Articles: mortality.
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Pulmonary embolism (PE) and obstructive sleep apnea (OSA) remain a major health issue worldwide with potential overlapping pathophysiological mechanisms. PE, the most severe form of venous thromboembolism, is associated with high morbidity and mortality, presenting challenges in management and prevention, especially in high-risk populations. OSA is a prevalent condition characterized by repeated episodes of upper airway closure resulting in intermittent hypoxia and sleep fragmentation. ⋯ Moderate-to-severe OSA has been linked to worse clinical presentations and outcomes. Furthermore, OSA has been associated with increased risks of PE recurrence and mortality. Future research directions should include clarifying the bidirectional relationship between these conditions and evaluating the effectiveness and safety of continuous positive airway pressure (CPAP) therapy in improving outcomes in patients with concurrent acute PE and OSA.
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Venous thromboembolism (VTE) remains a major source of morbidity and mortality in severely injured patients despite current methods of risk stratification and prophylaxis, suggesting incomplete understanding of VTE risk factors. Given the liver's role in coagulation, we hypothesized that liver injury (LI) is associated with increased rates of VTE in severely injured patients. ⋯ In severely injured patients, LI is an independent predictor of PE, but not DVT, suggesting LI is the source of either emboli or a more complex locally prothrombotic focus leading to downstream thrombi in the lung without causing upstream systemic venous thrombi. Further work should focus on elucidation of mechanisms including the portal venous blood coagulation profile, endothelial injury in the liver, and the potential for stasis of venous blood traversing an injured liver as well as the role for including LI in VTE risk stratification.
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Paediatric anaesthesia · Jan 2025
Supervision of Pediatric Anesthesia After-Hours: A Survey of Pediatric Anesthetists in Australia and New Zealand.
After-hours pediatric anesthesia may pose increased risks, with a heightened potential for sudden cardio-respiratory decline. While mortality rates are low in Australia and New Zealand, critical events and morbidity occur more frequently and present ongoing challenges. However, little is known about how trainees are supervised during these high-risk periods. ⋯ Pediatric anesthetists in Australia and New Zealand recognize major risk factors but tend to supervise more remotely after-hours. Further research is needed to evaluate the effects of these supervision practices on outcomes.
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Cytoreductive surgery (CRS) and Hyperthermic Intraperitoneal Chemotherapy (HIPEC) can improve survival for patients with peritoneal surface malignancy. Completeness of cytoreduction correlates with prognosis. The role of gastrectomy in these patients is not well described. ⋯ 8% of patients who underwent CRS+HIPEC for non-gastric primaries underwent gastrectomy. Gastrectomy patients were more likely to have higher PCI and incomplete resections with increased complications and mortality. PCI, resection status, LN's, tumor grade, and primary site, but not gastrectomy type, are significantly associated with OS.