Articles: cations.
-
Critical care medicine · Jul 2018
Case ReportsExtensive Myocardial Calcification in Critically Ill Patients.
To describe an unusual complication on extracorporeal membrane oxygenation. ⋯ Intensivists should be aware of this rare but rapid complication on extracorporeal membrane oxygenation support that may directly impact outcome. The precise role of extracorporeal membrane oxygenation support in the timing and frequency of new-onset diffuse myocardial calcification deserves further investigation.
-
Rates of mastectomy for breast cancer treatment and immediate reconstruction continue to rise. With increasing scrutiny on outcomes and patient satisfaction, there is an impetus for providers to be more deliberate in appropriate patient selection for breast reconstruction. The Breast Reconstruction Risk Assessment (BRA) Score was developed for prediction of complications after primary prosthetic breast reconstruction, focusing on calculating risk estimations for a variety of complications based on individual patient demographic and perioperative characteristics. In this study, we evaluated mastectomy skin flap necrosis (MSFN) as a function of patient characteristics to validate the BRA Score. ⋯ The BRA Score was expanded to estimate complication risk after tissue expander placement up to 1 year postoperatively. The risk of MSFN as calculated by the BRA Score: Extended Length is consistent with published studies demonstrating increased risk with specific comorbidities, and further validates expansion of the BRA score risk calculator.
-
Critical care medicine · Jul 2018
Trends in Use of Midodrine in the ICU: A Single-Center Retrospective Case Series.
Midodrine is an oral alpha-agonist approved for orthostatic hypotension. The use of midodrine as a vasopressor sparing agent has steadily increased in the ICU despite limited evidence for its safety in that setting. We describe the trends in use and reported side effects and complications of midodrine in multidisciplinary ICUs of a tertiary care institution. ⋯ Our results suggest that midodrine is being increasingly used as an adjunct to increase mean arterial pressure and facilitate weaning of vasopressors in the ICU. Prospective trials are required to further establish the appropriate timing, efficacy, safety, and cost-effectiveness of midodrine use in ICU patients.
-
Colorectal surgery is a focus of enhanced recovery protocols (ERP). The use of transversus abdominis plane (TAP) block for abdominal surgery has demonstrated effectiveness in ERP, however, no direct comparison of epidural vs TAP for nonanalgesic clinical factors has been published to date. The primary aim of this study was to compare epidural with TAP for length of stay in colorectal surgery. ⋯ Transversus abdominis plane block was associated with a 0.5-day reduction in length of stay in a standardized ERP compared with epidural. Early indication favors TAP in patients with a history of postoperative urinary retention, as a trend of urinary retention was associated with epidural. Transversus abdominis plane block offers an effective alternative to epidural in colorectal surgery, regardless of operative approach.
-
It is increasingly important for faculty to teach deliberately and provide timely, detailed, and formative feedback on surgical trainee performance. We initiated a multicenter study to improve resident evaluative processes and enhance teaching and learning behaviors while engaging residents in their education. ⋯ By adopting recognized educational models with repeated Plan, Do, Check, Act cycles, we increased the quality of preoperative learning objectives, showed more frequent, detailed, and timely assessments of resident performance, and demonstrated more effective self-reflection by residents. We monitored trends, identified opportunities for improvement and successfully sustained those improvements over time, applying a team-based approach.