Vacuum-Assisted Abdominal Closure in Surgical Emergency: A Single Institution Experience Treating a Cohort with a Prevalence of Faecal Peritonitis

Abstract Vacuum-assisted abdominal closure (VAAC) has evolved as a promising method for treatment of emergent surgical patients. The aim of the study was an assessment of the complication rate and outcomes following routine application of VAAC in a cohort of patients suffering predominantly with peritonitis of the lower gastrointestinal tract (GIT) origin. The prospectively collected data was analysed retrospectively, including demographic data, aetiological factors, comorbid conditions and severity of the disease. The indications for VAAC included complicated intra-abdominal infection, purulent peritonitis with sepsis and/or risk of increased intra-abdominal pressure. In total, 130 patients were managed with VAAC. The median age was 63.5 years, with a predominance of male patients (61.5%). Systemic inflammatory response was present in 68.5%, the median C-reactive protein (CRP) was 239.58 mg/l, Procalcitonin (PCT) level 7.02 ng/ml, and lactate 1.84 mmol/l before intervention. The median Sequential Organ Failure Assessment (SOFA) score was 4 and the Mannheim Peritonitis Index was 26. Sepsis developed in 87.0% of patients, and 43.8% had septic shock. VAAC was applied in 58.5% due to a perforation of the lower GIT, in 26.1% due to perforation of the upper GIT, and in 15.4% for other reasons. A median of two (interquartile range, IQR 1–3) VAAC system changes were performed in a period of 7 (IQR 4–11) days. In 88.6% of cases, multiple types of microorganisms were present. The application of VAAC resulted in a significant decrease of the postoperative SOFA score, and CRP, PCT and lactate levels (p < 0.001). The complications included a “frozen abdomen”, enterocutaneous fistula, intraabdominal abscess and bleeding in 7.7%, 5.4% and 6.0% cases, respectively. Primary abdominal closure was accomplished in 76.2%, resulting in a 23.1% mortality rate. VAAC was found to be safe in the treatment of abdominal sepsis including in patients with faecal peritonitis. Complete abdominal closure can be achieved in the majority of patients resulting in a lower mortality rate.

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Prevalence of Hyponatremia and Its Associated Morbimortality in Hospitalized Patients Receiving Parenteral Nutrition

Annals of Nutrition and Metabolism ◽

10.1159/000477675 ◽

2017 ◽

Vol 71 (1-2) ◽

pp. 1-7 ◽

Cited By ~ 4

Author(s):

Emilia Gómez-Hoyos ◽

Martín Cuesta ◽

Nayade Del Prado-González ◽

Pilar Matía ◽

Natalia Pérez-Ferre ◽

...

Keyword(s):

Body Mass Index ◽

Mortality Rate ◽

Parenteral Nutrition ◽

Demographic Data ◽

Tertiary Hospital ◽

Hospital Length ◽

Hospitalized Patients ◽

Hospital Length Of Stay ◽

Control Subjects ◽

Comorbidity Index

Background: The objective of the study was to determine the prevalence of hyponatremia (HN) and its associated morbimortality in hospitalized patients receiving parenteral nutrition (PN). Methods: A retrospective study including 222 patients receiving total PN (parenteral nutrition group [PNG]) over a 7-month period in a tertiary hospital and 176 matched to 179 control subjects without PN (control subjects group [CSG]). Demographic data, Charlson Comorbidity Index (CCI), date of HN detection-(serum sodium or SNa <135 mmol/L)-intrahospital mortality, and hospital length-of-stay (LOS) were registered. In the PNG, body mass index (BMI) and SNa before, during, and after PN were recorded. Results: HN was more prevalent in the PNG: 52.8 vs. 35.8% (p = 0.001), and independent of age, gender, or CCI (OR 1.8 [95% CI 1.1-2.8], p = 0.006). In patients on PN, sustained HN (75% of all intraindividual SNa <135 mmol/L) was associated with a higher mortality rate independent of age, gender, CCI, or BMI (OR 7.38 [95% CI 1.07-50.8], p = 0.042). The absence of HN in PN patients was associated with a shorter hospital LOS (<30 days) and was independent of other comorbidities (OR 3.89 [95% CI 2.11-7.18], p = 0.001). Conclusions: HN is more prevalent in patients on PN. Sustained HN is associated with a higher intrahospital mortality rate. Absence of HN is associated with a shorter hospital LOS.

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Hypercoagulability in Septic Shock Patients With Thrombocytopenia

Journal of Intensive Care Medicine ◽

10.1177/08850666211024188 ◽

2021 ◽

pp. 088506662110241

Author(s):

Sang-Min Kim ◽

Sang-Il Kim ◽

Gina Yu ◽

June-Sung Kim ◽

Seok In Hong ◽

...

Keyword(s):

Emergency Department ◽

Septic Shock ◽

Multivariate Analysis ◽

Platelet Count ◽

Mortality Rate ◽

Confidence Interval ◽

Sofa Score ◽

Odds Ratio ◽

Fibrinogen Level ◽

Limited Information

Background: Despite thrombocytopenia, patients with sepsis often experience hypercoagulability. However, limited information is available on the prevalence and effect of hypercoagulability in patients with sepsis-induced thrombocytopenia. Hence, we evaluated the prevalence of hypercoagulability and the association between hypercoagulability and clinical outcomes in septic shock patients with thrombocytopenia. Methods: Thromboelastography (TEG) was performed prospectively in 1294 patients with septic shock at the emergency department (ED) between January 2016 and December 2019. After excluding 405 patients who did not require resuscitation, refused enrollment, or developed septic shock after ED presentation, 889 patients were included. We defined thrombocytopenia as an admission platelet count lower than 150,000/µl according to SOFA score. We defined hypocoagulability and hypercoagulability as coagulation index (CI)< −3 and >3 on TEG, respectively. Results: Of the 889 septic shock patients (mean age 65.6 ± 12.7 years, 58.6% male), 473 (53.2%) had thrombocytopenia. Eighty-five (18.0%) patients showed hypercoagulable TEG and73 (15.4%) patients showed hypocoagulable TEG. The hypercoagulable TEG group had a significantly higher fibrinogen level and a lower 28-day mortality rate than the normal and hypocoagulable TEG groups (518 vs. 347 and 315 mg/dL; 7.1% vs. 21.1% and 36.8%, P < 0.01, respectively). In multivariate analysis, hypercoagulable TEG was associated with a decreased mortality rate (odds ratio: 0.395; 95% confidence interval, 0.162-0.965). Conclusions: In septic shock patients with thrombocytopenia, hypercoagulability was not uncommon. TEG can quickly distinguish the hypercoagulability and hypocoagulability states and serve as a valuable tool for evaluating the degree and risk in septic shock patients with thrombocytopenia.

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Morbidity and mortality after fragility hip fracture in a Saudi Arabian population: Report from a single center

Journal of International Medical Research ◽

10.1177/0300060517706283 ◽

2017 ◽

Vol 45 (3) ◽

pp. 1175-1180 ◽

Cited By ~ 6

Author(s):

Mir Sadat-Ali ◽

Moaad Alfaraidy ◽

Abdulaziz AlHawas ◽

Ahmed Abdallah Al-Othman ◽

Dakheel A Al-Dakheel ◽

...

Keyword(s):

Hip Fracture ◽

Mortality Rate ◽

Demographic Data ◽

Femoral Fractures ◽

Morbidity And Mortality ◽

High Morbidity ◽

Fragility Hip Fracture ◽

Asa Score ◽

Telephone Interviews ◽

American Society

Objective To determine the functional morbidity and mortality after fragility hip fracture and compare the mortality with three other common diseases. Methods Data were collected from patients admitted to King Fahd Hospital of the University, AlKhobar from January 2010 to December 2014. Demographic data included the preoperative American Society of Anesthesiologists (ASA) score as assessed by the anesthetist and the type of surgery. Personal and telephone interviews were performed, and data were entered into a database and analyzed. Results We identified 203 patients with fragility proximal femoral fractures, and the data of 189 patients (109 male, 80 female; average age, 66.90 ± 13.43 years) were available for analysis. The overall mortality rate was 26.98% (51 patients). The mortality rate was significantly higher among patients with an ASA score of 4 (36.36%) than 1 (20.45%). With respect to morbidity, only 48.23% of patients were able to return to their pre-fracture status; 32.35% of those who required assisted walking and 83.4% of those who required a wheelchair became bedridden. Conclusions Our data demonstrate that patients with fragility hip fractures have high morbidity and a mortality rate approaching 30%. Age and the ASA score significantly influence this high mortality rate.

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Routine veterinary anaesthetic management practices in South Africa

Journal of the South African Veterinary Association ◽

10.4102/jsava.v71i3.707 ◽

2000 ◽

Vol 71 (3) ◽

Cited By ~ 14

Author(s):

K.E. Joubert

Keyword(s):

South Africa ◽

Mortality Rate ◽

Continuing Education ◽

Management Practices ◽

Demographic Data ◽

Anaesthetic Management ◽

Practice Size ◽

Induction Of Anaesthesia ◽

Education Courses ◽

Induction Agents

A survey of the routine anaesthetic management of dogs and cats during sterilisation by veterinarians in South Africa was conducted. This report describes the premedication, induction and maintenance agents most commonly used in dogs and cats. Information about monitoring of patients during the procedure and who is responsible for induction of anaesthesia and monitoring was obtained. Questionnaires were analysed with regard to demographic data, practice size, continuing education, the number of surgical procedures and sterilisations performed per week and an estimate of yearly mortality. Acetylpromazine is the most commonly used premedication in dogs and xylazine in cats. Thiopentone in dogs and alphaxalone/alphadolone in cats were the induction agents most commonly used. Alphaxalone/alphadolone in cats and halothane in dogs are the most commonly used maintenance agents. Records of anaesthesia are poorly kept and monitoring of patients is poorly performed. Respiratory rate is the parameter most commonly monitored (90.7 %), and in most cases is the sole parameter. On average 10.34 ± 8.25 cats were operated per week, of which 5.45 ±5.60 were sterilised; 17.79 ±11.61 dogs were operated per week, of which 8.65 ±7.10 were sterilised. In total, 190 patients died under anaesthesia, a mortality rate of 1:1243. Just over 50 % of practitioners had attended continuing education courses during their careers.

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Interim-analysis of the COSA (COVID-19 patients treated with the Seraph® 100 Microbind® Affinity filter) registry

Nephrology Dialysis Transplantation ◽

10.1093/ndt/gfab347 ◽

2021 ◽

Author(s):

Julius J Schmidt ◽

Dan Nicolae Borchina ◽

Mariet van´t Klooster ◽

Khalida Bulhan-Soki ◽

Reuben Okioma ◽

...

Keyword(s):

Mortality Rate ◽

Sofa Score ◽

Cox Regression ◽

Treatment Time ◽

Outcome Data ◽

Adverse Outcomes ◽

Icu Patients ◽

Icu Admission ◽

Late Initiation ◽

Bacterial Superinfection

Abstract Background The Seraph®100 Microbind Affinity Blood Filter® is a hemoperfusion device that is licensed for the reduction of pathogens, including several viruses, in the blood. It received Emergency Use Authorization (EUA) for the treatment of severe coronavirus disease 2019 (COVID-19) by the FDA. Several studies have shown that the blood viral load of SARS-CoV-2 correlates with adverse outcomes and removal of the nucleocapsid of the SARS-CoV-2 virus by the Seraph®100 has been recently demonstrated. The aim of this registry was to evaluate safety and efficacy of Seraph®100 treatment for COVID-19 patients. Methods Twelve hospitals from six countries representing two continents documented patient and treatment characteristics as well as outcome parameters without reimbursement. Additionally, mortality and safety results of the device were reported. One hundred-and-two treatment sessions in 82 patients were documented in the registry. Four patients were excluded from mortality analysis due to incomplete outcome data, which were available in the other 78 patients. Results Overall, a 30-day mortality rate of 46.2% in the 78 patients with complete follow up was reported. Median treatment time was 5.00 [4.00–13.42] h. and 43.1% of the treatments were performed as hemoperfusion only. Adverse events of the Seraph®100 treatment were reported in 8.8% of the 102 treatments and represented premature end of treatment due to circuit failure. Patients that died were treated later in their ICU stay and onset of COVID symptoms. They also had higher ferritin levels. Multivariate Cox regression revealed that delayed Seraph®100 treatment after ICU admission (>60 hours) as well as bacterial superinfection were associated with mortality. While average predicted mortality rate according to SOFA score in ICU patients was 56.7% the observed mortality was 50.7%. In non-ICU patients 4C-Score average predicted a mortality rate of 38.0% while the observed mortality rate was 11.1% Conclusions The treatment of COVID-19 patients with Seraph®100 is well tolerated and the circuit failure rate was lower than previously reported for KRT in COVID-19 patients. Mortality corelated with late initiation of Seraph treatment after ICU admission and bacterial superinfection infection. Compared to predicted mortality according to 4C-Score and SOFA Score, mortality of Seraph®100 treated patients reported in the registry was lower.

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Results Of Treatment Of Acute Diffuse Purulent Peritonitis Using Laparostomy

The American Journal of Medical Sciences and Pharmaceutical Research ◽

10.37547/tajmspr/volume02issue11-12 ◽

2020 ◽

Vol 02 (11) ◽

pp. 66-71

Author(s):

S. A. Ruziboev ◽

◽

A. A. Avazov ◽

Sh. Kh. Sattarov ◽

A. N. Elmuradov ◽

...

Keyword(s):

Bacterial Translocation ◽

Abdominal Cavity ◽

Multiple Organ ◽

The Body ◽

Abdominal Pressure ◽

Results Of Treatment ◽

Abdominal Hypertension ◽

Purulent Peritonitis ◽

Intractable Problems ◽

Cause Of Deaths

Currently, despite significant achievements in the field of surgery, anesthesiology and resuscitation, the results of treatment of patients with advanced purulent peritonitis remain one of the most intractable problems, almost every sixth patient with acute surgical diseases and injuries of the abdominal cavity is admitted to medical institutions with peritonitis [1,3] Common peritonitis in 17-29% complicates the course of most acute surgical diseases and is the main cause of deaths in surgical hospitals [3,7]. Lethality in advanced peritonitis remains extremely high and reaches 20-39% [1,2,4,5]. In recent decades, great importance has been attached to recording intra-abdominal pressure in purulent pathology of the abdominal cavity. It was found that intra-abdominal hypertension occurs in every third patient with acute surgical pathology and negatively affects the functioning of all organs and systems of the body [1,6,8]. Pathological changes that occur with acute and excessive increase in intra-abdominal pressure (IAP) are manifestations of abdominal compartment syndrome (ACS) with disorders of the cardiovascular system; urinary disorders, disorders of perfusion of internal organs and the development of intestinal ischemia, which contributes to bacterial translocation and endogenous infection [2,7,8]. Ischemic blood flow disorders of the splanchnic zone are fraught with the development of bacterial translocation and the development of systemic inflammatory response syndrome and multiple organ failure (PON). Unsatisfactoriness with such results gave rise to a fundamentally different approach to the surgical treatment of common forms of peritonitis-the introduction of an open abdominal management method based on the ideas of I. Mikulich (1881), Jean-Louis Faure (1928), N. S. Makoch (1984) and D. Steinberg (1979).

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Laparostomy in a rural hospital: an African case report for a very important tool to be spread and increased

Journal of Peritoneum (and other serosal surfaces) ◽

10.4081/joper.2017.31 ◽

2017 ◽

Author(s):

Gian Domenico Arzu ◽

Riccardo Conventi ◽

Giovanni Putoto ◽

Emmanuel Onapa

Keyword(s):

Intestinal Obstruction ◽

Low Income ◽

Open Abdomen ◽

Primary Anastomosis ◽

Foley Catheter ◽

Abdominal Sepsis ◽

Low Income Countries ◽

Abdominal Pressure ◽

Second Look ◽

Aged Woman

Laparostomy is a surgical technique enabling the surgeon to leave abdominal fascial edges opened after a laparotomy. This is a useful tool that can be very important in patients with intraabdominal hypertension. Open abdomen indications are: trauma, severe abdominal sepsis, intestinal infarction, vascular surgery and when the surgeon cannot close the abdomen due to high intra abdominal pressure in order to avoid abdominal compartment syndrome or in case of a second look in order to evaluate the conditions of the abdomen (and particularly of the gut). We used this technique in a low income country for a patient with intestinal obstruction where performing a primary anastomosis during the first operation was at high risk of leakage. A middle-aged woman was admitted in Pope John’s Hospital - Aber, Uganda for abdominal pain and intestinal obstruction (IO) symptoms. A laparotomy found a tract of small gut necrotic and twisted under a single adhesion. The small gut above the volvulus was dilated for the obstruction created by the adhesion. We decided to excise the necrotic intestine and leave the abdomen open for a second look and delayed anastomosis and closure. The managing of the IO was conducted by inserting a big Foley catheter in the proximal intestine to drain its enteric content in a similar fashion to a guided external fistula. Open abdomen is a very important technique, relatively new, that can impact positively in treating some surgical patients even in rural hospitals and in the absence of Intensive Care Unit. A simple trick can solve successfully the IO due to the volvulus. Laparostomy should be spread more in African and low-income countries.

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Comparison of Cefepime-Cefpirome and Carbapenem Therapy for Acinetobacter Bloodstream Infection in a Multicenter Study

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.02392-19 ◽

2020 ◽

Vol 64 (6) ◽

Author(s):

Yea-Yuan Chang ◽

Ya-Sung Yang ◽

Shang-Liang Wu ◽

Yung-Chih Wang ◽

Te-Li Chen ◽

...

Keyword(s):

Mortality Rate ◽

Bloodstream Infection ◽

Antimicrobial Therapy ◽

Sofa Score ◽

Cox Regression ◽

Content Type ◽

Cox Regression Analysis ◽

Medical Centers ◽

Acinetobacter Pittii ◽

Underlying Diseases

ABSTRACT Carbapenems are currently the preferred agents for the treatment of serious Acinetobacter infections. However, whether cefepime-cefpirome can be used to treat an Acinetobacter bloodstream infection (BSI) if it is active against the causative pathogen(s) is not clear. This study aimed to compare the efficacy of cefepime-cefpirome and carbapenem monotherapy in patients with Acinetobacter BSI. The population included 360 patients with monomicrobial Acinetobacter BSI receiving appropriate antimicrobial therapy admitted to four medical centers in Taiwan in 2012 to 2017. The predictors of 30-day mortality were determined by Cox regression analysis. The overall 30-day mortality rate in the appropriate antibiotic treatment group was 25.0% (90/360 patients). The crude 30-day mortality rates for cefepime-cefpirome and carbapenem therapy were 11.5% (7/61 patients) and 26.3% (21/80 patients), respectively. The patients receiving cefepime-cefpirome or carbapenem therapy were infected by Acinetobacter nosocomialis (51.8%), Acinetobacter baumannii (18.4%), and Acinetobacter pittii (12.1%). After adjusting for age, Sequential Organ Failure Assessment (SOFA) score, invasive procedures, and underlying diseases, cefepime-cefpirome therapy was not independently associated with a higher or lower 30-day mortality rate compared to that with the carbapenem therapy. SOFA score (hazard ratio [HR], 1.324; 95% confidence interval [CI], 1.137 to 1.543; P < 0.001) and neutropenia (HR, 7.060; 95% CI, 1.607 to 31.019; P = 0.010) were independent risk factors for 30-day mortality of patients receiving cefepime-cefpirome or carbapenem monotherapy. The incidence densities of 30-day mortality for cefepime-cefpirome versus carbapenem therapy were 0.40% versus 1.04%, respectively. The therapeutic response of cefepime-cefpirome therapy was comparable to that with carbapenems among patients with Acinetobacter BSI receiving appropriate antimicrobial therapy.

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Role of extracellular glutamate measured by cerebral microdialysis in severe traumatic brain injury

Journal of Neurosurgery ◽

10.3171/2009.12.jns09689 ◽

2010 ◽

Vol 113 (3) ◽

pp. 564-570 ◽

Cited By ~ 99

Author(s):

Roukoz Chamoun ◽

Dima Suki ◽

Shankar P. Gopinath ◽

J. Clay Goodman ◽

Claudia Robertson

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Intracranial Pressure ◽

Mortality Rate ◽

Functional Outcome ◽

Excitatory Amino Acid ◽

Demographic Data ◽

Cerebral Microdialysis ◽

Factors Affecting

Object Authors of several studies have implied a key role of glutamate, an excitatory amino acid, in the pathophysiology of traumatic brain injury (TBI). However, the place of glutamate measurement in clinical practice and its impact on the management of TBI has yet to be elucidated. The authors' objective in the present study was to evaluate glutamate levels in TBI, analyzing the factors affecting them and determining their prognostic value. Methods A prospective study of patients with severe TBI was conducted with an inclusion criterion of a Glasgow Coma Scale score ≤ 8 within 48 hours of injury. Invasive monitoring included intracranial pressure measurements, brain tissue PO2, jugular venous O2 saturation, and cerebral microdialysis. Patients received standard care including mass evacuation when indicated and treatment of elevated intracranial pressure values. Demographic data, CT findings, and outcome at 6 months of follow-up were recorded. Results One hundred sixty-five patients were included in the study. Initially high glutamate values were predictive of a poor outcome. The mortality rate was 30.3% among patients with glutamate levels > 20 μmol/L, compared with 18% among those with levels ≤ 20 μmol/L. Two general patterns were recognized: Pattern 1, glutamate levels tended to normalize over the monitoring period (120 hours); and Pattern 2, glutamate levels tended to increase with time or remain abnormally elevated. Patients showing Pattern 1 had a lower mortality rate (17.1 vs 39.6%) and a better 6-month functional outcome among survivors (41.2 vs 20.7%). Conclusions Glutamate levels measured by microdialysis appear to have an important role in TBI. Data in this study suggest that glutamate levels are correlated with the mortality rate and 6-month functional outcome.

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