| 1. |
- Acosta, Stefan, et al.
(author)
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Causes and consequences of mesenteric embolization after endovascular aorto-iliac intervention - a nested case control study
- 2017
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In: Anaesthesiology Intensive Therapy. - 1642-5758. ; 49:2, s. 122-129
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Journal article (peer-reviewed)abstract
- Background: Causes and consequences of mesenteric embolization after endovascular aorto-iliac procedures have not been studied adequately. Methods: Consecutive patients with mesenteric embolization after endovascular aorto-iliac intervention between 2011 and 2015 (case-group, n = 9) were investigated and compared with age, gender and procedure-matched random controls (n = 36). Results: Compared to the control group, a higher proportion of patients with mesenteric embolization were current smokers (89% vs. 53%; P = 0.048) and had renal insufficiency at admission (44% vs. 11%; P = 0.019). In patients treated for aorto-iliac occlusive disease, aortic irregularity (shagginess) was more severe (P = 0.015), visceral thrombus volume was larger (P = 0.004) and operation-Time was longer (P = 0.009) among the case-group. However, no differences were found between cases with mesenteric embolization caused by endovascular aortic aneurysm repair versus controls. Myoglobin, arterial blood lactate, aspartate aminotransferase, alanine aminotransferase and pancreatic amylase levels were elevated in 100%, 67%, 89%, 89%, 89% and 56% of patients with mesenteric embolization, respectively. Overall in-hospital mortality among cases was 33% (3/9). The in-hospital mortality was 17% (1/6) in patients treated with open abdomen therapy, of whom five were managed with stomas. Conclusion: Smoking cessation, careful patient selection and procedure planning with identification of severe shaggy aortas might prevent mesenteric embolization during aorto-iliac procedures. In suspected cases of mesenteric embolization, elevated myoglobin and arterial blood lactate may be indicative of this complication. Aspartate and alanine aminotranferases, as well as pancreatic amylase, are also relevant tests to assess the extent of organ ischaemia. Damage control with open abdomen therapy and the creation of stomas seem justifiable in order to improve survival in this complex situation.
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| 2. |
- Acosta, Stefan, et al.
(author)
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Open abdomen in acute mesenteric ischemia
- 2019
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In: Anaesthesiology Intensive Therapy. - : Termedia Sp. z.o.o.. - 1642-5758. ; 51:2, s. 159-162
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Journal article (peer-reviewed)abstract
- In acute mesenteric ischemia, early diagnosis should optimally be followed by either open or endovascular intestinal revascularization. All too often, diagnosis is delayed and diagnosis and treatment are performed at the same time during explorative laparotomy. The majority of patients will be diagnosed when transmural intestinal infarction has developed and at this time point damage control strategies involving intestinal revascularization, bowel resection, open abdomen and second look may be necessary to salvage the patient. This review outlines the principles of the damage control surgery approach in acute mesenteric ischemia and the rationale for temporary open abdomen. In patients in need of long-term open abdomen therapy, negative pressure wound therapy with continuous fascial traction is a preferred technique achieving a high delayed fascial closure rate.
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| 3. |
- Acosta, Stefan, et al.
(author)
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Vacuum-Assisted wound closure and mesh-mediated fascial traction for open abdomen therapy - a systematic review
- 2017
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In: Anaesthesiology Intensive Therapy. - 1642-5758 .- 1731-2515. ; 49:2, s. 139-145
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Research review (peer-reviewed)abstract
- Background: The aim of this paper was to review the literature on vacuum-Assisted wound closure and mesh-mediated fascial traction (VAWCM) in open abdomen therapy. It was designed as systematic review of observational studies. Methods: A Pub Med, EMBASE and Cochrane search from 2007/01-2016/07 was performed combining the Medical Subject Headings "vacuum", "mesh-mediated fascial traction", "temporary abdominal closure", "delayed abdominal closure", "open abdomen", "abdominal compartment syndrome", "negative pressure wound therapy" or "vacuum assisted wound closure". Results: Eleven original studies were found including patients numbering from 7 to 111. Six studies were prospective and five were retrospective. Nine studies were on mixed surgical (n = 9), vascular (n = 6) and trauma (n = 6) patients, while two were exclusively on vascular patients. The primary fascial closure rate per protocol varied from 80-100%. The time to closure of the open abdomen varied between 9-32 days. The entero-Atmospheric fistula rate varied from 0-10.0%. The in-hospital survival rate varied from 57-100%. In the largest prospective study, the incisional hernia rate among survivors at 63 months of median follow-up was 54% (27/50), and 16 (33%) repairs out of 48 incisional hernias were performed throughout the study period. The study patients reported lower short form health survey (SF-36) scores than the mean reference population, mainly dependent on the prevalence of major co-morbidities. There was no difference in SF-36 scores or a modified ventral hernia pain questionnaire (VHPQ) at 5 years of follow up between those with versus those without incisional hernias. Conclusions: A high primary fascial closure rate can be achieved with the vacuum-Assisted wound closure and meshmediated fascial traction technique in elderly, mainly non-Trauma patients, in need of prolonged open abdomen therapy.
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| 4. |
- Adamski, Jan, et al.
(author)
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Incidence of in-hospital cardiac arrest in Poland
- 2016
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In: ANAESTHESIOLOGY INTENSIVE THERAPY. - 1642-5758. ; 48:5, s. 288-293
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Journal article (peer-reviewed)abstract
- Background: In-hospital cardiac arrest with its poor prognosis is a challenging problem in hospitals. The aim of this study was to evaluate in Polish hospitals the frequency of in-hospital cardiac arrests with the subsequent mortality, with special emphasis on the type of unit at which the event occurred, and the patient's demographic data, such as age and sex.Methods: The study was a retrospective analysis of data for 2012 registered in the Polish General Hospital Morbidity Study. This research covered all Polish hospitals, excluding only government and psychiatric hospitals. The study inclusion criterion was the incidence of cardiac arrest in any hospital ward, recorded by the respective ICD-10 diagnosis code.Results: Of the 7,775,553 patients hospitalized, the diagnosis of cardiac arrest was reported in a total of 22,602 patients, which included 22,317 adults (98.7% of all patients) and 285 children (1.3%). Overall mortality after cardiac arrest among adults was 74.2%, and in children 46.7%. In both absolute numbers and as percentages of all documented cases, cardiac arrests occurred most often at the departments of intensive care, internal medicine, cardiology and emergency medicine. The accompanying mortality was lower than average at the departments of intensive care, cardiology, cardiology high dependency unit and emergency medicine. The median age of patients with cardiac arrest who died in the hospital was higher than the median age of those who survived (72 vs. 64; P < 0.05). Although cardiac arrests were reported more often among men than women (58.2% vs. 41.8%; P < 0.001), the hospital mortality was higher among women (79.2% vs. 71.6%; P < 0.001).Conclusion: The frequency of in-hospital cardiac arrests in Polish hospitals and the subsequent mortality is not substantially different from that observed in other countries. However, our study, based on ICD-10 diagnosis codes, gives only limited information about the patients and circumstances of this event. An in-depth analysis of the causes, prognoses, and outcome of in-hospital cardiac arrests could be facilitated by the creation of a national registry.
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| 5. |
- Adamski, Jan, et al.
(author)
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The differences between two selected intensive care units located in central and northern Europe : preliminary observation
- 2015
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In: ANAESTHESIOLOGY INTENSIVE THERAPY. - 1642-5758. ; 47:2, s. 117-124
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Journal article (peer-reviewed)abstract
- Background: The aim of this study was to evaluate possible differences in the functioning of two selected intensive care units in Poland and Finland. The activity of the units was analysed over a period of one year. Methods: The following parameters were compared: demography of treated populations, site of admission, category of illness, severity of illness (APACHE-II scale), mean length of stay, demanded workload (TISS-28 scale), mortality (both ICU and hospital) and standardized mortality ratio (SMR). Results: The results of this study indicated that most of the patients in the Polish ICU, regardless of age, diagnosis and APACHE II score, presented significantly longer lengths of stay (14.65 +/- 13.6 vs 4.1 +/- 4.7 days, P = 0.0001), higher mean TISS-28 score (38.9 +/- 9.1 vs 31.2 +/- 6.1, P = 0.0001) and higher ICU and hospital mortality (41.5% vs 10.2% and 44.7% vs 21.8%, respectively, P = 0.0001). The values of SMR were 0.9 and 0.85 for the Finnish and Polish ICUs, respectively. Conclusion: The collected data indicate huge differences in the utilisation of critical care resources. Treatment in Polish ICU is concentrated on much more severely ill patients which might be sometimes accompanied by futility of care. In order to verify and correctly interpret the presented phenomena, further studies are needed.
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| 6. |
- Andersson, Sebastian, et al.
(author)
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EndoVAC hybrid therapy for salvage of patients with infected femoral artery reconstructions
- 2019
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In: Anaesthesiology Intensive Therapy. - : Termedia Sp. z.o.o.. - 1642-5758. ; 51:2, s. 112-120
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Journal article (peer-reviewed)abstract
- BACKGROUND: EndoVAC hybrid therapy for infected femoral artery reconstructions consists of endovascular relining with a stent graft, surgical debridement and vacuum-assisted wound closure (VAC), and may be considered as a bailout procedure. The aim of this study was to analyze differences in risk factors of patients receiving EndoVAC compared to standard VAC therapy for perivascular infected femoral artery reconstructions, and to describe the technique, complications and outcome of EndoVAC therapy. MATERIAL AND METHODS: Retrospective analysis of 183 patients receiving VAC or EndoVAC therapy for perivascular infections in the groin from January 2004 to December 2017 was performed. Failure of wound treatment was defined as a wound not healed within four months, visible graft material or native artery after one month, bleeding from the wound leading to discontinuation of treatment, death or amputation due to groin infection. RESULTS: The EndoVAC patients (n = 13) more often had ischemic heart disease (P = 0.008), more late wound infections after index operation (P < 0.001), had more often undergone previous ipsilateral groin incisions (P = 0.006) and presented more often with hemorrhage/femoral pseudoaneurysm (P < 0.001), compared to the standard VAC patients (n = 170). Major complications after EndoVAC therapy were stent graft occlusion (n = 3), major hemorrhage from the repaired reconstruction (n = 2), major amputation within six months (n = 4) and death due to infected reconstruction (n = 2). Ten (77%) groins healed, eight without major complications. CONCLUSION: EndoVAC therapy appears to be a life-saving minimally invasive treatment option in surgical high-risk patients with infected femoral artery reconstruction and disrupted vascular anastomosis.
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| 7. |
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| 8. |
- Kander, Thomas, et al.
(author)
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Effects of red blood cell transfusions given to non-septic critically ill patients : a propensity score matched study
- 2021
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In: Anaesthesiology Intensive Therapy. - : Termedia Sp. z.o.o.. - 1642-5758. ; 53:5, s. 390-397
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Journal article (peer-reviewed)abstract
- Background: Previous studies have demonstrated that low-grade red blood cell transfusions (RBC) given to septic patients are harmful. The objectives of the present study were to compare mortality and morbidity in non-septic critically ill patients who were given low-grade RBC transfusions at haemoglobin level > 70 g L–1 with patients without RBC-transfusions any of the first 5 days in intensive care. Methods: Adult patients admitted to a general intensive care unit between 2007 and 2018 at a university hospital were eligible for inclusion. Patients who received > 2 units RBC transfusion per day during the first 5 days after admisasion, with pre-transfusion haemoglobin level < 70 g L–1 or with severe sepsis or septic shock, were excluded. Results: In total, 9491 admissions were recorded during the study period. Propensity score matching resulted in 2 well matched groups with 674 unique patients in each. Median pre-transfusion haemoglobin was 98 g L–1 (interquartile range 91–107 g L–1). Mortality was higher in the RBC group with an absolute risk increase for death at 180 days of 5.9% (95% CI: 3.6–8.3; P< 0.001). Low-grade RBC-transfusion was also associated with renal, circulatory, and respiratory failure as well as a higher SOFA-max score. Sensitivity analyses suggested that disease trajectories during the exposure time did not significantly differ between the groups. Conclusions: Low-grade RBC-transfusions given to non-septic critically ill patients without significant anaemia were associated with increased mortality, increased kidney, circulatory, and respiratory failure, as well as higher SOFA-max score.
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| 9. |
- Kirkpatrick, Andrew W., et al.
(author)
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Methodological background and strategy for the 2012-2013 updated consensus definitions and clinical practice guidelines from the abdominal compartment society
- 2015
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In: ANAESTHESIOLOGY INTENSIVE THERAPY. - 1642-5758. ; 47, s. S63-S77
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Research review (peer-reviewed)abstract
- The Abdominal Compartment Society (www.wsacs.org) previously created highly cited Consensus Definitions/Management Guidelines related to intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS). Implicit in this previous work, was a commitment to regularly reassess and update in relation to evolving research. Two years preceding the Fifth World Congress on Abdominal Compartment Syndrome, an International Guidelines committee began preparation. An oversight/steering committee formulated key clinical questions regarding IAH//ACS based on polling of the Executive to redundancy, structured according to the Patient, Intervention, Comparator, and Outcome (PICO) format. Scientific consultations were obtained from Methodological GRADE experts and a series of educational teleconferences were conducted to educate scientific review teams from among the wscacs. org membership. Each team conducted systematic or structured reviews to identify relevant studies and prepared evidence summaries and draft Grades of Recommendation Assessment, Development and Evaluation (GRADE) recommendations. The evidence and draft recommendations were presented and debated in person over four days. Updated consensus definitions and management statements were derived using a modified Delphi method. A writing committee subsequently compiled the results utilizing frequent Internet discussion and Delphi voting methods to compile a robust online Master Report and a concise peer-reviewed summarizing publication. A dedicated Paediatric Guidelines Subcommittee reviewed all recommendations and either accepted or revised them for appropriateness in children. Of the original 12 IAH/ACS definitions proposed in 2006, three (25%) were accepted unanimously, with four (33%) accepted by >80%, and four (33%) accepted by >50%, but required discussion to produce revised definitions. One (8%) was rejected by >50%. In addition to previous 2006 definitions, the panel also defined the open abdomen, lateralization of the abdominal musculature, polycompartment syndrome, abdominal compliance, and suggested a refined open abdomen classification system. Recommendations were possible regarding intra-abdominal pressure (IAP) measurement, approach to sustained IAH, philosophy of protocolized IAP management and same-hospital-stay fascial closure, use of decompressive laparotomy, and negative pressure wound therapy. Consensus suggestions included use of non-invasive therapies for treating IAH/ACS, considering body position and IAP, damage control resuscitation, prophylactic open abdomen usage, and prudence in early biological mesh usage. No recommendations were made for the use of diuretics, albumin, renal replacement therapies, and utilizing abdominal perfusion pressure as a resuscitation-endpoint. Collaborating Methodological Guideline Development and Clinical Experts produced Consensus Definitions/Clinical Management statements encompassing the most contemporary evidence. Data summaries now exist for clinically relevant IAH/ACS questions, which will facilitate future scientific reanalysis.
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| 10. |
- Siegel, Tomasz, et al.
(author)
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Prospective assessment of the standardized mortality ratio (SMR) as a measure of quality of care in an intensive care unit - a single-centre study
- 2015
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In: ANAESTHESIOLOGY INTENSIVE THERAPY. - 1642-5758. ; 47:4, s. 328-332
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Journal article (peer-reviewed)abstract
- Background: The standardized mortality ratio (SMR) is a recognized indicator of critical care quality. This ratio is used to compare actual hospital mortality of all patients treated in an Intensive Care Unit (ICU) with predicted mortality. The aim of this study was a prospective analysis of SMR as a measure of the quality of care in a single ICU. Methods: A prospective study was performed during a 12-month period in the ICU of the Czerniakowski Hospital in Warsaw. Predicted hospital mortality was calculated using the SAPS 3 model. The value of the SMR was evaluated in three risk groups (low, moderate, and high risk) and included the surgical status of patients (nonoperative, after elective or emergency surgery). Results: A total of 341 patients were included. The SMR in the general population was 0.98 (95% CI 0.74-1.28). In the low-and high-risk groups, the value of the SMR did not differ significantly from 1. In the average risk group, as well as among patients undergoing elective surgery, the value of the SMR tended to exceed 1. Conclusions: In groups of patients with low and high risk, the values of the SMR indicated a favourable quality of care. Study results should prompt a detailed analysis of the course of treatment for patients with an average risk of death. Analysis of the treatment course and qualification criteria for surgery in patients undergoing elective surgery is also indicated.
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| 11. |
- Weigl, Wojciech, et al.
(author)
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Methods of assessing fluid responsiveness in septic shock patients : a narrative review
- 2022
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In: ANAESTHESIOLOGY INTENSIVE THERAPY. - : Termedia Sp. z.o.o.. - 1642-5758 .- 1731-2531. ; 54:2, s. 175-183
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Research review (peer-reviewed)abstract
- A growing body of evidence shows that some septic patients experience fluid overload, which leads to an increased number of serious complications and death. This is because the majority of septic patients are fluid non-responders. Therefore, a reliable distinction of which patient would benefit from fluid boluses is crucial in current sepsis mana-gement. Several methods used to assess fluid responsiveness have been developed. The principle of "dynamic" measurements (in contrast to static indices such as central venous pressure) involves the induction of a change in cardiac preload and the mea-surement of its effect on stroke volume. Dynamic methods are based on either heart-lung interaction during mechanical ven-tilation or on an assessment of change in cardiac stroke volume in response to fluid provocative stimuli such as rapid fluid administration, passive leg raising, or the end -expiratory occlusion test. Most dynamic measurements are easy to perform and inter-pret as well as being available at the bedside. However, they vary in their invasiveness, difficulty in performance, reliability, and limitations. In this study, we provide an overview of various methods for assessing fluid responsive-ness and indicate those that potentially lead to haemodynamically guided fluid restric-tive treatment that would prevent fluid overload in septic patients.
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