scholarly journals Value of Extended Warming in Patients Undergoing Elective Surgery

2015 ◽  
Vol 100 (1) ◽  
pp. 105-108 ◽  
Author(s):  
Tarik J. Wasfie ◽  
Kimberly R. Barber
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Core Temperature ◽  
Surgical Outcomes ◽  
Elective Surgery ◽  
Temperature Management ◽  
Relative Decrease ◽  
Temperature Controlled ◽  
Status Survey

Abstract Perioperative temperature management is imperative for positive surgical outcomes. This study assessed the clinical and wellbeing benefits of extending normothermia by using a portable warming gown. A total of 94 patients undergoing elective surgery were enrolled. They were randomized pre-operatively to either a portable warming gown or the standard warming procedure. The warming gown stayed with patients from pre-op to operating room to postrecovery room discharge. Core temperature was tracked throughout the study. Patients also provided responses to a satisfaction and comfort status survey. The change in average core temperature did not differ significantly between groups (P = 0.23). A nonsignificant 48% relative decrease in hypothermic events was observed for the extended warming group (P = 0.12). Patients receiving the warming gown were more likely to report always having their temperature controlled (P = 0.04) and significantly less likely to request additional blankets for comfort (P = 0.006). Clinical outcomes and satisfaction were improved for patients with extended warming.

scholarly journals Effects of Target Temperature Management on the Outcome of Septic Patients with Fever

2017 ◽  
Vol 2017 ◽  
pp. 1-10 ◽  
Author(s):  
Ye Gao ◽  
Jianjun Zhu ◽  
Chenyu Yin ◽  
Jianliang Zhu ◽  
Tao Zhu ◽  
...  
Keyword(s):  
Low Temperature ◽  
Clinical Outcomes ◽  
Core Temperature ◽  
T Lymphocyte ◽  
Temperature Management ◽  
Target Temperature Management ◽  
Target Temperature ◽  
Hemodynamic Changes ◽  
Temperature Group ◽  
Immune Factors

Objectives. To investigate the effects of target temperature management on hemodynamic changes, inflammatory and immune factors, and clinical outcomes of sepsis patients with fever. Methods. Patients diagnosed with sepsis with a core temperature of ≥39°C were randomly divided into two groups: a low-temperature group (LT group: 36.5°C–38°C) and a high-temperature group (HT group: 38.5°C–39.5°C). A target core temperature was achieved within 6 hrs posttreatment and maintained for 24 hrs. Then, the hemodynamic changes, inflammatory and immune factors, and clinical outcomes were evaluated. Results. Compared with the HT group, C-reactive protein (CRP), procalcitonin (PCT), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) showed a significant decrease in the LT group (P<0.05). In contrast, IL-4 and IL-10 were higher in the LT group than in the HT group (P<0.05). The CD4-T lymphocyte (CD4+), CD8-T lymphocyte (CD8+), and monocytic human leukocyte antigen-DR (mHLA-DR) in the LT group were higher than in the HT group (P<0.05). The ICU stay and the anti-infection treatment costs were higher in the LT group (P<0.05). Conclusion. Low-temperature management of patients resulted in a low level of proinflammatory cytokines. Excessive temperature control in sepsis patients with fever may be harmful.

Impact of Hybrid Operating Rooms on Long-Term Clinical Outcomes Following Fenestrated and Branched Endovascular Aortic Repair

2021 ◽  
pp. 152660282199672
Author(s):  
Giovanni Tinelli ◽  
Marie Bonnet ◽  
Adrien Hertault ◽  
Simona Sica ◽  
Gian Luca Di Tanna ◽  
...  
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Cox Regression ◽  
Statistical Significance ◽  
Aortic Aneurysms ◽  
Study Patient ◽  
Cox Regression Analysis ◽  
Significant Difference ◽  
The Impact

Purpose: Evaluate the impact of hybrid operating room (HOR) guidance on the long-term clinical outcomes following fenestrated and branched endovascular repair (F-BEVAR) for complex aortic aneurysms. Materials and Methods: Prospectively collected registry data were retrospectively analyzed to compare the procedural, short- and long-term outcomes of consecutive F-BEVAR performed from January 2010 to December 2014 under standard mobile C-arm versus hybrid room guidance in a high-volume aortic center. Results: A total of 262 consecutive patients, including 133 patients treated with a mobile C-arm equipped operating room and 129 with a HOR guidance, were enrolled in this study. Patient radiation exposure and contrast media volume were significantly reduced in the HOR group. Short-term clinical outcomes were improved despite higher case complexity in the HOR group, with no statistical significance. At a median follow-up of 63.3 months (Q1 33.4, Q3 75.9) in the C-arm group, and 44.9 months (Q1 25.1, Q3 53.5, p=0.53) in the HOR group, there was no statistically significant difference in terms of target vessel occlusion and limb occlusion. When the endograft involved 3 or more fenestrations and/or branches (complex F-BEVAR), graft instability (36% vs 25%, p=0.035), reintervention on target vessels (20% vs 11%, p=0.019) and total reintervention rates (24% vs 15%, p=0.032) were significantly reduced in the HOR group. The multivariable Cox regression analysis did not show statistically significant differences for long-term death and aortic-related death between the 2 groups. Conclusion: Our study suggests that better long-term clinical outcomes could be observed when performing complex F-BEVAR in the latest generation HOR.

Blood, Sweat, Toil, and Tears of Surgical Training. Part I: Blood

2007 ◽  
Vol 15 (4) ◽  
pp. 307-309 ◽  
Author(s):  
Andrew J Drain ◽  
Jonathon I Ferguson ◽  
Sharon Wilkinson ◽  
Samer AM Nashef
Keyword(s):  
Adverse Effect ◽  
Blood Loss ◽  
Operating Room ◽  
Clinical Outcomes ◽  
Surgical Training ◽  
Clinical Service ◽  
Significant Difference ◽  
Potential Impact ◽  
The Impact ◽  
Cardiac Operations

There may be conflict between the requirements of surgical training and those of the clinical service if training has an impact on clinical outcomes. One area of potential impact is perioperative blood loss. We compared total and 12-hour blood loss after 2,079 consecutive cardiac operations performed over 2 years by trainees and consultants. One- and two-way analyses of variance with EuroSCORE and surgeon status as factors were carried out to evaluate the impact of surgeon status on blood loss. There was no difference in blood loss between consultants and trainees. We also compared the rates between consultants and trainees of patients returning to the operating room due to bleeding. This showed a significant difference, with trainees having a higher rate of investigation for bleeding. Cardiac surgical training can be achieved without an adverse effect on blood loss, but it may be associated with a higher rate of re-intervention for bleeding.

Abstract 10475: Heat Loss Augmented by Extracorporeal Circulation is Associated with Overcooling in Cardiac Arrest Survivors Who Underwent Targeted Temperature Management

Circulation ◽  
2021 ◽  
Vol 144 (Suppl_2) ◽  
Author(s):  
Byungkook Lee ◽  
Dong Hun Lee
Keyword(s):  
Water Temperature ◽  
Core Temperature ◽  
Neurological Outcome ◽  
Temperature Management ◽  
Extracorporeal Circuit ◽  
Matched Cohort ◽  
Maintenance Period ◽  
Neurological Outcomes ◽  
The Core ◽  
Poor Neurological Outcome

Introduction: Extracorporeal circuit-based salvage therapy can affect targeted temperature management (TTM) in comatose out-of-hospital cardiac arrest (OHCA) survivors. We investigated the association of patients with extracorporeal device with TTM and neurological outcome. Methods: We performed a retrospective analysis using prospectively collected data from adult comatose OHCA survivors who underwent TTM between October 2015 and December 2020. We defined patients with ECMO and/or CRRT as the extracorporeal group. We calculated the cooling rate during the induction period; the minimum, maximum, and mean time-weighted core temperatures (TWCT), and the standard deviation (SD) of the core temperature and water temperature during the maintenance period based on the temperature measured every minute. We defined the sum of TWCT more and less than 33°C as positive and negative TWCT, respectively. The primary outcome was a poor neurological outcome, defined as cerebral performance category 3-5. We used propensity score (PS) matching to adjust the characteristics of patients who required an extracorporeal circuit device. Results: Of the 223 included patients, 140 (62.8%) patients had poor neurological outcome and 40 (17.9%) patients were categorized into the extracorporeal group. The extracorporeal group had a rapid cooling rate (2.08°C/h [1.13-3.73] vs. 1.24°C/h [0.77-1.79]; p < 0.001). The extracorporeal group had lower mean core temperature; higher core temperature SD; lower positive TWCT; higher negative TWCT; and higher maximum, minimum, and mean water temperature than the no-extracorporeal group. In PS matched cohort, the extracorporeal group had a lower minimum core temperature, lower mean core temperature, higher core temperature SD, higher negative TWCT, higher maximum water temperature, and higher mean water temperature. The neurological outcomes were not different between the two groups, in either the whole or PS-matched cohort. Conclusions: The extracorporeal group achieved the target temperature earlier. The core temperature distribution during the maintenance period was further skewed below 33°C in the extracorporeal group. The extracorporeal group had similar neurological outcomes to the no-extracorporeal group.

scholarly journals Hemorrhage in long segment cervical schwannoma; case report and literature review

2020 ◽  
Vol 11 ◽  
pp. 476
Author(s):  
Prashant Raj Singh ◽  
Nitish Nayak ◽  
Surendra Kumar Gupta ◽  
Raghavendra Kumar Sharma ◽  
Anju Shukla ◽  
...  
Keyword(s):  
Case Report ◽  
Literature Review ◽  
Clinical Outcomes ◽  
Surgical Outcomes ◽  
Multiple Factors ◽  
Pathological Characteristics ◽  
S 100 ◽  
Subdural Hemorrhages ◽  
The One ◽  
Subarachnoid Hemorrhages

Background: Although hemorrhages associated with cervical and thoracic intraspinal schwannomas are typically localized to the subarachnoid hemorrhages (SAH) or subdural hemorrhages (SDH) compartments, rare intratumoral bleeds may also occur. Methods: In the literature, we found and analyzed multiple factors for 13 cases (e.g., epidemiological, clinical, and pathological) of cervical schwannomas with intratumoral hemorrhages (ITH). We added the 14th case of a 35-year-old female with along segment cervical schwannoma with ITH who presented with acute quadriplegia and respiratory decompensation. Results: These 14 patients averaged 51.77 years of age, 60% were male, and the tumor involved 2.83 segments. The incidence of SAH and ITH was noted in five cases each, while SDH’s were very rare. The pathological characteristics were consistent with the diagnosis of cellular schwannomas with S-100 positivity. The clinical outcomes were good (100%) in all the cases, including the one presented (modified McCormick score III). Conclusion: Cervical schwannomas with ITH are rare, and the surgical outcomes in such patients are good-excellent (>90%). The histopathology is always of prime importance and decisive in establishing and confirming the etiology of such ITH.

Surgical outcomes are hampered after endoscopic ultrasonography-guided ethanol lavage and/or Taxol injection in cystic lesions of the pancreas

2021 ◽  
Author(s):  
Seong-Ryong Kim ◽  
Kwang-Min Park ◽  
Dae Wook Hwang ◽  
Jae Hoon Lee ◽  
Sang Hyun Shin ◽  
...  
Keyword(s):  
Distal Pancreatectomy ◽  
Clinical Outcomes ◽  
Endoscopic Ultrasonography ◽  
Surgical Outcomes ◽  
Pancreatic Head ◽  
Laparoscopic Distal Pancreatectomy ◽  
Ductal Adenocarcinoma ◽  
Cystic Tumor ◽  
Solid Pseudopapillary Tumor ◽  
Cystic Lesions

Abstract Background and Aims Endoscopic ultrasonography-guided ethanol lavage and Taxol injection (EUS-ELTI) in pancreatic cystic lesions have been recently performed in some medical centers. This study aimed to optimize the patient selection and analyze the outcomes in patients who underwent surgery after EUS-ELTI in pancreatic cystic lesions. Methods Among 310 patients who underwent EUS-ELTI between January 2007 and December 2014, 23 underwent surgery after EUS-ELTI owing to incomplete treatment and/or adverse events. We evaluated the surgical outcomes in patients who underwent surgery after EUS-ELTI. Then, we retrospectively compared the clinical outcomes of the patients who underwent the surgery after EUS-ELTI with those of patients who underwent upfront surgery for left-sided pancreatic lesions without the EUS-ELTI procedure. Results The pathology revealed degenerated cysts in 12 patients, mucinous cyst neoplasms in five patients, neuroendocrine tumors in two patients, and one intraductal papillary mucinous neoplasm (IPMN), one solid pseudopapillary tumor, one pancreatic ductal adenocarcinoma arising from an IPMN, and one hepatoid carcinoma. Twelve patients underwent laparoscopic distal pancreatectomy and five patients underwent open distal pancreatectomy. All six patients who had lesions in the pancreatic head underwent open pancreaticoduodenectomy. When we retrospectively compared the clinical outcomes between patients who underwent laparoscopic distal pancreatectomy after EUS-ELTI and those who did not receive the EUS-ELTI procedure, the spleen-preserving rate was 0% in the EUS-ELTI group and 61.7% (365/592) in the non-EUS-ELTI group (P < 0.001). Clinically relevant postoperative pancreatic fistulas occurred in 33.3% of patients in the EUS-ELTI group and in 6.8% of patients in the non-EUS-ELTI group (P = 0.025). The mean postoperative hospital stay was also shorter in the non-EUS-ELTI group than in the EUS-ELTI group (8.66 ± 5.66 and 13.56 ± 7.20, P = 0.032). Conclusion Surgical outcomes are compromised after EUS-ELTI in the cystic tumor of the pancreas. Further investigations are needed for investigation of the efficacy and safety of the EUS-ELTI procedure.

Abstract 338: Relationship Between Post-arrest Care Cardiac Index and Clinical Outcomes in Comatose Survivors of Out-of-hospital Cardiac Arrest: Insights From the CAPITAL-RETURN Trial

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Juan J Russo ◽  
Paul Boland ◽  
Simon Parlow ◽  
Rudy Unni ◽  
Pietro Di Santo ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiac Index ◽  
Clinical Outcomes ◽  
Primary Outcome ◽  
Temperature Management ◽  
Neurologic Dysfunction ◽  
Icu Admission ◽  
Shockable Rhythm ◽  
Hospital Cardiac Arrest ◽  
Capital Return

Introduction: Comatose survivors of out-of-hospital cardiac arrest (OHCA) have decreased cardiac index (CI) following return of spontaneous circulation. Although reversible, a reduced CI can contribute to cerebral hypoperfusion and impaired neurologic outcomes. We sought to examine the relationship between CI and clinical outcomes following OHCA. Methods: CAPITAL-RETURN was a prospective study examining hemodynamics in comatose survivors of OHCA undergoing targeted temperature management. Between August 2016 and December 2017, comatose survivors of OHCA with an initial shockable rhythm underwent continuous, blinded monitoring of CI using bioimpedance (Cheetah Medical, Portland, OR, USA) for 96 hours after intensive care unit (ICU) admission. In the present study, we examined the association between CI and the composite of death or severe neurologic dysfunction at 6 months (primary outcome) using logistic regression. Severe neurologic dysfunction was defined as a modified Rankin Scale score ≥4. We excluded patients who died or had withdrawal of advanced life support within 72 hours of ICU admission. Results: In 53 patients in this analysis (mean age 59±13 years, downtime 24±13 minutes, STEMI 35%), the rate of the primary outcome was 25%. The mean CI was lower in patients with (3.0±0.5 L/min/m 2 ) versus without (3.3±0.5 L/min/m 2 ) the primary outcome (p=0.018). A higher mean CI during the first 96 hours of ICU admission was associated with lower rates of the primary outcome (OR 0.85 per 0.1L/min/m 2 increase in CI; p=0.025). This association persisted after adjusting for age and downtime (OR 0.78 per 0.1L/min/m2 increase in CI; p=0.014). Cardiac index was similar in patients with versus without the primary outcome at the end of the 96-hour monitoring period (Figure). Conclusion: In comatose survivors of OHCA with an initial shockable rhythm, a higher CI during the first 96 hours of ICU admission is associated with lower rates of death or severe neurologic dysfunction.

scholarly journals Electroencephalography in Predicting Short-Term Clinical Outcomes after Cardiac Arrest

2020 ◽  
Vol 47 (4) ◽  
pp. 519-524
Author(s):  
Yun Ho Choi ◽  
In-Uk Song ◽  
Sung-Woo Chung ◽  
Taewon Kim
Keyword(s):  
Cardiac Arrest ◽  
Clinical Outcomes ◽  
Low Voltage ◽  
Burst Suppression ◽  
The Other ◽  
Temperature Management ◽  
Early Recovery ◽  
Significant Group ◽  
Gcs Score ◽  
Eeg Pattern

ABSTRACT:Background:Early consciousness recovery after cardiac arrest (CA) is one of the most explicit and self-evident prognostic factors for clinical outcomes. We aimed to evaluate the prognostic value of electroencephalography (EEG) phenotypes according to the American Clinical Neurophysiology Society’s Critical Care EEG classification for predicting early recovery after CA.Methods:Consecutive patients admitted to the ICU after CA were enrolled. We analyzed Glasgow Coma Scale (GCS) score within 10 days after CA and evaluated mortality within 28 days according to EEG pattern subtype.Results:Among the total of 71 patients, 9 had periodic discharges (PDs) EEG pattern, 4 had rhythmic delta activity (RDA), 8 had spike-and-wave (SW), 22 had low voltage, 5 had burst suppression, and 23 had other EEG patterns. Initial GCS scores, GCS scores 3 days after CA (or 3 days after targeted temperature management [TTM]), and 10 days after CA (or 10 days after TTM) were significantly different among EEG subtypes (p < 0.001, respectively) (Table 2). GCS scores were significantly higher in RDA and the other EEG group compared to the PDs, SW, low voltage, and burst suppression groups (p < 0.001). Significant group × time interactions were observed for the follow-up period between EEG phenotypes (p < 0.001) demonstrating the most increase in the other EEG pattern group.Conclusions:Consciousness states were significantly worse in the PDs, SW, burst suppression, and low-voltage groups compared to the RDA and the other EEG pattern within 10 days after CA. The degree of consciousness recovery differed significantly by EEG pattern subtype within 10 days.

Barbed and conventional sutures in spinal surgery patients: an economic and clinical outcomes comparison

2020 ◽  
Vol 29 (Sup5a) ◽  
pp. S9-S20
Author(s):  
Stephen S Johnston ◽  
Brian Po-Han Chen ◽  
Giovanni A Tommaselli ◽  
Simran Jain ◽  
John B Pracyk
Keyword(s):  
Operating Room ◽  
Clinical Outcomes ◽  
Spinal Surgery ◽  
Wound Closure ◽  
Index Admission ◽  
Barbed Suture ◽  
Wound Complications ◽  
Barbed Sutures ◽  
Significant Difference ◽  
Suture Group

Objective: To compare economic and clinical outcomes of barbed sutures versus conventional sutures alone in wound closure for patients undergoing spinal surgery. Method: A retrospective study using the Premier Healthcare Database. The database was searched for patients who underwent elective inpatient spinal surgery (fusion or laminectomy) for a spinal disorder between 1 January 2014 and 30 June 2018 (first=index admission). Using billing records for medical supplies used during the index admission, patients were classified into mutually-exclusive groups: patients with any use of STRATAFIX (Ethicon, US) knotless tissue control devices (barbed sutures group); or patients with use of conventional sutures alone (conventional sutures group). Outcomes included the index admission's length of stay, total and subcategories of hospital costs, non-home discharge, operating room time (ORT, minutes), wound complications and readmissions within ≤90 days. Propensity score matching and generalised estimating equations were used to compare outcomes between the study groups. Results: After matching, 3705 patients were allocated to each group (mean age=61.5 years [standard deviation, SD±12.9]; 54% were females). Compared with the conventional suture group, the barbed suture group had significantly lower mean ORT (239±117 minutes, versus 263±79 minutes conventional sutures, p=0.015). Operating room costs were also siginificantly lower in the barbed suture group ($6673±$3976 versus $7100±$2700 conventional sutures, p=0.020). Differences were statistically insignificant for other outcomes (all p>0.05). Subanalysis of patients undergoing fusions of ≥2 vertebral joints yielded consistent results. Conclusion: In this study, wound closure incorporating barbed sutures was associated with lower ORT and operating room costs, with no significant difference in wound complications or readmissions, when compared with conventional sutures alone.

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