المؤلفون: Otero, Tiffany M. N.^1,2, Yeh, D. Dante^3,4, Bajwa, Ednan K.^4,5, Azocar, Ruben J.⁶, Tsai, Andrea L.⁶, Belcher, Donna M.⁷, Quraishi, Sadeq A.^2,4 squraishi@mgh.harvard.edu

المصدر: Journal of Intensive Care Medicine. Apr2018, Vol. 33 Issue 4, p241-247. 7p.

مصطلحات موضوعية: *ACADEMIC medical centers, *ERYTHROCYTES, *AGE distribution, *ARTERIES, *BLOOD testing, *BLOOD pressure, *C-reactive protein, *CONFIDENCE intervals, *CREATININE, *CRITICALLY ill, *HEMOGLOBINS, *LONGITUDINAL method, *LUNG injuries, *NUTRITIONAL assessment, *SCIENTIFIC observation, *PATIENTS, *PHOSPHATES, *POISSON distribution, *RACE, *REGRESSION analysis, *RESEARCH, *RESPIRATORY insufficiency, *SEX distribution, *MECHANICAL ventilators, *DECISION making in clinical medicine, *ALBUMINS, *BODY mass index, *RETROSPECTIVE studies, *SEVERITY of illness index, *ODDS ratio

مصطلحات جغرافية: MASSACHUSETTS

مستخلص: Introduction: Elevated red cell distribution width (RDW) is associated with mortality in a variety of respiratory conditions. Recent data also suggest that RDW is associated with mortality in intensive care unit (ICU) patients. Although respiratory failure is common in the ICU, the relationship between RDW and pulmonary outcomes in the ICU has not been previously explored. Therefore, our goal was to investigate the association of admission RDW with 30-day ventilator-free days (VFDs) in ICU patients. Methods: We performed a retrospective analysis from an ongoing prospective, observational study. Patients were recruited from medical and surgical ICUs of a large teaching hospital in Boston, Massachusetts. The RDW was assessed within 1 hour of ICU admission. Poisson regression analysis was used to investigate the association of RDW (normal: 11.5%-14.5% vs elevated: >14.5%) with 30-day VFD, while controlling for age, sex, race, body mass index, Nutrition Risk in the Critically Ill score, the presence of chronic lung disease, Pao2/Fio2 ratio, and admission levels of hemoglobin, mean corpuscular volume, phosphate, albumin, C-reactive protein, and creatinine. Results: A total of 637 patients comprised the analytic cohort. Mean RDW was 15 (standard deviation 4%), with 53% of patients in the normal range and 47% with elevated levels. Median VFD was 16 (interquartile range: 6-25) days. Poisson regression analysis demonstrated that ICU patients with elevated admission RDW were likely to have 32% lower 30-day VFDs compared to their counterparts with RDW in the normal range (incidence rate ratio: 0.68; 95% confidence interval: 0.55-0.83: P < .001). Conclusions: We observed an inverse association of RDW and 30-day VFD, despite controlling for demographics, nutritional factors, and severity of illness. This supports the need for future studies to validate our findings, understand the physiologic processes that lead to elevated RDW in patients with respiratory failure, and determine whether changes in RDW may be used to support clinical decision-making. [ABSTRACT FROM AUTHOR]

المؤلفون: Santos, Jeffrey¹, Kuza, Catherine M.², Luo, Xi³, Ogunnaike, Babatunde³, Ahmed, M. Iqbal³, Melikman, Emily³, Moon, Tiffany³, Shoultz, Thomas⁴, Feeler, Anne⁴, Dudaryk, Roman⁵, Navas, Jose⁵, Vasileiou, Georgia⁶, Yeh, D. Dante⁶, Matsushima, Kazuhide⁷, Forestiere, Matthew⁷, Lian, Tiffany⁷, Grigorian, Areg¹, Ricks-Oddie, Joni⁸, Nahmias, Jeffry¹ jnahmias@hs.uci.edu

المصدر: American Surgeon. Oct2023, Vol. 89 Issue 10, p4038-4044. 7p.

مصطلحات موضوعية: *DISEASE risk factors, *RISK assessment, *TRAUMA centers, *CALCULATORS, *TRAUMA surgery

مستخلص: Background: The Trauma and Injury Severity Score (TRISS) uses anatomic/physiologic variables to predict outcomes. The National Surgical Quality Improvement Program Surgical Risk Calculator (NSQIP-SRC) includes functional status and comorbidities. It is unclear which of these tools is superior for high-risk trauma patients (American Society of Anesthesiologists Physical Status (ASA-PS) class IV or V). This study compares risk prediction of TRISS and NSQIP-SRC for mortality, length of stay (LOS), and complications for high-risk operative trauma patients. Methods: This is a prospective study of high-risk (ASA-PS IV or V) trauma patients (≥18 years-old) undergoing surgery at 4 trauma centers. We compared TRISS vs NSQIP-SRC vs NSQIP-SRC + TRISS for ability to predict mortality, LOS, and complications using linear, logistic, and negative binomial regression. Results: Of 284 patients, 48 (16.9%) died. The median LOS was 16 days and number of complications was 1. TRISS + NSQIP-SRC best predicted mortality (AUROC:.877 vs.723 vs.843, P =.0018) and number of complications (pseudo-R2/median error (ME) 5.26%/1.15 vs 3.39%/1.33 vs 2.07%/1.41, P <.001) compared to NSQIP-SRC or TRISS, but there was no difference between TRISS + NSQIP-SRC and NSQIP-SRC with LOS prediction (P =.43). Discussion: For high-risk operative trauma patients, TRISS + NSQIP-SRC performed better at predicting mortality and number of complications compared to NSQIP-SRC or TRISS alone but similar to NSQIP-SRC alone for LOS. Thus, future risk prediction and comparisons across trauma centers for high-risk operative trauma patients should include a combination of anatomic/physiologic data, comorbidities, and functional status. [ABSTRACT FROM AUTHOR]

المؤلفون: Huerta, Carlos Theodore¹ cth62@med.miami.edu, Ribieras, Antoine J.¹, Kodia, Karishma¹, Yeh, D. Dante¹, Kerman, David², Byers, Patricia¹

المصدر: American Surgeon. May2023, Vol. 89 Issue 5, p1997-2004. 8p.

مصطلحات موضوعية: *CROHN'S disease, *INTESTINAL perforation, *ENTERITIS, *LITERATURE reviews, *SMALL intestine, *ACUTE abdomen, *ENTEROSCOPY, *OSTOMY

مستخلص: Small bowel perforation is an uncommon but severe event in the natural history of Crohn's disease with fewer than 100 cases reported. We review Crohn's disease cases with necrotizing enteritis and share a case of a 26-year-old female who presented with a recurrent episode of small intestinal perforation. A PubMed literature review of case reports and series was conducted using keywords and combinations of "Crohn's disease," "small intestine perforation," "small bowel perforation," "free perforation," "regional enteritis," and "necrotizing enteritis." Data extracted included demographic data, pre- or postoperative steroid administration, medical or surgical management, and case fatality. Nineteen reports from 1935 to 2021 qualified for inclusion. There were 43 patients: 20 males and 23 females with a mean age of 36 ± 15 years old. 75 total perforations were described: 56 ileal (74.6%), 15 jejunal (20.0%), 2 cecal (2.7%), and 1 small intestine non-specified (2.7%). 38 of 43 patients were managed surgically by primary repair (11), ostomy creation (21), or an anastomosis (11). Of 11 case fatalities, medical management alone was associated with higher mortality (5/5; 100% mortality) compared to those treated surgically (6/38; 15.8% mortality; P <.001). Patient sex, disease history, acute abdomen, and pre- or postoperative steroid use did not significantly correlate with mortality. Jejunal perforation was significantly (P =.028) associated with event mortality while ileal was not (P =.45). Although uncommon, necrotizing enteritis should be considered in Crohn's patients who present with small intestinal perforation. These cases often require urgent surgical intervention and may progress to fulminant sepsis and fatality if not adequately treated. [ABSTRACT FROM AUTHOR]