The Journal of surgical research
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As management of congenital heart disease (CHD) improves, children with CHD increasingly present for noncardiac surgery. Prior studies report conflicting results on the association between CHD and adverse outcomes in noncardiac surgery. Studies reporting no such association predominantly analyze older children and adolescents. We evaluated whether the association between CHD and adverse surgical outcomes was attenuated by increased age. ⋯ In pediatric noncardiac surgery, an independent association of CHD with postoperative complications was only evident among children <1 y old.
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Rapid Ground Transport of Trauma Patients: A Moderate Distance From Trauma Center Improves Survival.
There is debate within the emergency medical services (EMS) community over the value of calling a helicopter for trauma patients within a moderate distance/<45 min, of a trauma center. Helicopter EMS (HEMS) generally have a wider scope and more advanced training than the ground EMS (GEMS). GEMS, on the other hand, have the benefit of being able to immediately initiate rapid transport to the trauma center without the delay involved with HEMS flying to the scene, landing, and assuming patient care. ⋯ Our data demonstrate that scene-to-ED time is paramount, and rapid ground transport should be used in blunt trauma patients when the scene is up to a moderate ground distance away from the trauma center and there would be a moderate-to-prolonged HEMS response time. In both analyses, hemodynamically unstable trauma patients had lower rates of mortality following ground transport. We recognize that there may be a subset of patients at these distances who could benefit from HEMS response, particularly if the flight crew can offer more advanced and specialized techniques; however, every effort should be made to minimize the scene-to-ED time, and HEMS response, scene, and transport time must be considered. This study only analyzed the patients within a moderate distance of the trauma center and at longer distances or in different environments; HEMS transport may indeed minimize the scene to ED time.
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Comparative Study
Rapid Release Protocol Optimizes Product Utilization Compared With Massive Transfusion Protocol in Selected Patients.
While massive transfusion protocols (MTPs) are effective means of expeditiously delivering blood products to patients with exsanguinating hemorrhage, activation often occurs in cases with small blood volume deficits, leading to product wastage and overtransfusion. We sought to determine whether the additional implementation of a new protocol (called Rapid Release [RR]), which uses less resources, would result in decrease in blood product wastage. We hypothesized that RR would result in the reservation of MTPs for sicker patients and that blood product wastage would decrease. ⋯ Contrary to our hypothesis, institution of the RR protocol resulted in higher mean wastage of FFP per activation despite the appropriateness of the RR protocol. Further efforts are warranted to refine the MTP to increase efficiency.
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For cirrhotic patients awaiting liver transplantation, the Model for End-Stage Liver Disease Sodium (MELD-Na) model is extensively studied. Because of the simplicity of the scoring system, there has been interest in applying MELD-Na to predict patient outcomes in the noncirrhotic surgical patient, and MELD-Na has been shown to predict postoperative morbidity and mortality after elective colectomy. Our aim was to identify the utility of MELD-Na to predict anastomotic leak in elective colorectal cases. ⋯ MELD-Na is an independent predictor of anastomotic leak in partial rectal resections. Anastomotic leak risk increases with increasing MELD-Na in elective colorectal resections, as does 30-d mortality and overall complication rate. As MELD-Na score increases to more than 20, restorative partial rectal resection has a 10% rate of anastomotic leak.
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Dry-suction chest drainage systems are used to achieve proper drainage of the pleural space after cardiothoracic operations. Data on the actual intrapleural pressure during the use of these systems is lacking. The present study was performed to evaluate pressure differences across the circuit using an ex vivo model. ⋯ While commercially available chest drainage systems are able to provide predictable levels of suction at the device, intrapleural pressures can be highly variable and depend on complete patency of connecting tubes. Systems capable of modulating the level of suction based on actual intrapleural pressures may enhance recovery after procedures requiring tube thoracotomy.