Internal and emergency medicine
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Observational Study
Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes.
Pericardial effusion can dangerously precipitate patient's hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010-2019). ⋯ Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65-20.01, and OR 5.81, 95% CI 2.11-15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45-11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.
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The purpose of this study is to report our experiences over 12 years with bronchoscopic interventions in patients with benign central airway stenosis using three types of working channels (rigid bronchoscope, laryngeal mask, and endotracheal intubation), with a focus on their related advantages, disadvantages, and postoperative complications. We analyzed the clinical data from 273 patients with benign central airway stenosis who underwent a bronchoscopic intervention. The Wilcoxon rank-sum test was used to analyze the immediate results after the first bronchoscopic intervention, and the Chi-square test was used to analyze the correlation between glottic edema and operation time. ⋯ And the incidence rate was significantly correlated with the operation time (P < 0.01). Therefore, for patients with benign central airway stenosis, the best choice of working channel during an operation should be made by the operation procedure, lesion location, and pathology of the patients. Shortening the operation time was an important factor in preventing glottic edema.
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Dealing with emergencies is a critical responsibility of physicians-in-training. Residents typically lead cardio-pulmonary resuscitation efforts in a teaching hospital. A 'Code Blue' is a situation that is highly challenging, time sensitive and very often highly anxiety-provoking. Recently, there is greater recognition of the need and value of integrating specific psychological performance skills training to better manage the stress of critical situations. In this study, we sought to evaluate the impact of including a psychological skills training program with BLS/ACLS training for performance and confidence optimization and mitigation of anxiety in 1 year residents related to participating in and leading emergency resuscitations. ⋯ The results of this study demonstrate that BLS/ACLS training can positively influence anxiety and confidence in residents related to their resuscitation skills, especially if combined with psychological skills training. Future studies should evaluate the incremental value of including psychological skills training with BLS/ACLS and its impact on enhancing physical performance skills.