American journal of surgery
-
The traditional approach to decompression of the thoracic outlet has been by transaxillary resection of the first rib. Recently, the trend has been toward a more selective and tailored surgical approach via the supraclavicular route. ⋯ A selective approach to thoracic outlet decompression, consisting of anterior scalenectomy and brachial plexus neurolysis for neurogenic symptoms, and reserving first rib resection for arterial and venous indications, is a safe procedure and yields satisfactory results in appropriately selected patients.
-
Respiratory failure secondary to a variety of causes remains a significant cause of morbidity and mortality in the pediatric population. Newer therapies are appearing frequently in an attempt to decrease the number of deaths from this disease state. We briefly review the current literature on some of the newer modalities including: high-frequency ventilation, surfactant, liquid ventilation, and nitric oxide. We then present our experience from the past 11 years in the most invasive, yet successful, therapy for acute respiratory failure-extracorporeal membrane oxygenation (ECMO). ⋯ While the newer treatment modalities discussed may have an important role in treating neonatal and pediatric respiratory failure in the near future, ECMO remains a cornerstone of the modern treatment modalities. Although somewhat invasive, ECMO is effective therapy with increasing survival rates each year.
-
To demonstrate the safety and efficacy of 65 degrees C (149 degrees F) centrally administered intravenous fluid (CIVF) compared to conventional 40 degrees C (104 degrees F) CIVF in the treatment of hypothermia. ⋯ CIVF at 65 degrees C is a safe and effective means of treating hypothermia.
-
Nosocomial pneumonia presents a diagnostic and therapeutic challenge in the care of critically ill patients. The present study was designed to determine as closely as possible the occurrence of nosocomial pneumonia in surgical intensive care unit (ICU) patients using clinical, radiographic, and bacteriological parameters in a prospective concurrent fashion. ⋯ Nosocomial pneumonia was initially suspected in 13% of this ICU population. Numerous clinical parameters clearly distinguished these pneumonia patients from others and they suffered a substantially higher mortality. However, within this pneumonia group, only half of the patients could be validated as truly having pneumonia using available clinical parameters. Nevertheless, those validated were indistinguishable in their clinical behavior from those who were not. This calls into question the need for elaborate and sometimes expensive investigations for diagnosis of nosocomial pneumonia.
-
Twenty-five percent of all nosocomial infections are wound infections. Professional guidelines support the timely use of preoperative prophylaxis for prevention of postoperative wound infections. Barriers exist in implementing this practice. IPRO, the New York State peer review organization, as part of the Health Care Financing Administration's Health Care Quality Improvement Program, sought to determine the proportion of patients receiving timely antibiotic prophylaxis for aortic grafts, hip replacements and colon resections in 44 hospitals in New York State. ⋯ Antibiotic prophylaxis was performed in 81% to 94% of cases, however, anywhere from 27% to 54% of all cases did not receive antibiotics in a timely fashion. By delegating implementation of ordered antibiotic prophylaxis to the anesthesia team, timing may be improved and the incidence of postoperative wound infections may decrease.