Journal of the American College of Surgeons
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Rates of discharge of surgical ICU (SICU) patients to extended care facilities (ECF) increase as SICU length of stay (LOS) increases. Increased SICU LOS and APACHE II scores have been related to increased hospital mortality. This study evaluated factors influencing ECF survival after SICU patient discharge. ⋯ Outcomes of ECF discharge after SICU admission is poor, with nearly 50% 2-year mortality. ECF mortality seems significantly higher for the elderly, with patients undergoing otolaryngologic procedures being at highest risk. Severity of illness at the time of SICU admission and SICU LOS does not seem to influence ECF outcomes.
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Comparative Study
Interventions to improve cardiopulmonary hemodynamics during laparoscopy in a porcine sepsis model.
Laparoscopy is increasingly used in severely ill and acutely septic patients. In animals undergoing laparoscopy, the hemodynamic response to sepsis is blunted. Specific interventions to augment the hemodynamic potential may make laparoscopic intervention a safer alternative in septic patients. We compared different interventions to improve hemodynamic performance during exploratory laparoscopy in a porcine endotoxic shock model. ⋯ Adverse effects of laparoscopy on cardiovascular hemodynamics in the septic state may be mediated by increased pulmonary vascular resistance, diminished venous return, or both. Specific interventions to reverse these variables may ameliorate hemodynamic changes seen.
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Pedestrian versus motor vehicle accidents are associated with substantial morbidity and mortality. Previous studies have examined pedestrian injury profiles on an individual hospital basis and have been limited by small patient populations. The objective of this study was to examine the demographics and injury profiles of pedestrian versus motor vehicle accidents in a large trauma system. ⋯ This study contributes the largest database reported on motor vehicle versus pedestrian accidents and finds that these accidents are common in a large urban trauma system. Hospital stay, Injury Severity Score, Revised Trauma Score, Glasgow Coma Scale, and the mortality rate worsen with age. The high mortality rate among the elderly indicates the need for more aggressive and effective prevention efforts.
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Improved survival with pediatric malignancies has been positively influenced by multidisciplinary cooperative studies using surgery, chemotherapy, and radiation therapy, but one-third of all children with cancer succumb to their condition. The identification of biologic and genetic characteristics as risk factors for the various tumors has led to changes in treatment using risk-based management as the template for care. ⋯ On the basis of these data, children with solid tumors are currently categorized into low-, intermediate-, and high-risk groups. Newer protocols individualize treatment using risk factors as predictors of outcomes. Risk-based management allows the clinician to weigh the risks and benefits of treatment for each patient to maximize survival, minimize longterm morbidity, and improve the quality of life.