Journal of the American College of Surgeons
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Fresh frozen plasma (FFP) as an adjunct in burn resuscitation to decrease endothelial cell permeability by restoring the glycocalyx is not yet standard of care, despite increasing evidence showing tis benefits. We hypothesize that utilizing an adjusted body weight index and starting resuscitation at a low rate of 2cc/kg/%TBSA with early plasma results in less fluid administration and superior clinical outcomes compared to traditional resuscitation methods such as Parkland formula. ⋯ Patients treated with the restrictive 2cc/kg+FFP formula received less fluid than the 3cc/kg and Parkland formula controls. With reduced fluids, patients had less mechanical ventilation, less dialysis, fewer tracheostomies, and better survival. AKI was minimal despite fluid restriction. Early experience suggests the new protocol is safe and feasible for further study.
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Anastomotic conversions and revisions remain crucial in addressing complications or sub-optimal outcomes following primary bariatric procedures. Preoperative malnutrition, proxied by hypoalbuminemia, has traditionally been considered a risk factor for postoperative morbidity. This study investigates the validity of this association in revisional and conversion metabolic/bariatric surgery (MBS). ⋯ Following adjustment for confounding patient factors, hypoalbuminemia alone did not arise as an independent predictive factor for the 30-day major complications such as leak, reoperation, or re-intervention after revisional and anastomotic conversion MBS, although there maybe increase in SSI and readmission rates.