Arch Surg Chicago
-
Randomized Controlled Trial Clinical Trial
The prevention of pulmonary complications after upper abdominal surgery in patients with noncompromised pulmonary status.
Controversy exists regarding the routine use of breathing exercises in the prevention of pulmonary complications after upper abdominal surgery. We prospectively randomized 153 patients who had noncompromised pulmonary status; the control group (84 patients) engaged in no breathing exercises, and the respiratory therapy group (69 patients) engaged in preoperative and postoperative breathing exercises supervised by the physical therapist. ⋯ In the present study, preoperative lung function tests had no additional or predictive value. We advise preoperative and postoperative breathing exercises as a prophylactic treatment in all patients scheduled for upper abdominal surgery.
-
The subclavian vein is a commonly used venous access route. Percutaneous cannulation is associated with complications and malpositioning of the catheter. ⋯ Findings show that traditional recommendations for patient positioning with the shoulders retracted and the head turned away can act to distort the subclavian vein anatomy and make successful cannulation more difficult. Positioning the patient flat with the head and shoulders in a neutral position is suggested.
-
We examined the impact of a trauma system on the survival of patients with a Trauma Score of 8 or less. We compared the observed survival with that predicted using a method that calculates the probability of survival (Ps) based on age, physiologic score, and anatomic severity of injury. Of 3394 patients triaged to trauma centers in a 12-month period, 283 (8.3%) had a Trauma Score of 8 or less. ⋯ The Ps was 18%; the observed survival was 29%. Of 60 patients with penetrating trauma and complete data, the Ps was 8%; the observed survival was 20%. We attribute the improved survival to the integration of prehospital and hospital care and expeditious surgery.
-
During a five-year period, 104 patients underwent a pericardial window procedure to diagnose possible cardiac injury. Eighty-eight procedures were performed by a subxiphoid approach, and 16 were transdiaphragmatic in combination with an exploratory laparotomy. There were 51 patients with stab wounds, 45 with gunshot wounds, and eight with blunt trauma. ⋯ Cardiac wounds repaired included the right ventricle (eight), left ventricle (three), right atrium (five), and cardiac vein or pericardial wounds (three). Complications were negligible and consisted of minor wound infections (two) and postpericardiotomy syndromes (two). The pericardial window provides a rapid and safe means of diagnosing cardiac injuries in patients with equivocal signs of heart injury while sparing the patient without a heart wound a major operation.