Surgical infections
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Surgical infections · Feb 2006
Mentors decrease compliance with best sterile practices during central venous catheter placement in the trauma resuscitation unit.
In the academic trauma unit during initial evaluation and resuscitation of trauma victims, central venous catheters are often placed by multiple operators. There are few data on compliance with accepted, standard sterile practices during such procedures. ⋯ Secondary operators, typically trauma surgery attendings, trauma/critical care fellows, or senior surgical residents, function as mentors in academic institutions and act as role models. Secondary operators participated in many of the studied cases, yet failed to demonstrate consistent use of MBP. In elective central venous catheter placement, those where there was the greatest opportunity to follow MBP, we observed a statistically significant difference in compliance rate between the primary and secondary operators. The study suggests the need to address the performance of the secondary operators and to educate them, as although they may be technically experienced in placing central venous catheters, they may comply less consistently with MBP.
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Patients with cancer suffer alterations of their metabolic state and nutritional depletion. This review was designed to evaluate the effect of different nutritional regimens on surgical outcomes. ⋯ Enteral immunonutrition should represent the first choice to nourish surgical subjects.
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Surgical infections · Jan 2006
ReviewEfficacy and safety of drotrecogin alfa (activated) for the therapy of surgical patients with severe sepsis.
The efficacy of therapy with drotrecogin alfa (activated) (DrotAA) (recombinant human activated protein C) for surgical patients with severe sepsis has been questioned, and there is concern that patients who have undergone surgery recently may be at increased risk of bleeding complications from the drug. This review was performed to analyze recent data and clinical trends in the management of surgical patients with severe sepsis with respect to the efficacy and safety of therapy with DrotAA. ⋯ Accumulating experience indicates that surgical patients with severe sepsis and a high risk of death (APACHE II>or=25 points) have a significantly lower mortality rate if treated with DrotAA. The increased risk of bleeding associated with therapy is acceptable given the clear improvement in survival. Surgical patients with sepsis who are at lower risk of death do not appear to benefit from therapy with DrotAA, which should be withheld in most circumstances because of the increased risk of bleeding.
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Fever is common in surgical patients. The list of potential causes is long and includes many noninfective etiologies. ⋯ The workup and therapy for the individual patient may differ, depending on the underlying disease and clinical appearance and the clinician's suspicion for infection. Subsequent testing should be based on the clinical findings. Perhaps more money is wasted in the evaluation of early postoperative fever than on any other aspect of postoperative care.