Articles: cations.
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Critical care medicine · Dec 2024
Prognostic Factors Associated With Intracranial Hemorrhage and Ischemic Stroke During Venovenous Extracorporeal Membrane Oxygenation: A Systematic Review.
Venovenous extracorporeal membrane oxygenation (ECMO) is a life-preserving intervention for patients with respiratory failure refractory to conventional mechanical ventilation. Intracranial hemorrhage (ICH) and ischemic stroke are life-threatening complications associated with venovenous ECMO. Despite this, little is known regarding the prognostic factors associated with these adverse neurologic events. We conducted a systematic review that characterizes these predictors of ICH and ischemic stroke during venovenous ECMO. ⋯ This systematic review demonstrates that abnormalities and changes in blood gas parameters from pre- to post-venovenous ECMO cannulation are probably associated with increased risk of ICH. Additional high-quality studies dedicated to probable predictors of these adverse neurologic events are crucial to understanding the pathophysiology of ICH and ischemic stroke in this population and informing clinical practice to mitigate the risk of these life-threatening events.
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The efficacy of enhanced recovery after surgery (ERAS) to improve the prognosis of patients who undergo laparoscopic distal gastrectomy (LDG) for gastric cancer is uncertain. This randomized study compared oncological outcomes in LDG after ERAS or conventional care. ⋯ Patients undergoing ERAS LDG had fewer overall complications, shorter hospital stay, decreased medical expenses, and improved 3-year OS and DFS rates, particularly in cases with stage III gastric cancer.
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The knowledge required to manage surgical patients has expanded considerably over the past 40 years. Simultaneously, the cost of medical education has increased substantially. Surgical trainees are at particular disadvantage due to the time demands of training. We aim to determine whether surgeon compensation over time has adequately accounted for increasing student debt burden. ⋯ The rate of debt accumulation has outpaced the rate of salary growth for general surgeons to a significant degree.
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To identify the risk factors, manifestations, and clinical implications of chyle leak (CL) after pancreatic surgery, and to reappraise the International Study Group for Pancreatic Surgery (ISGPS) definition and classification of CL. ⋯ Minimally invasive approach and daily maximum drainage volume were independent risk factors for CL in this cohort. Post-pancreatectomy patients with large-volume, TG-rich but non-milky drainage should be treated like clinically relevant CL.