scholarly journals Tension pneumoperitoneum: innovative decompression of this general surgical emergency

2011 ◽  
Vol 1 (2) ◽  
pp. 21
Author(s):  
Alun E. Jones ◽  
Dean Godfrey ◽  
Guy F. Nash
Keyword(s):  
High Risk ◽  
Emergency Laparotomy ◽  
The Novel ◽  
Surgical Emergency ◽  
Tension Pneumoperitoneum ◽  
Needle Decompression

We describe the novel use of a cannula in decompressing a large tension pneumoperitoneum secondary to perforated sigmoid diverticulum, in which the patient did not subsequently require an emergency laparotomy. Needle decompression was successfully used as part of a conservative regimen, thus avoiding potentially high-risk surgery.

scholarly journals Abdominal compartment syndrome caused by tension pneumoperitoneum in a scuba diver

2012 ◽  
Vol 94 (8) ◽  
pp. e6-e8 ◽  
Author(s):  
J Bunni ◽  
PJ Bryson ◽  
SM Higgs
Keyword(s):  
Compartment Syndrome ◽  
Abdominal Compartment Syndrome ◽  
Abdominal Pressure ◽  
Trauma Patients ◽  
Surgical Emergency ◽  
Tension Pneumoperitoneum ◽  
Needle Decompression ◽  
Experienced Female ◽  
Symptoms And Signs ◽  
Abdominal Compartment

Abdominal compartment syndrome is a surgical emergency caused by a raised intra-abdominal pressure, which may lead to respiratory, cardiovascular and renal compromise. It is most commonly seen in post-operative and trauma patients and it has a variety of causes. Tension pneumoperitoneum (TP) is a rare cause of abdominal compartment syndrome most often seen after gastrointestinal endoscopy with perforation. We present the case of a fit 52-year-old experienced female diver who developed TP and shock following a routine training dive to 27m. Following accidental inhalation of water, she had an unstaged ascent and, on reaching the surface, developed severe acute abdominal pain and distension. She was brought to our emergency department by air ambulance for assessment. Clinical and radiological examination revealed a shocked patient with dramatic free intra-abdominal gas and signs of abdominal compartment syndrome, which was treated with needle decompression. Symptoms and signs resolved quickly with no need for further surgical intervention. TP is a surgical emergency where surgery can be avoided with prompt diagnosis and treatment.

scholarly journals Guidelines for Perioperative Care for Emergency Laparotomy Enhanced Recovery After Surgery (ERAS) Society Recommendations: Part 1—Preoperative: Diagnosis, Rapid Assessment and Optimization

2021 ◽  
Author(s):  
Carol J. Peden ◽  
Geeta Aggarwal ◽  
Robert J. Aitken ◽  
Iain D. Anderson ◽  
Nicolai Bang Foss ◽  
...  
Keyword(s):  
High Risk ◽  
English Language ◽  
Enhanced Recovery ◽  
Enhanced Recovery After Surgery ◽  
Preoperative Care ◽  
Surgical Patient ◽  
Emergency Laparotomy ◽  
Emergency General Surgery ◽  
Optimal Care ◽  
Level Of Evidence

Abstract Background Enhanced Recovery After Surgery (ERAS) protocols reduce length of stay, complications and costs for a large number of elective surgical procedures. A similar, structured approach appears to improve outcomes, including mortality, for patients undergoing high-risk emergency general surgery, and specifically emergency laparotomy. These are the first consensus guidelines for optimal care of these patients using an ERAS approach. Methods Experts in aspects of management of the high-risk and emergency general surgical patient were invited to contribute by the International ERAS® Society. Pubmed, Cochrane, Embase, and MEDLINE database searches on English language publications were performed for ERAS elements and relevant specific topics. Studies on each item were selected with particular attention to randomized controlled trials, systematic reviews, meta-analyses and large cohort studies, and reviewed and graded using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system. Recommendations were made on the best level of evidence, or extrapolation from studies on non-emergency patients when appropriate. The Delphi method was used to validate final recommendations. The guideline has been divided into two parts: Part 1—Preoperative Care and Part 2—Intraoperative and Postoperative management. This paper provides guidelines for Part 1. Results Twelve components of preoperative care were considered. Consensus was reached after three rounds. Conclusions These guidelines are based on the best available evidence for an ERAS approach to patients undergoing emergency laparotomy. Initial management is particularly important for patients with sepsis and physiological derangement. These guidelines should be used to improve outcomes for these high-risk patients.

scholarly journals The Indices of Cardiovascular Magnetic Resonance Derived Atrial Dynamics May Improve the Contemporary Risk Stratification Algorithms in Children with Hypertrophic Cardiomyopathy

2021 ◽  
Vol 10 (4) ◽  
pp. 650
Author(s):  
Lidia Ziółkowska ◽  
Łukasz Mazurkiewicz ◽  
Joanna Petryka ◽  
Monika Kowalczyk-Domagała ◽  
Agnieszka Boruc ◽  
...  
Keyword(s):  
Hypertrophic Cardiomyopathy ◽  
High Risk ◽  
Risk Stratification ◽  
Heart Association ◽  
The Novel ◽  
Identification Performance ◽  
Strong Trend ◽  
Prognostic Utility ◽  
Conduit Function ◽  
High Risk Children

Introduction: The most efficient risk stratification algorithms are expected to deliver robust and indefectible identification of high-risk children with hypertrophic cardiomyopathy (HCM). Here we compare algorithms for risk stratification in primary prevention in HCM children and investigate whether novel indices of biatrial performance improve these algorithms. Methods and Results: The endpoints were defined as sudden cardiac death, resuscitated cardiac arrest, or appropriate implantable cardioverter-defibrillator discharge. We examined the prognostic utility of classic American College of Cardiology/American Heart Association (ACC/AHA) risk factors, the novel HCM Risk-Kids score and the combination of these with indices of biatrial dynamics. The study consisted of 55 HCM children (mean age 12.5 ± 4.6 years, 69.1% males); seven had endpoints (four deaths, three appropriate ICD discharges). A strong trend (DeLong p = 0.08) was observed towards better endpoint identification performance of the HCM Risk-Kids Model compared to the ACC/AHA strategy. Adding the atrial conduit function component significantly improved the prediction capabilities of the AHA/ACC Model (DeLong p = 0.01) and HCM Risk-Kids algorithm (DeLong p = 0.04). Conclusions: The new HCM Risk-Kids individualised algorithm and score was capable of identifying high-risk children with very good accuracy. The inclusion of one of the atrial dynamic indices improved both risk stratification strategies.

scholarly journals Pre-NELA vs NELA – has anything changed, or is it just an audit exercise?

2016 ◽  
Vol 98 (8) ◽  
pp. 554-559 ◽  
Author(s):  
M Mak ◽  
AR Hakeem ◽  
V Chitre
Keyword(s):  
Critical Care ◽  
High Risk ◽  
Uneventful Recovery ◽  
Emergency Laparotomy ◽  
Mortality And Morbidity ◽  
High Risk Patients ◽  
Possum Score ◽  
Operative Severity Score ◽  
Risk Patients ◽  
Set Up

BACKGROUND Following evidence suggestive of high mortality following emergency laparotomies, the National Emergency Laparotomy Audit (NELA) was set up, highlighting key standards in emergency service provision. Our aim was to compare our NHS trust’s adherence to these recommendations immediately prior to, and following, the launch of NELA, and to compare patient outcome. METHODS This was a retrospective study of patients who underwent an emergency laparotomy over the course of 6 months – 3 months either side of the initiation of NELA. RESULTS There were 44 patients before the initiation of NELA (pre-NELA, PN group) and 55 in the first 3 months of NELA (N group). We saw a significant increase in the proportion of patients whose decision to operate was made by the consultant: 75.0% in the PN group vs 100% in N group (subsequent data presented in this order) (P < 0.001). The presence of a consultant surgeon (75.0% vs 83.6%, P = 0.321) and anaesthetist (100.0% vs 90.9%, P = 0.064) in theatres were comparable in both groups. Risk stratification based on Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and Morbidity (P-POSSUM) score showed no difference in high-risk patients in both groups (47.7% vs 36.4%, P = 0.306). With the NELA initiative, however, significantly more patients were admitted directly from theatres to the critical care unit, when compared with the pre-NELA period (9.1% vs 27.3%, P = 0.038). This also reflected a significant reduction in unexpected escalation to a higher level of care during this period (10.0% vs 0%, P = 0.036). Significantly more patients had uneventful recovery in the NELA period (52.3 vs 76.4%, P = 0.018), although there was no difference in 30-day mortality between the groups (2.3% vs 7.3%, P = 0.378). CONCLUSIONS This study demonstrated a greater degree of consultant involvement in the decision to operate during NELA. More high-risk patients have been identified preoperatively with diligent risk assessment and, hence, have been proactively admitted to critical care units following laparotomy, which may account for the significant reduction in unexpected escalation to level 2 or level 3 care and thus in overall better patient outcomes.

scholarly journals Tension pneumoperitoneum: a very rare complication of acute gangrenous appendicitis

2016 ◽  
Vol 98 (8) ◽  
pp. e197-e199 ◽  
Author(s):  
P Das ◽  
R Mukherjee ◽  
D Pathak ◽  
A Gangopadhyay ◽  
S Halder ◽  
...  
Keyword(s):  
Rare Complication ◽  
Abdominal Distension ◽  
Exploratory Laparotomy ◽  
Hemodynamic Instability ◽  
Gangrenous Appendicitis ◽  
Free Air ◽  
Tension Pneumoperitoneum ◽  
Emergency Measure ◽  
Intraperitoneal Free Air ◽  
Needle Decompression

Tension pneumoperitoneum is a very rare consequence of acute gangrenous appendicitis. We report a case of a 32-year-old woman who presented with abdominal pain, progressively increasing abdominal distension, profound hemodynamic instability and ventilatory compromise. The diagnosis of tension pneumoperitoneum was confirmed by computed tomography, which showed compression of the intra-abdominal viscera and liver (saddlebag sign) by a large volume of intraperitoneal free air. Urgent needle decompression was done as an emergency measure. Exploratory laparotomy, planned due to persistent peritonitis, revealed gangrenous appendicitis with perforation near its base. Appendicectomy with excision of gangrenous portion of caecum was performed. The purpose of the reporting this case is to highlight that the tension pneumoperitoneum can be, very rarely, associated with gangrenous appendicitis and timely diagnosis is very important for the emergency management of this deadly condition.

scholarly journals Establishment of a novel scoring model for mortality risk prediction in HIV-infected patients with cryptococcal meningitis

2021 ◽  
Author(s):  
Ting Zhao ◽  
Xiao-Lei Xu ◽  
Jing-Min Nie ◽  
Xiao-Hong Chen ◽  
Zhong-Sheng Jiang ◽  
...  
Keyword(s):  
High Risk ◽  
Risk Prediction ◽  
Mortality Risk ◽  
Cryptococcal Meningitis ◽  
Area Under Curve ◽  
The Novel ◽  
Multicenter Cohort Study ◽  
Scoring Model ◽  
Risk Of Death ◽  
Prediction Probability

Abstract Purpose: Cryptococcal meningitis (CM) remains a leading cause of death in HIV-infected patients, despite advances in CM diagnostic and therapeutic strategies. This study was performed with the aim to develop and validate a novel scoring model to predict mortality risk in HIV-infected patients with CM (HIV/CM).Methods: Data on HIV/CM inpatients were obtained from a Multicenter Cohort study in China. Independent risk factors associated with mortality were identified based on data from 2013 to 2017, and a novel scoring model for mortality risk prediction was established. The prediction probability of the novel model was evaluated and verified using data from 2018 to 2020.Results: We found that six predictors, including age, stiff neck, impaired consciousness, intracranial pressure, CD4+ T-cell count, and urea levels, were associated with poor prognosis in HIV/CM patients. The novel scoring model could effectively identify HIV/CM patients at high risk of death on admission (area under curve 0.876; p＜0.001). When the cut-off value of 5.5 points or more was applied, the sensitivity and specificity was 74.1% and 83.8%, respectively. Additionally, our scoring model showed a good discriminatory ability in the validation cohort (area under curve 0·886; p＜0.001).Conclusions: Our developed scoring model of six variables is simple, convenient, and accurate for screening high-risk patients with HIV/CM, which may be a useful tool for physicians to assess prognosis in HIV/CM inpatients.

scholarly journals Our experience of the novel “flexible stylet method” for insertion of PD catheter in eight high-risk patients

2016 ◽  
Vol 2 (1) ◽  
Author(s):  
Hiroyuki Terawaki ◽  
Naotaro Fukushima ◽  
Keiko Aoyagi ◽  
Aya Nakajima ◽  
Masaaki Nakayama ◽  
...  
Keyword(s):  
High Risk ◽  
The Novel ◽  
High Risk Patients ◽  
Risk Patients

Artificial Intelligence for the Online Prediction of the Cool-down Time in a Subsea Pipeline After an Unplanned Shutdown

2021 ◽  
Author(s):  
Alberto Gerri ◽  
Ahmed Shokry ◽  
Enrico Zio ◽  
Marco Montini
Keyword(s):  
High Risk ◽  
Operating Conditions ◽  
Low Risk ◽  
Minimum Time ◽  
Computational Time ◽  
Risk Level ◽  
Support Vector ◽  
Svm Classifier ◽  
The Novel ◽  
Subsea Pipelines

Abstract Hydrates formation in subsea pipelines is one of the main reliability concerns for flow assurance engineers. A fast and reliable assessment of the Cool-Down Time (CDT), the period between a shut-down event and possible hydrates formation in the asset, is of key importance for the safety of operations. Existing methods for the CDT prediction are highly dependent on the use of very complex physics-based models that demand large computational time, which hinders their usage in an online environment. Therefore, this work presents a novel methodology for the development of surrogate models that predict, in a fast and accurate way, the CDT in subsea pipelines after unplanned shutdowns. The proposed methodology is, innovatively, tailored on the basis of reliability perspective, by treating the CDT as a risk index, where a critic CDT threshold (i.e. the minimum time needed by the operator to preserve the line from hydrates formation) is considered to distinguish the simulation outputs into high-risk and low-risk domains. The methodology relies on the development of a hybrid Machine Learning (ML) based model using datasets generated through complex physics-based model’ simulations. The hybrid ML-based model consists of a Support Vector Machine (SVM) classifier that assigns a risk level (high or low) to the measured operating condition of the asset, and two Artificial Neural Networks (ANNs) for predicting the CDT at the high-risk (low CDT) or the low-risk (high CDT) operating conditions previously assigned by the classifier. The effectiveness of the proposed methodology is validated by its application to a case study involving a pipeline in an offshore western African asset, modelled by a transient physics-based commercial software. The results show outperformance of the capabilities of the proposed hybrid ML-based model (i.e., SVM + 2 ANNs) compared to the classical approach (i.e. modelling the entire system with one global ANN) in terms of enhancing the prediction of the CDT during the high-risk conditions of the asset. This behaviour is confirmed applying the novel methodology to training datasets of different size. In fact, the high-risk Normalized Root Mean Square Error (NRMSE) is reduced on average of 15% compared to the NRMSE of a global ANN model. Moreover, it’s shown that high-risk CDT are better predicted by the hybrid model even if the critic CDT, which divides the simulation outputs in high-risk and low-risk values (i.e. the minimum time needed by the operator to preserve the line from hydrates formation), changes. The enhancement, in this case, is on average of 14.6%. Eventually, results show how the novel methodology cuts down by more than one hundred seventy-eight times the computational times for online CDT predictions compared to the physics-based model.

Anaesthetic considerations for emergency laparotomy

Nowa Medycyna ◽  
2020 ◽  
Vol 27 (3) ◽  
Author(s):  
Jacek Wadełek
Keyword(s):  
Risk Assessment ◽  
Decision Making ◽  
High Risk ◽  
Adverse Outcomes ◽  
Emergency Laparotomy ◽  
Life Threatening ◽  
The Right ◽  
Level Of Experience ◽  
Time Frames ◽  
Reduced Time

The majority of patients undergoing emergency laparotomy have potentially life?threatening conditions that require prompt intervention. The reduced time?frames available due to surgical urgency necessitate prompt and senior decision?making to minimise delays. The time taken to correct any anomalies needs to be balanced against the need for prompt surgery, particularly in time?sensitive situations involving sepsis or hypovolaemia. Therefore, corrective measures may be performed in parallel with surgery. Patients undergoing emergency laparotomy are at a high risk of adverse outcomes. Key elements of care for these patients include repeated risk assessment, early antibiotic therapy, as well as fluid resuscitation and appropriate timely interventions provided by clinicians with the right level of experience.

Clinical experience with new formulation SUBA®-itraconazole for prophylaxis in patients undergoing stem cell transplantation or treatment for haematological malignancies

2019 ◽  
Vol 74 (10) ◽  
pp. 3049-3055 ◽  
Author(s):  
Blake Nield ◽  
Stephen R Larsen ◽  
Sebastiaan J van Hal
Keyword(s):  
High Risk ◽  
Therapeutic Drug ◽  
The Novel ◽  
Haematological Malignancies ◽  
Patient Demographics ◽  
Drug Concentrations ◽  
Study Population ◽  
Trough Concentrations ◽  
New Formulation ◽  
Gastric Acid Suppression

AbstractBackgroundSUper BioAvailability-itraconazole (SUBA®-itraconazole) was introduced into Australia in April 2014 as a substitute for standard itraconazole on the basis of improved bioavailability, tolerance and interpatient variability. Shortly after its introduction, our centre converted to the novel formulation for mould prophylaxis in patients undergoing allogeneic HSCT, autologous HSCT or treatment for haematological malignancies with an intermediate/high risk of invasive fungal infection (IFI).MethodsA single-institution, investigator-initiated retrospective cohort study was conducted between June 2016 and April 2018 to assess therapeutic drug concentrations, safety and tolerability of a standard prophylactic dose of SUBA®-itraconazole.ResultsA total of 74 patients were assessed across 98 admissions with 178 measured itraconazole trough concentrations. The median duration of prophylaxis was 15.5 (1–59) days. No significant correlation was identified between trough concentrations and patient demographics including gender and weight. Drug concentrations were reduced by gastric acid suppression and diarrhoea. Therapeutic itraconazole trough concentrations (≥0.5 mg/L) were achieved at a median of 7 (95% CI = 6–8) days, with 87% of patients achieving therapeutic concentrations at day 14 (expected steady-state). One (1%) proven/probable IFI and 5 (5%) possible breakthrough IFIs were identified. Although adverse events were experienced by 42% of the cohort, only a single event was directly attributable to SUBA®-itraconazole, resulting in change of prophylactic agent.ConclusionsSUBA®-itraconazole achieved rapid therapeutic trough concentrations, was associated with low rates of IFI and was well tolerated in the study population. This formulation should be considered a realistic and safe first-line agent for the prevention of IFIs in those undergoing HSCT and intermediate/high-risk therapy for haematological malignancies.

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