◽  
Chewing Gum ◽  
Control Group ◽  
Controlled Clinical Trial ◽  
Bowel Motility ◽  
Gum Chewing ◽  
Significant Difference

Postoperative Ileus (POI) is one of the most common problems after obstetrics, gynecologic and abdominal surgeries. Sham feeding, such as gum chewing, accelerates the return of bowel function and the length of hospital stay. The present study aims to evaluate the effect of chewing gum on bowel motility in women undergoing post-operative cesarean section. Intervention study was used at the Postpartum Department of Maternity and Children Hospital, KSA. A randomized controlled clinical trial research design. Through a convenience technique, 80 post Caesarian Section (CS) women were included in the study. Data were collected through three tools: Tool (I): Socio-demographic data and reproductive history interview schedule. Tool (II): Postoperative Assessment Sheet. Tool (III): Outcomes of gum chewing and the length of hospital stay.  Method: subjects were assigned randomly into two groups of (40) the experimental and (40) the control. Subjects in the study group were asked to chew two pieces of sugarless gum for 30 min/three times daily in the morning, noon, and evening immediately after recovery from anesthesia and in Postpartum Department; while subjects in the control group followed the hospital routine care. Each woman in both groups was tested abdominally using a stethoscope to auscultate the bowel sounds and asked to report immediately the time of either passing flatus or stool. Results: illustrated that a highly statistically significant difference was observed between the two groups concerning their gum chewing outcomes. Where, P = 0.000. The study concluded that gum chewing is safe, well tolerated and appears to be effective in reducing the incidence and consequences of POI following CS.

Prevalence, Correlates and Management of Hyperglycemia in Diabetic Non-critically Ill Patients at a Tertiary Care Center in Lebanon

2019 ◽  
Vol 15 (2) ◽  
pp. 133-140 ◽  
Author(s):  
Ghada El Khoury ◽  
Hanine Mansour ◽  
Wissam K. Kabbara ◽  
Nibal Chamoun ◽  
Nadim Atallah ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Care Center ◽  
Descriptive Analysis ◽  
Tertiary Care ◽  
Multivariable Analysis ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Diabetic Patients

Background: Diabetes Mellitus is a chronic metabolic disease that affects 387 million people around the world. Episodes of hyperglycemia in hospitalized diabetic patients are associated with poor clinical outcomes and increased morbidity and mortality. Therefore, prevention of hyperglycemia is critical to decrease the length of hospital stay and to reduce complications and readmissions. Objective: The study aims to examine the prevalence of hyperglycemia and assess the correlates and management of hyperglycemia in diabetic non-critically ill patients. Methods: The study was conducted on the medical wards of a tertiary care teaching hospital in Lebanon. A retrospective chart review was conducted from January 2014 until September 2015. Diabetic patients admitted to Internal Medicine floors were identified. Descriptive analysis was first carried out, followed by a multivariable analysis to study the correlates of hyperglycemia occurrence. Results: A total of 235 medical charts were reviewed. Seventy percent of participants suffered from hyperglycemia during their hospital stay. The identified significant positive correlates for inpatient hyperglycemia, were the use of insulin sliding scale alone (OR=16.438 ± 6.765-39.941, p=0.001) and the low frequency of glucose monitoring. Measuring glucose every 8 hours (OR= 3.583 ± 1.506-8.524, p=0.004) and/or every 12 hours (OR=7.647 ± 0.704-79.231, p=0.0095) was associated with hyperglycemia. The major factor perceived by nurses as a barrier to successful hyperglycemia management was the lack of knowledge about appropriate insulin use (87.5%). Conclusion: Considerable mismanagement of hyperglycemia in diabetic non-critically ill patients exists; indicating a compelling need for the development and implementation of protocol-driven insulin order forms a comprehensive education plan on the appropriate use of insulin.

Stereotactic Electroencephalography Is Associated With Reduced Pain and Opioid Use When Compared with Subdural Grids: A Case Series

2021 ◽  
Author(s):  
Jonathan P Scoville ◽  
Evan Joyce ◽  
Joshua Hunsaker ◽  
Jared Reese ◽  
Herschel Wilde ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Chart Review ◽  
Statistical Tests ◽  
Case Series ◽  
Length Of Hospital Stay ◽  
Retrospective Chart Review ◽  
Opioid Use ◽  
Pain Scores ◽  
Surgical Methods ◽  
Significant Difference

Abstract BACKGROUND Minimally invasive surgery (MIS) has been shown to decrease length of hospital stay and opioid use. OBJECTIVE To identify whether surgery for epilepsy mapping via MIS stereotactically placed electroencephalography (SEEG) electrodes decreased overall opioid use when compared with craniotomy for EEG grid placement (ECoG). METHODS Patients who underwent surgery for epilepsy mapping, either SEEG or ECoG, were identified through retrospective chart review from 2015 through 2018. The hospital stay was separated into specific time periods to distinguish opioid use immediately postoperatively, throughout the rest of the stay and at discharge. The total amount of opioids consumed during each period was calculated by transforming all types of opioids into their morphine equivalents (ME). Pain scores were also collected using a modification of the Clinically Aligned Pain Assessment (CAPA) scale. The 2 surgical groups were compared using appropriate statistical tests. RESULTS The study identified 43 patients who met the inclusion criteria: 36 underwent SEEG placement and 17 underwent craniotomy grid placement. There was a statistically significant difference in median opioid consumption per hospital stay between the ECoG and the SEEG placement groups, 307.8 vs 71.5 ME, respectively (P = .0011). There was also a significant difference in CAPA scales between the 2 groups (P = .0117). CONCLUSION Opioid use is significantly lower in patients who undergo MIS epilepsy mapping via SEEG compared with those who undergo the more invasive ECoG procedure. As part of efforts to decrease the overall opioid burden, these results should be considered by patients and surgeons when deciding on surgical methods.

565 POST-OPERATIVE WEIGHT LOSS AND OUTCOMES FOLLOWING ESOPHAGECTOMY

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
R Khaw ◽  
S Munro ◽  
J Sturrock ◽  
H Jaretzke ◽  
S Kamarajah ◽  
...  
Keyword(s):  
Weight Loss ◽  
Length Of Stay ◽  
Hospital Stay ◽  
Enhanced Recovery ◽  
Length Of Hospital Stay ◽  
Failure To Thrive ◽  
Post Discharge ◽  
Postoperative Weight Loss ◽  
Poor Outcomes ◽  
The Impact

Abstract   Oesophageal cancer is the 11th most common cancer worldwide, with oesophagectomy remaining the mainstay curative treatment, despite significant associated morbidity and mortality. Postoperative weight loss remains a significant problem and is directly correlated to poor prognosis. Measures such as the Enhanced Recovery After Surgery (ERAS) programme and intraoperative jejunostomy feed have looked to tackle this. This study investigates the impact of these on mortality, length of hospital stay and postoperative weight loss. Methods Patients undergoing oesophagectomy between January 1st 2012—December 2014 and 28th October 2015–December 31st 2019 in a national tertiary oesophagogastric unit were included retrospectively. Variables measured included comorbidities, operation, histopathology, weights (pre- and post-operatively), length of hospital stay, postoperative complications and mortality. Pre-operative body weight was measured at elective admission, and further weights were identified from a prospectively maintained database, during further clinic appointments. Other data was collected through patient notes. Results 594 patients were included. Mean age at diagnosis was 65.9 years (13–65). Majority of cases were adenocarcinoma (63.3%), with varying stages of disease (TX-4, NX-3). Benign pathology accounted for 8.75% of cases. Mean weight loss post-oesophagectomy exceeded 10% at 6 months (SD 14.49). Majority (60.1%) of patients were discharged with feeding jejunostomy, and 5.22% of these required this feed to be restarted post-discharge. Length of stay was mean 16.5 days (SD 22.3). Complications occurred in 68.9% of patients, of which 13.8% were infection driven. Mortality occurred in 26.6% of patients, with 1.83% during hospital admission. 30-day mortality rate was 1.39%. Conclusion Failure to thrive and prolonged weight-loss following oesophagectomy can contribute to poor recovery, with associated complications and poor outcomes, including increased length of stay and mortality. Further analysis of data to investigate association between weight loss and poor outcomes for oesophagectomy patients will allow for personalised treatment of high-risk patients, in conjunction with members of the multidisciplinary team, including dieticians.

scholarly journals Effects of early corticosteroid use in patients with severe coronavirus disease 2019

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jong Hoon Hyun ◽  
Moo Hyun Kim ◽  
Yujin Sohn ◽  
Yunsuk Cho ◽  
Yae Jee Baek ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Clinical Outcomes ◽  
Case Fatality ◽  
Length Of Hospital Stay ◽  
Corticosteroid Treatment ◽  
Threshold Value ◽  
Steroid Use ◽  
Corticosteroid Administration ◽  
Significant Difference ◽  
Early Use

Abstract Background Coronavirus disease 2019 (COVID-19) is associated with acute respiratory distress syndrome, and corticosteroids have been considered as possible therapeutic agents for this disease. However, there is limited literature on the appropriate timing of corticosteroid administration to obtain the best possible patient outcomes. Methods This was a retrospective cohort study including patients with severe COVID-19 who received corticosteroid treatment from March 2 to June 30, 2020 in seven tertiary hospitals in South Korea. We analyzed the patient demographics, characteristics, and clinical outcomes according to the timing of steroid use. Twenty-two patients with severe COVID-19 were enrolled, and they were all treated with corticosteroids. Results Of the 22 patients who received corticosteroids, 12 patients (55%) were treated within 10 days from diagnosis. There was no significant difference in the baseline characteristics. The initial PaO2/FiO2 ratio was 168.75. The overall case fatality rate was 25%. The mean time from diagnosis to steroid use was 4.08 days and the treatment duration was 14 days in the early use group, while those in the late use group were 12.80 days and 18.50 days, respectively. The PaO2/FiO2 ratio, C-reactive protein level, and cycle threshold value improved over time in both groups. In the early use group, the time from onset of symptoms to discharge (32.4 days vs. 60.0 days, P = 0.030), time from diagnosis to discharge (27.8 days vs. 57.4 days, P = 0.024), and hospital stay (26.0 days vs. 53.9 days, P = 0.033) were shortened. Conclusions Among patients with severe COVID-19, early use of corticosteroids showed favorable clinical outcomes which were related to a reduction in the length of hospital stay.

Clinical evaluation of two adult oxygenator systems in terms of mortality and major adverse events

Perfusion ◽  
2021 ◽  
pp. 026765912110638
Author(s):  
Hüsnü Kamil Limandal ◽  
Mehmet Ali Kayğın ◽  
Servet Ergün ◽  
Taha Özkara ◽  
Mevriye Serpil Diler ◽  
...  
Keyword(s):  
Adverse Events ◽  
Hospital Stay ◽  
Artery Bypass ◽  
Length Of Hospital Stay ◽  
Fresh Frozen Plasma ◽  
Wound Complications ◽  
Significant Difference ◽  
Delayed Sternal Closure ◽  
Fresh Frozen ◽  
Major Adverse Events

Purpose The primary aim of this study was to examine the effects of two oxygenator systems on major adverse events and mortality. Methods A total of 181 consecutive patients undergoing coronary artery bypass grafting in our clinic were retrospectively analyzed. The patients were divided into two groups according to the oxygenator used: Group M, in which a Medtronic Affinity (Medtronic Operational Headquarters, Minneapolis, MN, USA) oxygenator was used, and Group S, in which a Sorin Inspire (Sorin Group Italia, Mirandola, Italy) oxygenator was used. Results Group S consisted of 89 patients, whereas Group M included 92 patients. No statistically significant differences were found between the two groups in terms of age ( p = .112), weight ( p = .465), body surface area ( p = .956), or gender ( p = .484). There was no statistically significant difference in hemorrhage on the first or second postoperative day ( p = .318 and p = .455, respectively). No statistically significant differences were observed in terms of red blood cell ( p = .468), fresh frozen plasma ( p = .116), or platelet concentrate transfusion ( p = .212). Infections, wound complications, and delayed sternal closure were significantly more common in Group M ( p = .006, p = .023, and p = .019, respectively). Extracorporeal membrane oxygenators and intra-aortic balloon pumps were required significantly more frequently in Group S ( p = .025 and p = .013, respectively). Major adverse events occurred in 16 (18%) patients in Group S and 14 (15.2%) patients in Group M ( p = .382). Mortality was observed in six (6.7%) patients in Group S and three (3.3%) patients in Group M ( p = .232). No statistically significant difference was found between the two groups in terms of length of hospital stay ( p = .451). Conclusion The clinical outcomes of the two oxygenator systems, including mortality, major adverse events, hemorrhage, erythrocyte and platelet transfusions, and length of hospital stay, were similar.

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