Critical care management and intensive care unit outcomes following cytoreductive surgery with hyperthermic intraperitoneal chemotherapy

AIM To study the early postoperative intensive care unit(ICU) management and complications in the first 2 wk of patients undergoing cytoreductive surgery(CRS) and hyperthermic intraperitoneal chemotherapy(HIPEC).METHODS Our study is a retrospective, observational study per-formed at Icahn School of Medicine at Mount Sinai, quaternary care hospital in New York City. All adult patients who underwent CRS and HIPEC between January 1, 2007 and December 31, 2012 and admitted to ICU postoperatively were studied. Fifty-one patients came to the ICU postoperatively out of 170 who underwent CRS and HIPEC therapy during the study period. Data analysis was performed using descriptive statistics.RESULTS Of the 170 patients who underwent CRS and HIPEC therapy, 51(30%) came to the ICU postoperatively. Mean ICU length of stay was 4 d(range 1-60 d) and mean APACHE Ⅱ score was 15(range 7-23). Thirtyone/fifty-one(62%) patients developed postoperative complications. Aggressive intraoperative and postoperative fluid resuscitation is required in most patients. Hypovolemia was seen in all patients and median amount of fluids required in the first 48 h was 6 L(range 1-14 L). Thirteen patients(25%) developed postoperative hypotension with seven requiring vasopressor support. The major cause of sepsis was intraabdominal, with 8(15%) developing anastomotic leaks and 5(10%) developing intraabdominal abscess. The median survival was 14 mo with 30 d mortality of 4%(2/51) and 90 d mortality of 16%(8/51). One year survival was 56.4%(28/51). Preoperative medical co morbidities, extent of surgical debulking, intraoperative blood losses, amount of intra op blood products required and total operative time are the factors to be considered while deciding ICU vs non ICU admission.CONCLUSION Overall, ICU outcomes of this study population are excellent. Triage of these patients should consider preoperative and intraoperative factors. Intensivists should be vigilant to aggressive postop fluid resuscitation, pain control and early detection and management of surgical complications.

Conf irmation of endotracheal tube placement using disposable f iberoptic bronchoscopy in the emergent setting

BACKGROUND:Patients intubated in the prehospital setting require quick and definitive confirmation of endotracheal (ET) tube placement upon arrival to the emergency department (ED).Direct and adjunct strategies exist,but each has limitations and there is no definitive gold standard.The utility of bronchoscopy in ED intubation has been studied,but scant literature exists on its use for ET tube confirmation.This study aims to assess effectiveness,ease and speed with which ET tube placement can be confirmed with disposable fiberoptic bronchoscopy.METHODS:Emergency medicine residents recruited from a 3-year urban residency program received 5 minutes of active learning on a simulation mannequin using a disposable,flexible Ambu aScope interfaced with a monitor.With residents blinded,the researcher randomly placed the ET tube in the trachea,esophagus or right mainstem.Residents identified ET tube position by threading the bronchoscope through the tube and viewing distal anatomy.Each resident underwent 4 trials.Accuracy,speed and perceptions of difficulty were measured.RESULTS:Residents accurately identified the location of the ET tube in 88 out of 92 trials (95.7%).The median time-to-guess was 7.0 seconds,IQR (5.0-10.0).Average perceived difficulty was 1.6 on a scale from 1-5 (1 being very easy and 5 being very difficult).No tubes were damaged or dislodged.CONCLUSION:While simulation cannot completely replicate the live experience,fiberoptic bronchoscopy appears to be a quick and accurate method for ET tube confirmation.Further studies directly comparing this novel approach to established practices on actual patients are warranted.

Cervical Cancer Prevention Challenges and Barriers to Cervical Cancer Screening and HPV Vaccinations in Ukraine and Eastern Europe

Objectives: To identify the obstacles and issues that hinder effective cancer prevention efforts in Ukraine. The study aims to provide a comprehensive assessment of the barriers to cancer prevention, including both infrastructure and behavioral factors, and identify potential solutions to address these challenges. Study Design: Comprehensive literature review. Methods: The following databases were searched: National Center for Biotechnology Information (NCBI) and PubMed (U.S. National Library of Medicine at the National Institutes of Health). The keywords used in the search included “Cervical Cancer”, “Human Papillomavirus Vaccination (HPV)”, “Ukraine”, “Eastern Europe”, “Healthcare Infrastructure in Disasters”, “Cervical Cancer Prevention”, “Pap Smear”, and “HPV Testing”. Results: A total of 3500 articles were screened. A total of 65 articles met the inclusion criteria. Limited public awareness and limited access to vaccination and screening, combined with inadequate treatment facilities lead to higher rates of cervical cancer. The COVID pandemic, war with Russia, and the Chernobyl disaster are significant factors for the low level of vaccination in Ukraine. Conclusion: The prevention and treatment of cervical cancer in Ukraine face significant challenges due to the inadequate HPV vaccination rates and screening by cytology. Efforts to improve funding and increase education of both the population and health care providers are necessary to increase interventions such as HPV vaccination, cervical cytology, and HPV testing to reduce cervical cancer rates in Ukraine.

Atypical Neuroleptic Malignant Syndrome: Pitfalls and Challenges in the Delirious Substance Abuser

Introduction: A rare and atypical form of Neuroleptic Malignant Syndrome (NMS) can be a deceptive and life threatening condition if not diagnosed properly in acute and critical care settings. Methods: The management of a patient presenting with atypical NMS without prominent rigidity, but with extensive rhabdomyolysis after the administration of haloperidol and ziprasidone is described in this report. Results: Prompt recognition of atypical features of NMS was managed by intensive care unit admission, supportive care and pharmacotherapy, leading to a complete resolution of the syndrome and a favorable outcome verified by laboratory findings. Conclusion: Early stages and atypical features of NMS may be variable in presentation and clinical course. The absence of muscle rigidity may not rule out NMS. A strong clinical suspicion based on clinical history is crucial for early diagnosis and treatment. Termination of dantrolene therapy may not be necessary during rhabdomyolysis and elevated aminotransferase levels.

The clinical differentiation of blood culture-positive and -negative sepsis in burn patients: a retrospective cohort stu

Background:Sepsis is a potentially life-threatening condition that occurs when the body’s response to infection leads to widespread inflammation and tissue damage.Negative cultures can make it difficult for clinicians to make a diagnosis and may raise questions about the validity of the definition of sepsis.In addition,the clinical distinctions between burn patients with blood culturepositive and-negative sepsis are also poorly understood.Therefore,this study aimed to examine the clinical differences between blood culture-positive and-negative sepsis in burn patients in order to improve the understanding of the pathophysiology and epidemiology of sepsis in this population.Methods:This study had a retrospective design,and the participants were adults aged≥18 years.Patients diagnosed with sepsis were divided into two groups based on their blood culture results within 1 week of sepsis diagnosis.Results:We enrolled 1643 patients admitted to our institution’s burn intensive care unit between January 2010 and December 2021.pH,platelet count,bicarbonate and haematocrit were significant in both the positive and negative groups.However,lymphocyte,red cell distribution width and blood urea nitrogen were significant only in the positive group,whereas lactate dehydrogenase was significant only in the negative group.Acinetobacter baumannii,Pseudomonas aeruginosa,and Klebsiella pneumonia are common gram-negative bacterial species,and Staphylococcus aureus and Staphylococcus epidermidis are common gram-positive bacterial species seen in burn patients with positive blood cultures.Carbapenem resistance was found to be associated with an unfavourable prognosis in gram-negative bacteria,with the exception of P.aeruginosa.Conclusions:pH,platelet count,bicarbonate and haematocrit were routine biomarkers that demon-strated statistical significance in both groups.Lactate dehydrogenase was significant in the blood-negative group,while red cell distribution width,blood urea nitrogen and lymphocyte count were significant in the positive group.Furthermore,the most common causes of sepsis are gram-negative bacteria,including A.baumannii,K.pneumoniae and P.aeruginosa.Additionally,resistance to carbapenems is associated with unfavourable outcomes.

世界腹腔间隙学会腹内高压和腹腔间隙综合征2013版专家共识与诊疗指南

随着人们对腹内压（intra-abdominal pressure,IAP）的重视,大量研究开始关注腹内高压（intraabdominal hypertension,IAH）和腹腔间隙综合征（abdominal compartment syndrome,ACS）.世界腹腔间隙学会（The abdominal compartment society,WSACS）先后在2006年提出了IAH和ACS的专家共识,2007年发表了诊疗指南,2009年明确了疾病相关研究的推荐方向.2013年WSACS发布了新的IAH和ACS专家共识与诊疗指南.该指南由多学科专家共同参与制定,大部分是外科专家和重症监护专家.专家们首先明确24个临床医师关心的IAH和ACS问题,随后进行了系统有序的文献整理.