Surgery
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Extracorporeal membrane oxygenation is routinely used for neonatal respiratory failure but is considered unsuccessful in adults based on old studies and old methods. We conducted a new phase 1 trial of modern extracorporeal life support (ECLS) in moribund adults with cardiorespiratory failure. ⋯ With modern techniques, ECLS can be lifesaving in adult cardiorespiratory failure when conventional therapy has failed.
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Traditional ward ratings and multiple-choice tests do not reliably assess clinical competence. This study determined the reliability of the Objective Structured Clinical Examination (OSCE) and its sensitivity in detecting the performance gains and deficits in surgical interns. ⋯ We conclude that the OSCE is an innovative, reliable tool for evaluating resident competence. Although outgoing interns performed better than did incoming interns, the OSCE scores clearly indicated major performance deficits in all interns.
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Randomized Controlled Trial Clinical Trial
Extracorporeal venovenous recirculation for the treatment of hypothermia during elective aortic surgery: a phase I study.
Hypothermia caused by massive transfusion or prolonged exposure during operation is difficult to reverse and is associated with adverse side effects. This prospective, randomized study evaluated a technique using extracorporeal venovenous recirculation (EVR) through a roller pump-driven device with a commercial countercurrent heat exchanger used for treatment of hypothermia (temperature < 35.5 degrees C) occurring during elective aortic operation. ⋯ These data show that EVR provides a safe and effective method for the treatment of hypothermia.
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Postoperative confusion is a well-known complication, but the pathogenetic mechanisms, of which hypoxemia may be one, are not completely understood. ⋯ These results suggest postoperative hypoxemia to be an important pathogenetic factor in postoperative mental dysfunction.
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This study was undertaken to evaluate the relative importance of factors related to the extent of multiple organ system failure (MOSF) and outcome in critical trauma. ⋯ Advancing age, prior chronic disease, malnutrition, coma on admission, and use of H2-receptor antagonists or antacids may impair host defenses of the gastrointestinal tract and predispose to invasive infection, thereby aggravating the severity of existing MOSF. These findings, together with the predominance of Enterobacteriaceae in patients with infection, suggest that bacterial translocation may be important in the late MOSF septic state. Although infection, particularly intraabdominal infection, is a major risk factor for MOSF, a nonspecific host response to critical trauma, as expressed by the ISS and transfusion requirement, and intestinal endotoxin may contribute to the development of the syndrome.