scholarly journals Primary versus Staged Closure of Exomphalos Major: Cardiac Anomalies Do Not Affect Outcome

2017 ◽  
Vol 28 (03) ◽  
pp. 279-284 ◽  
Author(s):  
Clare Rees ◽  
Lucinda Tullie ◽  
Agostino Pierro ◽  
Edward Kiely ◽  
Joe Curry ◽  
...  
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Primary Closure ◽  
Single Center ◽  
Fascial Defect ◽  
Pentalogy Of Cantrell ◽  
Cardiac Anomalies ◽  
Intensive Care Stay ◽  
Congenital Cardiac Anomalies ◽  
Liver Herniation

Aim The objective of the study is to describe management of exomphalos major and investigate the effect of congenital cardiac anomalies. Methods A single-center retrospective review (with audit approval) was performed of neonates with exomphalos major (fascial defect ≥ 5cm ± liver herniation) between 2004 and 2014.Demographic and operative data were collected and outcomes compared between infants who had primary or staged closure. Data, median (range), were analyzed appropriately. Results A total of 22 patients were included, 20 with liver herniation and 1 with pentalogy of Cantrell. Gestational age was 38 (30–40) weeks, birth weight 2.7 (1.4–4.6) kg, and 13 (60%) were male. Two were managed conservatively due to severe comorbidities, 5 underwent primary closure, and 15 had application of Prolene (Ethicon Inc) mesh silo and serial reduction. Five died, including two managed conservatively, none primarily of the exomphalos. Survivors were followed up for 38 months (2–71). Cardiac anomalies were present in 20 (91%) patients: 8 had minor and 12 major anomalies. Twelve (55%) patients had other anomalies. Primary closure was associated with shorter length of stay (13 vs. 85 days, p = 0.02), but infants had similar lengths of intensive care stay, duration of parenteral feeds, and time to full feeds. Infants with cardiac anomalies had shorter times to full closure (28 vs. 62 days, p = 0.03), but other outcomes were similar. Conclusion Infants whose defect can be closed primarily have a shorter length of stay, but other outcomes are similar. Infants with more significant abdominovisceral disproportion are managed with staged closure; the presence of major cardiac anomalies does not affect surgical outcome.

scholarly journals Hyperlactatemia and Lactic Acidosis Results in Longer Stay in Intensive Care Units (ICUs) and Development of Co-morbid in Post-operative Cardiac Surgery Patients

2016 ◽  
Vol 1 (05) ◽  
Author(s):  
Junaid Mahmood Alam ◽  
Aijaz Ahmed, ◽  
Ishrat Sultana ◽  
Syed Riaz Mahmood
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Length Of Stay ◽  
Lactic Acidosis ◽  
Intensive Care Units ◽  
Lactate Level ◽  
Normal Range ◽  
Intensive Care Stay ◽  
Pulmonary Abnormalities

Pathology of Hyperlactatemia and lactic acidosis is convoluted, including tissue hypoxia, pulmonary abnormalities, Ischemic shock, hypohemoglobinemia and generalized an-aerobic conditions. All or any one of these conditions may have occurred due to surgical intervention, long-term cardiogeneic syndromes or after long Intensive care stay. Present study described the assessment and correlation of post-operative Hyperlactatemia in cardiac surgery patients to the longer length of stay in Intensive care units (ICUs). Pre-operative and Post operative blood samples were analyzed in seventy five (Males = 59, females = 16) cardiac surgery patients for Lactate and other biochemical parameters were according to the prescribed methods. Post-operative blood sample analyses were also performed 4-6 hrs after surgery and after 24 hrs post-operatively. Six hours postoperative assessment of lactate, showed alerted levels, manifesting post-operative complications and development of co-morbid. It was also noted that patients (n = 21) with higher lactate >20mg/dl had to stay longer in ICUs (12-18 days stay, average 16.15 ± 2.50 days) as compared to those (n = 54) with normal range of lactate level (5-9 days stay, average 7.20 ± 2.10 days). It is thus concluded that post-operative Hyperlactatemia and lactic acidosis in cardiac surgery patients is a significant condition to detect poor outcome. Additionally post-operative lactate level can predict length of stay in ICUs and any prospect of developing adverse outcome and co-morbid.

Predictors for a prolonged intensive care stay after heart surgery

2004 ◽  
Vol 52 (S 1) ◽  
Author(s):  
J Sch�ttler ◽  
S Petersen ◽  
A B�ning ◽  
M Brandt ◽  
F Sch�neich ◽  
...  
Keyword(s):  
Intensive Care ◽  
Heart Surgery ◽  
Intensive Care Stay

Nutrition deficit during intensive care stay: incidence, predisposing factors and outcomes

2020 ◽  
Vol 86 (5) ◽  
Author(s):  
Juho P. Nurkkala ◽  
Timo I. Kaakinen ◽  
Merja A. Vakkala ◽  
Tero I. Ala-Kokko ◽  
Janne H. Liisanantti
Keyword(s):  
Intensive Care ◽  
Predisposing Factors ◽  
Intensive Care Stay

scholarly journals Colonization and Infection With MRSA and CRKP and Its Result in an Increased Mortality Rate Within the Intensive Care and High-Dependency Units in Barbados

2020 ◽  
Vol 41 (S1) ◽  
pp. s173-s174
Author(s):  
Keisha Gustave
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
High Mortality ◽  
Average Length ◽  
Cohort Analysis ◽  
Health Concern ◽  
Queen Elizabeth Hospital ◽  
Surveillance Program ◽  
Average Length Of Stay ◽  
High Dependency

Background: Methicillin-resistant Staphylococcus aureus(MRSA) and carbapenem-resistant Klebsiella pneumoniae (CRKP) are a growing public health concern in Barbados. Intensive care and critically ill patients are at a higher risk for MRSA and CRKP colonization and infection. MRSA and CRKP colonization and infection are associated with a high mortality and morbidly rate in the intensive care units (ICUs) and high-dependency units (HDUs). There is no concrete evidence in the literature regarding MRSA and CRKP colonization and infection in Barbados or the Caribbean. Objectives: We investigated the prevalence of MRSA and CRKP colonization and infection in the patients of the ICU and HDU units at the Queen Elizabeth Hospital from 2013 to 2017. Methods: We conducted a retrospective cohort analysis of patients admitted to the MICU, SICU, and HDU from January 2013 through December 2017. Data were collected as part of the surveillance program instituted by the IPC department. Admissions and weekly swabs for rectal, nasal, groin, and axilla were performed to screen for colonization with MRSA and CRKP. Follow-up was performed for positive cultures from sterile isolates, indicating infection. Positive MRSA and CRKP colonization or infection were identified, and patient notes were collected. Our exclusion criteria included patients with a of stay of <48 hours and patients with MRSA or CRKP before admission. Results: Of 3,641 of persons admitted 2,801 cases fit the study criteria. Overall, 161 (5.3%) were colonized or infected with MRSA alone, 215 (7.67%) were colonized or infected with CRKP alone, and 15 (0.53%) were colonized or infected with both MRSA and CRKP. In addition, 10 (66.6%) of patients colonized or infected with MRSA and CRKP died. Average length of stay of patients who died was 50 days. Conclusions: The results of this study demonstrate that MRSA and CRKP cocolonization and coinfection is associated with high mortality in patients within the ICU and HDU units. Patients admitted to the ICU and HDU with an average length of stay of 50 days are at a higher risk for cocolonization and coinfection with MRSA and CRKP. Stronger IPC measures must be implemented to reduce the spread and occurrence of MRSA and CRKP.Funding: NoneDisclosures: None

scholarly journals Outcomes of non-COVID-19 critically ill patients during the COVID-19 pandemic

2021 ◽  
Author(s):  
Răzvan Bologheanu ◽  
Mathias Maleczek ◽  
Daniel Laxar ◽  
Oliver Kimberger
Keyword(s):  
Intensive Care ◽  
Length Of Stay ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Specialty ◽  
Routine Care ◽  
Treatment Pathways ◽  
Icu Length Of Stay ◽  
Matched Study ◽  
The Impact

Summary Background Coronavirus disease 2019 (COVID-19) disrupts routine care and alters treatment pathways in every medical specialty, including intensive care medicine, which has been at the core of the pandemic response. The impact of the pandemic is inevitably not limited to patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and their outcomes; however, the impact of COVID-19 on intensive care has not yet been analyzed. Methods The objective of this propensity score-matched study was to compare the clinical outcomes of non-COVID-19 critically ill patients with the outcomes of prepandemic patients. Critically ill, non-COVID-19 patients admitted to the intensive care unit (ICU) during the first wave of the pandemic were matched with patients admitted in the previous year. Mortality, length of stay, and rate of readmission were compared between the two groups after matching. Results A total of 211 critically ill SARS-CoV‑2 negative patients admitted between 13 March 2020 and 16 May 2020 were matched to 211 controls, selected from a matching pool of 1421 eligible patients admitted to the ICU in 2019. After matching, the outcomes were not significantly different between the two groups: ICU mortality was 5.2% in 2019 and 8.5% in 2020, p = 0.248, while intrahospital mortality was 10.9% in 2019 and 14.2% in 2020, p = 0.378. The median ICU length of stay was similar in 2019: 4 days (IQR 2–6) compared to 2020: 4 days (IQR 2–7), p = 0.196. The rate of ICU readmission was 15.6% in 2019 and 10.9% in 2020, p = 0.344. Conclusion In this retrospective single center study, mortality, ICU length of stay, and rate of ICU readmission did not differ significantly between patients admitted to the ICU during the implementation of hospital-wide COVID-19 contingency planning and patients admitted to the ICU before the pandemic.

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