American journal of surgery
-
We performed an evaluation of antimicrobial guidelines for patients with surgical sepsis. ⋯ Our current antibiotic guidelines provide appropriate and accurate antimicrobial coverage. Noncompliance with the antibiotic protocol resulted in fewer ICU-free days and increased hospital mortality in surgical sepsis patients.
-
Our objective was to show that a chest X-ray (CXR) and an abdominal computed tomography (CT) scan are sufficient to identify most clinically significant thoracic injuries in trauma patients, rendering the thoracic CT scan useful in only a subset of patients. ⋯ Our pilot study suggests that a CXR and an abdominal CT scan will identify most occult intrathoracic injuries. Reserving a thoracic CT scan for patients with an abnormal CXR or high-risk mechanism could safely reduce cost and radiation exposure while still diagnosing significant thoracic injuries.
-
The management of surgical sepsis is challenging because of the complexity of interventions. The authors therefore created a computerized clinical decision support program to facilitate this process, with the goal of improving abdominal sepsis mortality. ⋯ The use of computerized clinical decision support results in significantly improved survival in patients with intra-abdominal surgical sepsis.
-
Multiple organ failure (MOF) emerged 30 years ago and became our research focus. Over the years, we have proposed a series of cartoons that rallied multidisciplinary translational research teams around common themes to generate "win-win" hypotheses that when tested (right or wrong) have advanced our understanding of MOF. MOF has a bimodal trajectory, and the gut plays a role in both trajectories. ⋯ Fortunately, most patients survive early SIRS, but some develop excessive anti-inflammation (ie, compensatory anti-inflammatory response syndrome). The gut also plays a role in this late indolent compensatory anti-inflammatory response syndrome-MOF trajectory. Multiple factors cause progressive gut dysfunction such that the gut (an important immunologic organ) worsens compensatory anti-inflammatory response syndrome and becomes the reservoir for pathogens and toxins that cause late sepsis.
-
Necrotizing soft-tissue infections (NSTIs) are a group of uncommon, rapidly progressive, potentially fatal disorders. The National Surgical Quality Improvement Program (NSQIP) Registry was used to determine current data on the incidence, treatment, and outcomes of NSTIs. ⋯ NSTIs are seen regularly in academic centers, and their incidence may be increasing. Despite a high incidence of comorbid conditions and frequent presentation with sepsis, mortality is lower than previously reported, reflecting ongoing progress in the treatment of these disorders at NSQIP hospitals.