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Peev MP, Balkhy HH. Multi-vessel off-pump total endoscopic coronary artery bypass—pearls and pitfalls. J Vis Surg 2023. [DOI: 10.21037/jovs-22-17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Peev MP, Kitahara H, Grady K, Balkhy HH. Robotic totally endoscopic mitral valve surgery with moderate hypothermic ventricular fibrillatory arrest. J Vis Surg 2023. [DOI: 10.21037/jovs-22-37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
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Milsom JW, Trencheva K, Momose K, Peev MP, Christos P, Shukla PJ, Garrett K. A pilot randomized controlled trial comparing THUNDERBEAT to the Maryland LigaSure energy device in laparoscopic left colon surgery. Surg Endosc 2022; 36:4265-4274. [PMID: 34724584 PMCID: PMC9085677 DOI: 10.1007/s00464-021-08765-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 10/04/2021] [Indexed: 01/29/2023]
Abstract
BACKGROUND The THUNDERBEAT is a multi-functional energy device which delivers both ultrasonic and bipolar energy, but there are no randomized trials which can provide more rigorous evaluation of the clinical performance of THUNDERBEAT compared to other energy-based devices in colorectal surgery. The aim of this study was to compare the clinical performance of THUNDERBEAT energy device to Maryland LigaSure in patients undergoing left laparoscopic colectomy. METHODS Prospective randomized trial with two groups: Group 1 THUNDERBEAT and Group 2 LigaSure in a single university hospital. 60 Subjects, male and female, of age 18 years and above undergoing left colectomy for cancer or diverticulitis were included. The primary outcome was dissection time to specimen removal (DTSR) measured in minutes from the start of colon mobilization to specimen removal from the abdominal cavity. Versatility (composite of five variables) was measured by a score system from 1 to 5 (1 being worst and 5 the best), and adjusted/weighted by coefficient of importance with distribution of the importance as follow: hemostasis 0.275, sealing 0.275, cutting 0.2, dissection 0.15, and tissue manipulation 0.1. Other variables were: dryness of surgical field, intraoperative and postoperative complications, and mortality. Follow-up time was 30 days. RESULTS 60 Patients completed surgery, 31 in Group 1 and 29 in Group 2. There was no difference in the DTSR between the groups, 91 min vs. 77 min (p = 0.214). THUNDERBEAT showed significantly higher score in dissecting and tissue manipulation in segment 3 (omental dissection), and in overall versatility score (p = 0.007) as well as versatility score in Segment 2 (retroperitoneal dissection p = 0.040) and Segment 3 (p = 0.040). No other differences were noted between the groups. CONCLUSIONS Both energy devices can be employed effectively and safely in dividing soft tissue and sealing mesenteric blood vessels during laparoscopic left colon surgery, with THUNDERBEAT demonstrating some advantages over LigaSure during omental dissection and tissue manipulation. CLINICALTRIAL gov # NCT02628093.
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Affiliation(s)
- Jeffrey W Milsom
- Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medicine College, New York, NY, 10065, USA.
| | - Koianka Trencheva
- Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medicine College, New York, NY, 10065, USA
| | - Kota Momose
- Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medicine College, New York, NY, 10065, USA
| | - Miroslav P Peev
- Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medicine College, New York, NY, 10065, USA
| | - Paul Christos
- Division of Biostatistics and Epidemiology, Department of Healthcare Policy & Research, Weill Cornell Medicine, New York, NY, USA
| | - Parul J Shukla
- Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medicine College, New York, NY, 10065, USA
| | - Kelly Garrett
- Section of Colorectal Surgery, Department of Surgery, Weill Cornell Medicine College, New York, NY, 10065, USA
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Peev MP, Nisivaco S, Torregrossa G, Arastu A, Shahul S, Balkhy HH. Robotic Off-Pump Totally Endoscopic Coronary Artery Bypass in Patients With Low Ejection Fraction. Innovations (Phila) 2022; 17:50-55. [PMID: 35225062 DOI: 10.1177/15569845211073929] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Robotic totally endoscopic coronary bypass (R-TECAB) has been shown to be a safe and effective technique with excellent outcomes. The aim of this study is to assess the feasibility of R-TECAB in patients with low left ventricular ejection fraction (LVEF) and to report our midterm outcomes with up to 7-year follow-up. Methods: All patients undergoing R-TECAB at our institution between July 2013 and July 2020 were retrospectively reviewed. A total of 100 patients were identified with low LVEF defined as ≤40%. The preoperative characteristics, perioperative and postoperative outcomes, as well as the midterm results were reviewed. Results: The mean LVEF was 31%, and 62% of all patients had preexisting congestive heart failure. Of the cohort, 59% had 3-vessel disease and 6% underwent previous cardiac surgery. Multivessel TECAB was performed in 54%. Hybrid coronary revascularization occurred in 36 individuals. Two patients required cardiopulmonary bypass, and 35% were extubated in the operating room. No sternotomy conversions were required. One patient underwent reoperation for bleeding. No perioperative stroke, myocardial infarction, or mortality occurred. The left internal mammary artery graft patency was 97% at a mean of 1.6 months in the staged hybrid percutaneous coronary intervention group. At midterm follow-up the cardiac-related mortality was 5%. Heart transplant or left ventricular assist device was required in 4 patients, and 1 patient experienced a myocardial infarction. Freedom from major adverse cardiac events was 89%. Conclusions: Off-pump TECAB can be successfully performed in patients with low LVEF in the setting of an experienced and dedicated robotic cardiac surgery team. Our data demonstrate the feasibility of the technique with excellent perioperative and midterm outcomes.
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Affiliation(s)
- Miroslav P Peev
- Department of Surgery, Section of Cardiac Surgery, 12246University of Chicago, IL, USA
| | | | - Gianluca Torregrossa
- Department of Surgery, Section of Cardiac Surgery, 12246University of Chicago, IL, USA
| | | | - Sajid Shahul
- Department of Anesthesia, University of Chicago, IL, USA
| | - Husam H Balkhy
- Department of Surgery, Section of Cardiac Surgery, 12246University of Chicago, IL, USA
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Symalla T, Peev MP, Song T, Naftel D, Myers S, Koehl D, Cantor RS, Pinney S, Jeevanandam V. STS INTERMACS Database: The Key to Conduct Single-arm Trials in Advanced Heart Failure Patients. Ann Thorac Surg 2021; 113:808-815. [PMID: 33930360 DOI: 10.1016/j.athoracsur.2021.04.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 03/21/2021] [Accepted: 04/13/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Safe introduction of novel mechanical circulatory support (MCS) devices into clinical practice is a challenging process. Single-arm trials using a control arm from existing database is an effective alternative that could be applied for regulatory approval. This study analyzes the capability of the Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) database to establish objective performance criteria and select patient population that could be used for future single-arm MCS trials. METHODS Patients with INTERMACS profiles IM1-2 and IM3-5, who underwent implant of isolated Left Ventricular Assist Devises between 2014-2017 were included. Both cohorts were further stratified into Shock and Non-Shock groups using surrogate markers of shock (ECMO, temporary VAD, vasopressor infusions). Survival, transplant rates, adverse events, 6 min walk test and quality of life measures were obtained for all 4 groups at 6 and 12 months. RESULTS Total of 7,907 patients were divided into IM1-2(n=3,909), IM3-5(n=3,998), Shock(n=3,469) and Non-Shock(n=3,040). Re-categorization occurred in 11% of patients from the IM3-5 group into the Shock group. Overall, patients in the Shock group had similar outcomes to the IM 1-2 group (1-year survival: 86% vs 85%, p=0.74). Patients in the Non-Shock group also had similar outcomes to the IM 3-5 (1-year survival: 90% vs 90%, p=0.43). CONCLUSIONS INTERMACS database can successfully establish objective performance criteria and concurrent control group for single-arm trials that could be used to support regulatory approval of new, less invasive MCS. INTERMACS data allows reliable comparisons of outcomes and adverse events.
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Affiliation(s)
- Trever Symalla
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA
| | - Miroslav P Peev
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA.
| | - Tae Song
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA
| | - David Naftel
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Susan Myers
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Devin Koehl
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Ryan S Cantor
- Kirklin Institute for Research in Surgical Outcomes (KIRSO), The University of Alabama at Birmingham, Birmingham AL
| | - Sean Pinney
- Department of Medicine, The University of Chicago Medical Center, Chicago IL, USA
| | - Valluvan Jeevanandam
- Section of Cardiac Surgery, Department of Surgery, The University of Chicago Medical Center, Chicago IL, USA
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Carrano FM, Peev MP, Saunders JK, Melis M, Tognoni V, Di Lorenzo N. The Role of Minimally Invasive and Endoscopic Technologies in Morbid Obesity Treatment: Review and Critical Appraisal of the Current Clinical Practice. Obes Surg 2019; 30:736-752. [DOI: 10.1007/s11695-019-04302-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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van Brunschot S, Hollemans RA, Bakker OJ, Besselink MG, Baron TH, Beger HG, Boermeester MA, Bollen TL, Bruno MJ, Carter R, French JJ, Coelho D, Dahl B, Dijkgraaf MG, Doctor N, Fagenholz PJ, Farkas G, Castillo CFD, Fockens P, Freeman ML, Gardner TB, Goor HV, Gooszen HG, Hannink G, Lochan R, McKay CJ, Neoptolemos JP, Oláh A, Parks RW, Peev MP, Raraty M, Rau B, Rösch T, Rovers M, Seifert H, Siriwardena AK, Horvath KD, van Santvoort HC. Minimally invasive and endoscopic versus open necrosectomy for necrotising pancreatitis: a pooled analysis of individual data for 1980 patients. Gut 2018; 67:697-706. [PMID: 28774886 DOI: 10.1136/gutjnl-2016-313341] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 06/08/2017] [Accepted: 06/09/2017] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Minimally invasive surgical necrosectomy and endoscopic necrosectomy, compared with open necrosectomy, might improve outcomes in necrotising pancreatitis, especially in critically ill patients. Evidence from large comparative studies is lacking. DESIGN We combined original and newly collected data from 15 published and unpublished patient cohorts (51 hospitals; 8 countries) on pancreatic necrosectomy for necrotising pancreatitis. Death rates were compared in patients undergoing open necrosectomy versus minimally invasive surgical or endoscopic necrosectomy. To adjust for confounding and to study effect modification by clinical severity, we performed two types of analyses: logistic multivariable regression and propensity score matching with stratification according to predicted risk of death at baseline (low: <5%; intermediate: ≥5% to <15%; high: ≥15% to <35%; and very high: ≥35%). RESULTS Among 1980 patients with necrotising pancreatitis, 1167 underwent open necrosectomy and 813 underwent minimally invasive surgical (n=467) or endoscopic (n=346) necrosectomy. There was a lower risk of death for minimally invasive surgical necrosectomy (OR, 0.53; 95% CI 0.34 to 0.84; p=0.006) and endoscopic necrosectomy (OR, 0.20; 95% CI 0.06 to 0.63; p=0.006). After propensity score matching with risk stratification, minimally invasive surgical necrosectomy remained associated with a lower risk of death than open necrosectomy in the very high-risk group (42/111 vs 59/111; risk ratio, 0.70; 95% CI 0.52 to 0.95; p=0.02). Endoscopic necrosectomy was associated with a lower risk of death than open necrosectomy in the high-risk group (3/40 vs 12/40; risk ratio, 0.27; 95% CI 0.08 to 0.88; p=0.03) and in the very high-risk group (12/57 vs 28/57; risk ratio, 0.43; 95% CI 0.24 to 0.77; p=0.005). CONCLUSION In high-risk patients with necrotising pancreatitis, minimally invasive surgical and endoscopic necrosectomy are associated with reduced death rates compared with open necrosectomy.
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Affiliation(s)
- Sandra van Brunschot
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Robbert A Hollemans
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands.,Department of Research and Development, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Olaf J Bakker
- Department of Surgery, University Medical Center Utrecht, Utrecht
| | - Marc G Besselink
- Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Todd H Baron
- Department of Gastroenterology and Hepatology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Hans G Beger
- Department of Surgery, University of Ulm, Ulm, Germany
| | | | - Thomas L Bollen
- Department of Radiology, St Antonius Hospital, Nieuwegein, The Netherlands
| | - Marco J Bruno
- Department of Gastroenterology and Hepatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Ross Carter
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - Jeremy J French
- Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Djalma Coelho
- Department of Surgery, Hospital Clementino Fraga Filho, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
| | - Björn Dahl
- Department of Internal Medicine, Oldenburg Municipal Hospital, Oldenburg, Germany
| | - Marcel G Dijkgraaf
- Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands
| | - Nilesh Doctor
- Department of Gastrointestinal Surgery, Jaslok Hospital and Research Center, Mumbai, India
| | - Peter J Fagenholz
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Gyula Farkas
- Department of Surgery, University of Szeged, Szeged, Hungary
| | | | - Paul Fockens
- Department of Gastroenterology, Academic Medical Center, Amsterdam, The Netherlands
| | - Martin L Freeman
- Department of Gastroenterology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Timothy B Gardner
- Department of Gastroenterology and Hepatology, Dartmouth-Hitchcock Medical Center, One Medical Center Drive, Lebanon, New Hampshire, USA
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hein G Gooszen
- Operating Rooms-Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Gerjon Hannink
- Orthopaedic Research Lab, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Rajiv Lochan
- Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK
| | - Colin J McKay
- West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Glasgow, UK
| | - John P Neoptolemos
- Clinical Directorate of General Surgery, National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Atilla Oláh
- Department of Surgery, Petz-Aladár Teaching Hospital, Györ, Hungary
| | - Rowan W Parks
- Department of Surgery, University of Edinburgh, Edinburgh, UK
| | - Miroslav P Peev
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Raraty
- Clinical Directorate of General Surgery, National Institutes of Health Research Liverpool Pancreas Biomedical Research Unit, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Bettina Rau
- Department of Surgery, University of Rostock, Rostock, Germany
| | - Thomas Rösch
- Department of Interdisciplinary Endoscopy, University Hospital Hamburg-Eppendorf, Hamburg, Germany
| | - Maroeska Rovers
- Operating Rooms-Evidence Based Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hans Seifert
- Department of Internal Medicine, Oldenburg Municipal Hospital, Oldenburg, Germany
| | | | - Karen D Horvath
- Department of Surgery, University of Washington, Seattle, USA
| | - Hjalmar C van Santvoort
- Department of Surgery, University Medical Center Utrecht, Utrecht.,Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands
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Peev MP, Lim ATC, Zou T, Brinckerhoff LH. Metastatic Epicardial Leiomyoma with uncertain malignant potential. J Surg Case Rep 2018; 2017:rjx179. [PMID: 29423163 PMCID: PMC5798081 DOI: 10.1093/jscr/rjx179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 09/06/2017] [Indexed: 11/14/2022] Open
Abstract
A 49-year-old female with history of uterine leiomyoma and intermittent shortness of breath presented to the emergency department with new onset of tachycardia and chest pain. Subsequent cardiac work up revealed hypoechoic mass compressing the right ventricle. Computer tomography guided biopsy for tissue characterization revealed a benign spindle cell tumor. Surgical resection of a large epicardial tumor was undertaken. The histologic examination of the tumor was consistent with Estrogen and Progesterone positive leiomyoma of uncertain malignant potential. To the authors’ knowledge, this is the first case report of a metastasizing epicardial leiomyoma that exhibits an unknown malignant potential. This case brings together common gynecologic disorder with complex thoracic surgery diagnosis and management. Differential diagnosis of cardiac tumors in patients with history of uterine leiomyoma should include metastasizing leiomyoma. The mainstay of therapy is surgical resection with immediate symptom relieve.
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Affiliation(s)
- Miroslav P Peev
- Department of Surgery, New York University Langone Medical Center, New York, NY, USA
| | | | - Tianle Zou
- Department of Pathology, Tufts Medical Center, Boston, MA, USA
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Yeh DD, Peev MP, Quraishi SA, Osler P, Chang Y, Rando EG, Albano C, Darak S, Velmahos GC. Clinical Outcomes of Inadequate Calorie Delivery and Protein Deficit in Surgical Intensive Care Patients. Am J Crit Care 2016; 25:318-26. [PMID: 27369030 DOI: 10.4037/ajcc2016584] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Adequate nutritional therapy in critically ill patients is integral to optimal outcome. OBJECTIVE To evaluate the association between cumulative macronutrient deficit and overall morbidity in surgical intensive care unit patients. METHODS Adult patients receiving enteral nutrition for more than 72 hours were included if they had no previous admission to the surgical intensive care unit, had received no enteral feedings before admission, had no intestinal obstruction or ileus, and survived 72 hours or more after admission. Data on demographics, outcomes, and nutritional intake during the unit stay were collected for up to 14 days until oral intake began, discharge, or death. Outcome variables included lengths of stay in the hospital and intensive care unit, days with no mechanical ventilation, complications, and mortality. RESULTS Of 94 participants, 71% were men, mean age was 63 years, and mean score on the Acute Physiology and Chronic Health Evaluation II was 14. Patients with high cumulative calorie deficit (≥ 6000 cal) and high protein deficit (≥ 300 g) had significantly fewer days with no mechanical ventilation (P < .001), longer unit stays (P < .001), longer hospital stays (P = .007), more total complications (P = .007), and more infectious complications (P = .009) than other participants. These associations remained significant in multivariable models after adjustments for age, sex, reason for admission, and propensity score of deficit. In-hospital and 30-day mortality did not differ. CONCLUSIONS Cumulative macronutrient deficits have important clinical outcomes in surgical intensive care patients.
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Affiliation(s)
- D Dante Yeh
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital.
| | - Miroslav P Peev
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
| | - Sadeq A Quraishi
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
| | - Polina Osler
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
| | - Yuchiao Chang
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
| | - Erin Gillis Rando
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
| | - Caitlin Albano
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
| | - Sharon Darak
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
| | - George C Velmahos
- D. Dante Yeh is an assistant professor of surgery, Harvard Medical School, Boston, Massachusetts, and a staff surgeon and intensivist, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts. Miroslav P. Peev is a general surgery resident, Tufts University, Boston, Massachusetts, and a research fellow, Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital. Sadeq A. Quraishi is an assistant professor of anesthesia, Harvard Medical School, and a staff anesthetist and intensivist, Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital. Polina Osler is a medical student, Harvard Medical School. Yuchiao Chang is an assistant professor of medicine, Harvard Medical School, and a statistician, Department of Medicine, Division of General Internal Medicine, Massachusetts General Hospital. Erin Gillis Rando, Caitlin Albano, and Sharon Darak are critical care dietitians, Department of Nutrition and Food Services, Massachusetts General Hospital. George C. Velmahos is professor of surgery, Harvard Medical School, and division chief, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital
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10
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Fagenholz PJ, Peev MP, Thabet A, Michailidou M, Chang Y, Mueller PR, Hahn PF, Velmahos GC. Abscess due to perforated appendicitis: factors associated with successful percutaneous drainage. Am J Surg 2015; 212:794-798. [PMID: 26499054 DOI: 10.1016/j.amjsurg.2015.07.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Revised: 07/06/2015] [Accepted: 07/19/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND Percutaneous drainage is the standard treatment for perforated appendicitis with abscess. We studied factors associated with complete resolution (CR) with percutaneous drainage alone. METHODS Ninety-eight patients underwent percutaneous drainage for acute appendicitis complicated by abscess (October 1990 to September 2010). CR was defined as clinical recovery, resolution of the abscess on imaging, and drain removal without recurrence. Patients achieving CR were compared with patients not achieving CR. RESULTS The rate of CR was 78.6% (n = 77). Abscess grade was the only radiological factor associated with CR (P = .007). The CR rate was higher with transgluteal drainage (90.9% vs 79.2%) than with other anatomic approaches (P = .018) and higher with computed tomography-guided drainage than with ultrasound-guided drainage (82.7% vs 64.3%, P = .046). CONCLUSION CR was more likely to be achieved in patients with lower abscess grade, computed tomography-guided drainage, and a transgluteal approach.
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Affiliation(s)
- Peter J Fagenholz
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA.
| | - Miroslav P Peev
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Ashraf Thabet
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Maria Michailidou
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Yuchiao Chang
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
| | - Peter R Mueller
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Peter F Hahn
- Division of Abdominal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - George C Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Department of Surgery, Massachusetts General Hospital, 165 Cambridge Street, Boston, MA, 02114, USA
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11
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Naraghi L, Peev MP, Esteve R, Chang Y, Berger DL, Thayer SP, Rattner DW, Lillemoe KD, Kaafarani H, Yeh DD, de Moya MA, Fagenholz PJ, Velmahos GS, King DR. The influence of anesthesia on heart rate complexity during elective and urgent surgery in 128 patients. J Crit Care 2014; 30:145-9. [PMID: 25239820 DOI: 10.1016/j.jcrc.2014.08.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2014] [Revised: 08/15/2014] [Accepted: 08/18/2014] [Indexed: 11/29/2022]
Abstract
BACKGROUND As an emerging "new vital sign," heart rate complexity (by sample entropy [SampEn]) has been shown to be a useful trauma triage tool by predicting occult physiologic compromise and need for life-saving interventions. Sample entropy may be confounded by anesthesia possibly limiting its value intraoperatively. We investigated the effects of anesthesia on SampEn during elective and urgent surgical procedures. We hypothesized that SampEn is reduced by general anesthesia. METHODS With institutional review board-approved waiver of informed consent, 128 patients undergoing elective or urgent general surgery were prospectively enrolled. Real-time heart rate complexity was calculated using SampEn through electrocardiogram recordings of 200 consecutive beats in a continuous sliding-window fashion. We recorded SampEn starting 10 minutes before induction until 10 minutes after emergence from anesthesia. The time before induction of anesthesia was categorized as period 1, the time after induction and before emergence as period 2 (intraoperative), and the time after emergence as period 3. We analyzed SampEn changes as patients moved between the different periods and made 3 comparisons: from period 1 with period 2 (comparison A), from period 2 with period 3 (comparison B). We also compared period 1 with period 3 SampEn (comparison C). RESULTS The mean SampEn value for all patients before induction of anesthesia was 1.55 ± 0.58. In each 1 of the 3, comparisons there was a decline in SampEn. Comparison A had a mean decrease of 0.53 ± 0.55 (P < .0001), comparison B had a decrease of 0.13 ± 0.52 (P < .0051), and the mean SampEn difference for comparison C was 0.66 ± 0.53 (P < .0001). Certain pharmacologics had significant effect on SampEn as did need for urgent surgery and American Society of Anesthesiologists class. CONCLUSION Sample entropy decreases after induction of anesthesia and continues to decrease even immediately after emergence in patients without any immediately life-threatening conditions. This finding may complicate interpretation low complexity as a predictor of life-saving interventions in patients in the perioperative period.
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Affiliation(s)
- Leily Naraghi
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Miroslav P Peev
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Rogette Esteve
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Yuchiao Chang
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - David L Berger
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Sarah P Thayer
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - David W Rattner
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Keith D Lillemoe
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Haytham Kaafarani
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Daniel D Yeh
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Marc A de Moya
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - Peter J Fagenholz
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - George S Velmahos
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA
| | - David R King
- Department of Surgery, Massachusetts General Hospital, &, Harvard Medical School, Boston, MA 02114, USA.
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12
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Sartelli M, Catena F, Ansaloni L, Coccolini F, Corbella D, Moore EE, Malangoni M, Velmahos G, Coimbra R, Koike K, Leppaniemi A, Biffl W, Balogh Z, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Tugnoli G, Jovine E, Ordonez CA, Whelan JF, Fraga GP, Gomes CA, Pereira GA, Yuan KC, Bala M, Peev MP, Ben-Ishay O, Cui Y, Marwah S, Zachariah S, Wani I, Rangarajan M, Sakakushev B, Kong V, Ahmed A, Abbas A, Gonsaga RAT, Guercioni G, Vettoretto N, Poiasina E, Díaz-Nieto R, Massalou D, Skrovina M, Gerych I, Augustin G, Kenig J, Khokha V, Tranà C, Kok KYY, Mefire AC, Lee JG, Hong SK, Lohse HAS, Ghnnam W, Verni A, Lohsiriwat V, Siribumrungwong B, El Zalabany T, Tavares A, Baiocchi G, Das K, Jarry J, Zida M, Sato N, Murata K, Shoko T, Irahara T, Hamedelneel AO, Naidoo N, Adesunkanmi ARK, Kobe Y, Ishii W, Oka K, Izawa Y, Hamid H, Khan I, Attri A, Sharma R, Sanjuan J, Badiel M, Barnabé R. Complicated intra-abdominal infections worldwide: the definitive data of the CIAOW Study. World J Emerg Surg 2014; 9:37. [PMID: 24883079 PMCID: PMC4039043 DOI: 10.1186/1749-7922-9-37] [Citation(s) in RCA: 159] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Accepted: 05/11/2014] [Indexed: 11/29/2022] Open
Abstract
The CIAOW study (Complicated intra-abdominal infections worldwide observational study) is a multicenter observational study underwent in 68 medical institutions worldwide during a six-month study period (October 2012-March 2013). The study included patients older than 18 years undergoing surgery or interventional drainage to address complicated intra-abdominal infections (IAIs). 1898 patients with a mean age of 51.6 years (range 18-99) were enrolled in the study. 777 patients (41%) were women and 1,121 (59%) were men. Among these patients, 1,645 (86.7%) were affected by community-acquired IAIs while the remaining 253 (13.3%) suffered from healthcare-associated infections. Intraperitoneal specimens were collected from 1,190 (62.7%) of the enrolled patients. 827 patients (43.6%) were affected by generalized peritonitis while 1071 (56.4%) suffered from localized peritonitis or abscesses. The overall mortality rate was 10.5% (199/1898). According to stepwise multivariate analysis (PR = 0.005 and PE = 0.001), several criteria were found to be independent variables predictive of mortality, including patient age (OR = 1.1; 95%CI = 1.0-1.1; p < 0.0001), the presence of small bowel perforation (OR = 2.8; 95%CI = 1.5-5.3; p < 0.0001), a delayed initial intervention (a delay exceeding 24 hours) (OR = 1.8; 95%CI = 1.5-3.7; p < 0.0001), ICU admission (OR = 5.9; 95%CI = 3.6-9.5; p < 0.0001) and patient immunosuppression (OR = 3.8; 95%CI = 2.1-6.7; p < 0.0001).
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Affiliation(s)
| | - Fausto Catena
- Emergency Surgery, Maggiore Parma Hospital, Parma, Italy
| | - Luca Ansaloni
- Department of General Surgery, Ospedali Riuniti, Bergamo, Italy
| | | | - Davide Corbella
- Department of Anestesiology, Ospedali Riuniti, Bergamo, Italy
| | - Ernest E Moore
- Department of Surgery, Denver Health Medical Center, Denver, USA
| | | | - George Velmahos
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Massachusetts, USA
| | - Raul Coimbra
- Department of Surgery, UC San Diego Health System, San Diego, USA
| | - Kaoru Koike
- Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Ari Leppaniemi
- Department of Abdominal Surgery, University Hospital Meilahti, Helsinki, Finland
| | - Walter Biffl
- Department of Surgery, Denver Health Medical Center, Denver, USA
| | - Zsolt Balogh
- Department of Surgery, University of Newcastle, Newcastle, NSW, Australia
| | - Cino Bendinelli
- Department of Surgery, University of Newcastle, Newcastle, NSW, Australia
| | - Sanjay Gupta
- Department of Surgery, Govt Medical College and Hospital, Chandigarh, India
| | - Yoram Kluger
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | | | | | | | - Elio Jovine
- Department of Surgery, Maggiore Hospital, Bologna, Italy
| | | | - James F Whelan
- Division of Trauma/Critical Care Department of Surgery Virginia Commonwealth University, Richmond, VA, USA
| | - Gustavo P Fraga
- Division of Trauma Surgery, Campinas University, Campinas, Brazil
| | | | | | - Kuo-Ching Yuan
- Department of Surgery, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Miklosh Bala
- Department of General Surgery, Hadassah Medical Center, Jerusalem, Israel
| | - Miroslav P Peev
- Division of Trauma, Emergency Surgery and Surgical Critical Care, Harvard Medical School, Massachusetts General Hospital, Massachusetts, USA
| | - Offir Ben-Ishay
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Yunfeng Cui
- Department of Surgery, Tianjin Nankai Hospital, Nankai Clinical School of Medicine, Tianjin Medical University, Tianjin, China
| | - Sanjay Marwah
- Department of Surgery, Pt BDS Post-graduate Institute of Medical Sciences, Rohtak, India
| | | | - Imtiaz Wani
- Department of Surgery, SKIMS, Srinagar, India
| | | | - Boris Sakakushev
- First Clinic of General Surgery, University Hospital/UMBAL/St George Plovdiv, Plovdiv, Bulgaria
| | - Victor Kong
- Department of Surgery, Edendale Surgery, Pietermaritzburg, Republic of South Africa
| | - Adamu Ahmed
- Department of Surgery, Ahmadu Bello University Teaching Hospital Zaria, Kaduna, Nigeria
| | - Ashraf Abbas
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | | | | | | | - Elia Poiasina
- Department of General Surgery, Ospedali Riuniti, Bergamo, Italy
| | - Rafael Díaz-Nieto
- Department of General and Digestive Surgery, Virgen de la Victoria, University Hospital, Malaga, Spain
| | - Damien Massalou
- Department of General Surgery and Surgical Oncology, Université de Nice Sophia-Antipolis, Universitary Hospital of Nice, Nice, France
| | - Matej Skrovina
- Department of Surgery, Hospital and Oncological Centre, Novy Jicin, Czech Republic
| | - Ihor Gerych
- Department of General Surgery, Lviv Emergency Hospital, Lviv, Ukraine
| | - Goran Augustin
- Department of Surgery, University Hospital Center Zagreb, Zagreb, Croatia
| | - Jakub Kenig
- 3rd Department of General Surger Jagiellonian Univeristy, Narutowicz Hospital, Krakow, Poland
| | | | | | | | | | - Jae Gil Lee
- Department of Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Suk-Kyung Hong
- Division of Trauma and Surgical Critical Care, Department of Surgery, University of Ulsan, Seoul, Republic of Korea
| | | | - Wagih Ghnnam
- Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - Alfredo Verni
- Department of Surgery, Cutral Có Clinic, Cutral Có, Argentina
| | - Varut Lohsiriwat
- Department of Surgery, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | | | - Tamer El Zalabany
- Department of Surgery, Bahrain Defence Force Hospital, Manama, Bahrain
| | - Alberto Tavares
- Department of Surgery, Hospital Regional de Alta Especialidad del Bajio, Leon, Mexico
| | - Gianluca Baiocchi
- Clinical and Experimental Sciences, Brescia Ospedali Civili, Brescia, Italy
| | - Koray Das
- General Surgery, Adana Numune Training and Research Hospital, Adana, Turkey
| | - Julien Jarry
- Visceral Surgery, Military Hospital Desgenettes, Lyon, France
| | - Maurice Zida
- Visceral Surgery, Teaching Hospital Yalgado Ouedraogo, Ouedraogo, Burkina Faso
| | - Norio Sato
- Department of Primary Care & Emergency Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kiyoshi Murata
- Department of Acute and Critical care medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tomohisa Shoko
- The Shock Trauma and Emergency Medical Center, Matsudo City Hospital, Chiba, Japan
| | - Takayuki Irahara
- Emergency and Critical Care Center of Nippon Medical School, Tama-Nagayama Hospital, Tokyo, Japan
| | | | - Noel Naidoo
- Department of Surgery, Port Shepstone Hospital, Port Shepstone, South Africa
| | | | - Yoshiro Kobe
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan
| | - Wataru Ishii
- Department of Emergency and Critical Care Medicine, Chiba University Hospital, Chiba, Japan ; Depatment of Emergency Medicine, Kyoto Second Red Cross Hospital, Kyoto, Japan
| | - Kazuyuki Oka
- Tajima emergency & Critical Care Medical Center, Toyooka Public Hospital, Toyooka, Hyogo, Japan
| | - Yoshimitsu Izawa
- Emergency and Critical Care Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Hytham Hamid
- Department of Surgery, Mayo General Hospital Castlebar Co. Mayo, Castlebar, Ireland
| | - Iqbal Khan
- Department of Surgery, Mayo General Hospital Castlebar Co. Mayo, Castlebar, Ireland
| | - Ak Attri
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Rajeev Sharma
- Department of General Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Juan Sanjuan
- Department of Surgery, Fundación Valle del Lilí, Cali, Colombia
| | - Marisol Badiel
- Department of Surgery, Fundación Valle del Lilí, Cali, Colombia
| | - Rita Barnabé
- Department of Surgery, Maggiore Hospital, Bologna, Italy
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13
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Peev MP, Yeh DD, Quraishi SA, Osler P, Chang Y, Gillis E, Albano CE, Darak S, Velmahos GC. Causes and consequences of interrupted enteral nutrition: a prospective observational study in critically ill surgical patients. JPEN J Parenter Enteral Nutr 2014; 39:21-7. [PMID: 24714361 DOI: 10.1177/0148607114526887] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Malnutrition and underfeeding are major challenges in caring for critically ill patients. Our goal was to characterize interruptions in enteral nutrition (EN) delivery and their impact on caloric debt in the surgical intensive care unit (ICU). MATERIALS AND METHODS We performed a prospective, observational study of adults admitted to surgical ICUs at a Boston teaching hospital (March-December 2012). We categorized EN interruptions as "unavoidable" vs "avoidable" and compared caloric deficit between patients with ≥1 EN interruption (group 1) vs those without interruptions (group 2). Multivariable logistic regression was used to investigate the association of EN interruption with the risk of underfeeding. Poisson regression was used to investigate the association of EN interruption with length of stay (LOS) and mortality. RESULTS Ninety-four patients comprised the analytic cohort. Twenty-six percent of interruptions were deemed "avoidable." Group 1 (n = 64) had a significantly higher mean daily and cumulative caloric deficit vs group 2 (n = 30). Patients in group 1 were at a 3-fold increased risk of being underfed (adjusted odds ratio, 2.89; 95% confidence interval [CI], 1.03-8.11), had a 30% higher risk of prolonged ICU LOS (adjusted incident risk ratio [IRR], 1.27; 95% CI, 1.14-1.42), and had a 50% higher risk of prolonged hospital LOS (adjusted IRR, 1.53; 95% CI, 1.41-1.67) vs group 2. CONCLUSIONS In our cohort of critically ill surgical patients, EN interruption was frequent, largely "unavoidable," and associated with undesirable outcomes. Future efforts to optimize nutrition in the surgical ICU may benefit from considering strategies that maximize nutrient delivery before and after clinically appropriate EN interruptions.
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Affiliation(s)
- Miroslav P Peev
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - D Dante Yeh
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts Department of Surgery, Harvard Medical School, Boston, Massachusetts
| | - Sadeq A Quraishi
- Department of Anesthesia, Critical Care and Pain Medicine, Massachusetts General Hospital, Boston, Massachusetts Department of Anesthesia, Harvard Medical School, Boston, Massachusetts
| | - Polina Osler
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts
| | - Yuchiao Chang
- Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts Department of Medicine, Harvard Medical School, Boston, Massachusetts
| | - Erin Gillis
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Caitlin E Albano
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - Sharon Darak
- Department of Nutrition and Food Services, Massachusetts General Hospital, Boston, Massachusetts
| | - George C Velmahos
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, Massachusetts Department of Surgery, Harvard Medical School, Boston, Massachusetts
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14
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Peev MP, Naraghi L, Chang Y, Demoya M, Fagenholz P, Yeh D, Velmahos G, King DR. Real-time sample entropy predicts life-saving interventions after the Boston Marathon bombing. J Crit Care 2013; 28:1109.e1-4. [PMID: 24120576 DOI: 10.1016/j.jcrc.2013.08.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Revised: 08/23/2013] [Accepted: 08/25/2013] [Indexed: 11/19/2022]
Abstract
PURPOSE Identifying patients in need of a life-saving intervention (LSI) during a mass casualty event is a priority. We hypothesized that real-time, instantaneous sample entropy (SampEn) could predict the need for LSI in the Boston Marathon bombing victims. MATERIALS AND METHODS Severely injured Boston Marathon bombing victims (n = 10) had sample entropy (SampEn) recorded upon presentation using a continuous 200-beat rolling average in real time. Treating clinicians were blinded to real-time results. The correlation between SampEn, injury severity, number, and type of LSI was examined. RESULTS Victims were males (60%) with a mean age of 39.1 years. Injuries involved lower extremities (50.0%), head and neck (24.2%), or upper extremities (9.7%). Sample entropy negatively correlated with Injury Severity Score (r = -0.70; P = .023), number of injuries (r = -0.70; P = .026), and the number and need for LSI (r = -0.82; P = .004). Sample entropy was reduced under a variety of conditions. (Table see text). CONCLUSIONS Sample entropy strongly correlates with injury severity and predicts LSI after blast injuries sustained in the Boston Marathon bombings. Sample entropy may be a useful triage tool after blast injury.
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Affiliation(s)
- Miroslav P Peev
- Department of Surgery, Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA
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15
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Sartelli M, Catena F, Ansaloni L, Moore E, Malangoni M, Velmahos G, Coimbra R, Koike K, Leppaniemi A, Biffl W, Balogh Z, Bendinelli C, Gupta S, Kluger Y, Agresta F, Di Saverio S, Tugnoli G, Jovine E, Ordonez C, Gomes CA, Junior GAP, Yuan KC, Bala M, Peev MP, Cui Y, Marwah S, Zachariah S, Sakakushev B, Kong V, Ahmed A, Abbas A, Gonsaga RAT, Guercioni G, Vettoretto N, Poiasina E, Ben-Ishay O, Díaz-Nieto R, Massalou D, Skrovina M, Gerych I, Augustin G, Kenig J, Khokha V, Tranà C, Kok KYY, Mefire AC, Lee JG, Hong SK, Segovia Lohse HA, Ghnnam W, Verni A, Lohsiriwat V, Siribumrungwong B, Tavares A, Baiocchi G, Das K, Jarry J, Zida M, Sato N, Murata K, Shoko T, Irahara T, Hamedelneel AO, Naidoo N, Adesunkanmi ARK, Kobe Y, Attri A, Sharma R, Coccolini F, El Zalabany T, Khalifa KA, Sanjuan J, Barnabé R, Ishii W. Complicated intra-abdominal infections in a worldwide context: an observational prospective study (CIAOW Study). World J Emerg Surg 2013; 8:1. [PMID: 23286785 PMCID: PMC3538624 DOI: 10.1186/1749-7922-8-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Accepted: 01/02/2013] [Indexed: 12/16/2022] Open
Abstract
Despite advances in diagnosis, surgery, and antimicrobial therapy, mortality rates associated with complicated intra-abdominal infections remain exceedingly high. The World Society of Emergency Surgery (WSES) has designed the CIAOW study in order to describe the clinical, microbiological, and management-related profiles of both community- and healthcare-acquired complicated intra-abdominal infections in a worldwide context. The CIAOW study (Complicated Intra-Abdominal infection Observational Worldwide Study) is a multicenter observational study currently underway in 57 medical institutions worldwide. The study includes patients undergoing surgery or interventional drainage to address complicated intra-abdominal infections. This preliminary report includes all data from almost the first two months of the six-month study period. Patients who met inclusion criteria with either community-acquired or healthcare-associated complicated intra-abdominal infections (IAIs) were included in the study. 702 patients with a mean age of 49.2 years (range 18–98) were enrolled in the study. 272 patients (38.7%) were women and 430 (62.3%) were men. Among these patients, 615 (87.6%) were affected by community-acquired IAIs while the remaining 87 (12.4%) suffered from healthcare-associated infections. Generalized peritonitis was observed in 304 patients (43.3%), whereas localized peritonitis or abscesses was registered in 398 (57.7%) patients. The overall mortality rate was 10.1% (71/702). The final results of the CIAOW Study will be published following the conclusion of the study period in March 2013.
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