1
|
Nahar T, Roberts A, Brigode W, Siddiqi M, Capron G, Starr F, Bokhari F. "HYPER-EARLY" Tracheostomy within 48 hours has less Complications and Better Prognosis Compared to Traditional Tracheostomy. Am Surg 2022; 88:1517-1521. [PMID: 35412861 DOI: 10.1177/00031348221082288] [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: 11/15/2022]
Abstract
INTRODUCTION Tracheostomies may be performed "early" or "late." There is no agreement on the best timing for tracheostomy. This study compares tracheostomies and complications when performed within 48 hours with those performed from 48 hours to 21 days. METHODS Patients who underwent tracheostomy in the 2017-2018 National Trauma Data Bank (NTDB) were categorized into 2 groups: early tracheostomy (≤48 hours) and late tracheostomy (>48 hours to 21 days). Primary outcome measured was mortality. Chi square models, Mann-Whitney U Test, and multivariate logistics were used for data analysis. RESULTS 843 patients had tracheostomy performed, of which 16% underwent early tracheostomy. Majority were male in both early (84%) and late (74%) tracheostomy groups. Mortality was not statically significant in early (13%) or late (9%) (P = .151). Total duration of ventilation in early tracheostomy group was less (5 days) compared to late tracheostomy group (16 days, P < .001). Patients with late tracheostomy had almost 18% cases of ventilator-associated pneumonia (VAP) when compared to early tracheostomy patients (7%, P < .001). Early tracheostomy patients also had shorter hospital length of stay (HLOS) (13 vs 27 days) and intensive care unit (ICU) length of stay (LOS) (7 vs 20 days) than late tracheostomy patients (P<.001). Early tracheostomy patients also had shorter hospital length of stay (HLOS) (13 vs 27 days) and intensive care unit (ICU) length of stay (LOS) (7 vs 20 days) than late tracheostomy patients (P < .001). CONCLUSION Tracheostomy performed as early as 48 hours is beneficial as it demonstrates a decrease time on ventilator, decreased HLOS, as well as lower VAP rates. Our data shows "hyper-early" tracheostomies might be more beneficial that the current national practice.
Collapse
|
2
|
Siddiqi M, Guiab K, Roberts A, Evan T, Nahar T, Patel V, Capron G, Brigode W, Starr F, Bokhari F. Maternal Outcomes After Trauma in Pregnancy: A National Database Study. Am Surg 2022; 88:1760-1765. [PMID: 35333642 DOI: 10.1177/00031348221083940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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: 11/16/2022]
Abstract
OBJECTIVES Trauma is an important non-obstetric cause of mortality in pregnant females. METHODS The National Trauma Databank (NTDB) was queried between 2017 and 2018. Pregnant women >20 weeks gestation, who underwent trauma, were included. They were categorized into different age groups from 12-18, 18-35, and 36-50 years of age. The primary outcome measure was 30-day mortality. RESULTS 1,058 pregnant trauma patients were included. Mean age was 26.7 ± 6 years. Of those 94.5% had blunt and 3.8% had penetrating injuries. Median GCS and ISS were 15 (15, 15) and 2 (1, 5), respectively. Penetrating trauma patients required more operative intervention (57.5%) than blunt trauma patients (24.6%). Univariate analysis comparing age groups 12-18, 19-35, and >36 years revealed differences. (P < .05) in ED systolic blood pressure (110.9 ± 19.7 vs 117.3 ± 20.3 vs 129.1 ± 29.3 mmHg, P = .01) and diabetes mellitus (.0 vs 2.7% vs 6.6% P = .03). There was no difference in HLOS (P = .72), complications (P = .279), and mortality (P = .32). Multivariate logistic regression analysis revealed that compared to patients 12-18 years old, patients 19 to 35 (P = .27) or those >36 (P = 1.0) did not show a significant difference in mortality. Patients with high ISS had higher complication rates (OR 1.09; 95% CI 1.04-1.15) and prolonged HLOS (OR 1.00; 95% CI 1.07-1.15). CONCLUSION On average pregnant women (>20 weeks gestation) who presented to trauma centers had minor injuries and maternal age or mechanism of injury did not affect mortality. Despite a low ISS, a significant number of these patients required operative procedures.
Collapse
Affiliation(s)
- Mahwash Siddiqi
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Keren Guiab
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Andrew Roberts
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Teresa Evan
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Tanzilan Nahar
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Vidhi Patel
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Gweniviere Capron
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - William Brigode
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Frederic Starr
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| | - Faran Bokhari
- Trauma and Burn Department, 25430John H Stroger Hospital of Cook County, Chicago, IL, USA
| |
Collapse
|
3
|
Abstract
Aortic artery dissection is a rare but well-recognized complication of Turner's syndrome. Isolated carotid or vertebral artery dissection has not previously been reported. The authors report the clinical and magnetic resonance imaging findings in a 30-year-old woman with Turner's syndrome who developed a high cervical spinal cord infarction with a Brown-Sequard syndrome owing to bilateral vertebral artery dissection. The diagnosis and management of the case is reviewed.
Collapse
Affiliation(s)
- P Muscat
- Department of Neurology, Box 1052, Mount Sinai School of Medicine, 1 Gustav Levy Place, New York, NY 10029, USA
| | | | | | | | | |
Collapse
|
4
|
Nahar T, Croft L, Shapiro R, Fruchtman S, Diamond J, Henzlova M, Machac J, Buckley S, Goldman ME. Comparison of four echocardiographic techniques for measuring left ventricular ejection fraction. Am J Cardiol 2000; 86:1358-62. [PMID: 11113413 DOI: 10.1016/s0002-9149(00)01243-1] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Accurate quantitative measurement of left ventricular (LV) ejection fraction (EF) by 2-dimensional echocardiography is limited by subjective visual endocardial border detection. Both harmonic and precision contrast microbubbles provide better delineation of endocardial borders than fundamental imaging. The aim of this study was to correlate 2-dimensional echocardiographic quantification of LVEF measured by 4 currently available techniques with radionuclide angiography. A total of 50 patients who underwent radionuclide (EF) measurement (47 of 50 had technically difficult echocardiograms by fundamental imaging) underwent echocardiography by 4 methods: fundamental alone, fundamental with contrast, harmonic alone, and harmonic with contrast. Three echocardiologists measured the biplane 2-dimensional echocardiographic LVEF independently and were blinded to radionuclide angiography. The correlation of echocardiographic EF with radionuclide EF improved incrementally with each method. However, contrast with harmonic imaging provided the closest correlation (r = 0.95, 0.96, and 0.95 as assessed by the 3 independent analysts.
Collapse
Affiliation(s)
- T Nahar
- Zena & Michael A. Weiner Cardiovascular Institute, Mount Sinai Medical Center, New York, New York 10029, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Fayad ZA, Nahar T, Fallon JT, Goldman M, Aguinaldo JG, Badimon JJ, Shinnar M, Chesebro JH, Fuster V. In vivo magnetic resonance evaluation of atherosclerotic plaques in the human thoracic aorta: a comparison with transesophageal echocardiography. Circulation 2000; 101:2503-9. [PMID: 10831525 DOI: 10.1161/01.cir.101.21.2503] [Citation(s) in RCA: 236] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The structure and composition of aortic atherosclerotic plaques are associated with the risk of future cardiovascular events. Magnetic resonance (MR) imaging may allow accurate visualization and characterization of aortic plaques. METHODS AND RESULTS We developed a noninvasive MR method, free of motion and blood flow artifacts, for submillimeter imaging of the thoracic aortic wall. MR imaging was performed on a clinical MR system in 10 patients with aortic plaques identified by transesophageal echocardiography (TEE). Plaque composition, extent, and size were assessed from T1-, proton density-, and T2- weighted images. Comparison of 25 matched MR and TEE cross-sectional aortic plaque images showed a strong correlation for plaque composition (chi(2) = 43.5, P<0.0001; 80% overall agreement; n = 25) and mean maximum plaque thickness (r = 0.88, n = 25; 4.56+/-0.21 mm by MR and 4.62+/-0.31 mm by TEE). Overall aortic plaque extent as assessed by TEE and MR was also statistically significant (chi(2) = 61.77, P<0.0001; 80% overall agreement; n = 30 regions). CONCLUSIONS This study demonstrates that noninvasive MR evaluation of the aorta compares well with TEE imaging for the assessment of atherosclerotic plaque thickness, extent, and composition. This MR method may prove useful for the in vivo study of aortic atherosclerosis.
Collapse
Affiliation(s)
- Z A Fayad
- Zena and Michael A. Wiener Cardiovascular Institute, Department of Radiology, Mount Sinai School of Medicine, New York, USA.
| | | | | | | | | | | | | | | | | |
Collapse
|
6
|
Nelson JE, Croft LB, Nahar T, Vorchheimer D. Evaluation of subclavian catheter position. J Cardiothorac Vasc Anesth 1999; 13:359-61. [PMID: 10392692 DOI: 10.1016/s1053-0770(99)90278-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- J E Nelson
- Department of Medicine, Mount Sinai School of Medicine, New York, NY, USA
| | | | | | | |
Collapse
|
7
|
Abstract
BACKGROUND Current techniques of mitral valve repair rely on decreasing valve area to increase leaflet apposition, but fail to address subvalvular dysfunction. A novel repair has been introduced with partial left ventriculectomy, which apposes the anterior leaflet to a corresponding point on the posterior leaflet creating a double-orifice valve, with reported adequate control of mitral regurgitation. METHODS We started to use the "bow-tie" repair as an adjunct to posterior ring annuloplasty in cases in which mitral regurgitation was not adequately controlled by decreasing mitral valve area (n = 6), or when placement of an annuloplasty ring was impractical (n = 4). Mean follow-up was 336 days (range, 82 to 551 days) with no postoperative deaths. RESULTS Mitral regurgitation decreased from 3.6+/-0.5 to 0.8+/-0.4 (p < 0.0001), with a concomitant increase in ejection fraction from 33%+/-13% to 45%+/-11% (p = 0.0156) before hospital discharge. Mitral valve area, measured by pressure half-time, decreased from a mean of 2.5+/-0.3 to 2.1+/-0.3 cm2, with a mean transvalvular gradient of 4.5+/-2.0 mm Hg. In patients whose mitral valve was repaired using the bow-tie alone, mitral regurgitation was reduced from 4+, to a trace to 1+. Postoperatively, mitral valve area increased from 1.9 to 2.5 cm2 during exercise, further supporting the concept that this technique preserves mitral valve annular function. CONCLUSIONS These observations suggest that the bow-tie repair may offer advantages over conventional techniques of mitral valve repair and should be considered as an adjunct, especially in patients with impaired left ventricular function.
Collapse
Affiliation(s)
- J P Umaña
- Division of Cardiothoracic Surgery, Columbia University College of Physicians & Surgeons, New York, New York, USA
| | | | | | | | | | | | | |
Collapse
|
8
|
Abstract
Thrombus formation at the pulmonary venous anastomotic site after lung transplantation may have catastrophic consequences, including allograft failure and stroke. However, treatment with systemic anticoagulation may facilitate bleeding in the early postoperative period. In the present report, we describe the clinical and transesophageal echocardiographic findings of pulmonary venous thrombosis in two patients in the immediate postoperative period after lung transplantation. Treatment with systemic anticoagulation was not feasible because of extensive postoperative thoracic bleeding in each instance. A conservative approach was taken on the basis of the small size of each thrombus and lack of accelerated flow velocity at the site of the thrombus. Each thrombus resolved spontaneously without clinical sequelae. These two cases suggest that thrombus size and flow velocity at the anastomotic site may be used to guide the clinical management of pulmonary venous thrombosis after lung transplantation.
Collapse
Affiliation(s)
- T Nahar
- Department of Medicine, College of Physicians & Surgeons of Columbia University, New York, New York 10032, USA
| | | | | | | | | | | |
Collapse
|
9
|
Abstract
Transvenous endomyocardial biopsy is a well established procedure to diagnose rejection after heart transplantation as well as to assess for other cardiomyopathic processes. However, it is rarely used to obtain samples of unidentified cardiac masses. We report a case of a primary cardiac sarcoma in which the histologic diagnosis was provided by transesophageal echocardiography-guided transvenous biopsy. This procedure is accurate and can avoid the potential risk of a diagnostic thoracotomy.
Collapse
Affiliation(s)
- M T Savoia
- Division of Cardiology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | | | | | | | | | | | | |
Collapse
|