Pub Date : 2022-10-21DOI: 10.12746/swrccc.v10i45.1101
A. Motes
Sedative medications have been used in intensive care units (ICU) to minimize discomfort, prevent pain /anxiety, allow invasive procedures, reduce stress, and improve synchrony in mechanically ventilated (MV) patients. However, these drugs can have adverse effects resulting in increased length of ICU/hospital stay, health care costs, morbidity, and mortality. This review summarizes the mechanisms of action, usual doses, side effects, adverse effects, contraindications, and recent studies of sedatives which are frequently used in adult ICUs and the sedation assessment tools for measuring quality and depth of sedation in adult ICU patients. Keywords sedations, mechanical ventilation, intensive care unit, sedation assessment tools
{"title":"Monitoring sedation during mechanical ventilation","authors":"A. Motes","doi":"10.12746/swrccc.v10i45.1101","DOIUrl":"https://doi.org/10.12746/swrccc.v10i45.1101","url":null,"abstract":"Sedative medications have been used in intensive care units (ICU) to minimize discomfort, prevent pain /anxiety, allow invasive procedures, reduce stress, and improve synchrony in mechanically ventilated (MV) patients. However, these drugs can have adverse effects resulting in increased length of ICU/hospital stay, health care costs, morbidity, and mortality. This review summarizes the mechanisms of action, usual doses, side effects, adverse effects, contraindications, and recent studies of sedatives which are frequently used in adult ICUs and the sedation assessment tools for measuring quality and depth of sedation in adult ICU patients. \u0000 \u0000Keywords sedations, mechanical ventilation, intensive care unit, sedation assessment tools","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82311716","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-21DOI: 10.12746/swrccc.v10i45.1099
Muhammad Sarwar, Divya Wyatt, B. Batson, K. Iwuji
{"title":"Aspiration of a tweezer as a foreign body","authors":"Muhammad Sarwar, Divya Wyatt, B. Batson, K. Iwuji","doi":"10.12746/swrccc.v10i45.1099","DOIUrl":"https://doi.org/10.12746/swrccc.v10i45.1099","url":null,"abstract":"","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78324846","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-21DOI: 10.12746/swrccc.v10i45.1021
Avery Williams, Blair Buschmann, Afrina Rimu, Jennifer Phy
Background: Addison’s disease is an adrenal cortex disorder that is considered rare and the pathophysiology is not well understood. There are very few cases reported during pregnancy. Case: Our patient is a 30-year-old previously healthy female that presented to the Reproductive Endocrinology and Infertility clinic at 7 weeks and 2 days pregnant with shortness of breath. After further evaluation, she was noted to have symptoms that led to the differential diagnosis of Addison’s disease. The patient’s 21 hydroxylase antibody was positive which along with the other tests, confirmed the diagnosis. Endocrinology started the patient on hydrocortisone and fludrocortisone. Conclusion: There is more research that needs to be done but the rarity of this disorder makes this case important for understanding Addison’s disease and its treatment.
{"title":"Addison’s disease presenting as shortness of breath and hypotension in early pregnancy","authors":"Avery Williams, Blair Buschmann, Afrina Rimu, Jennifer Phy","doi":"10.12746/swrccc.v10i45.1021","DOIUrl":"https://doi.org/10.12746/swrccc.v10i45.1021","url":null,"abstract":"Background: Addison’s disease is an adrenal cortex disorder that is considered rare and the pathophysiology is not well understood. There are very few cases reported during pregnancy. \u0000Case: Our patient is a 30-year-old previously healthy female that presented to the Reproductive Endocrinology and Infertility clinic at 7 weeks and 2 days pregnant with shortness of breath. After further evaluation, she was noted to have symptoms that led to the differential diagnosis of Addison’s disease. The patient’s 21 hydroxylase antibody was positive which along with the other tests, confirmed the diagnosis. Endocrinology started the patient on hydrocortisone and fludrocortisone. \u0000Conclusion: There is more research that needs to be done but the rarity of this disorder makes this case important for understanding Addison’s disease and its treatment.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74055131","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-21DOI: 10.12746/swrccc.v10i45.1093
Abbie Evans, K. Nugent
The 2018 Critical Care Medicine Guidelines for Analgesia and Sedation in the ICU Good Practice Statement emphasized the importance in the treatment of pain taking precedence over sedation. Within these guidelines, a multimodal analgesia approach is standard of care in the ICU, which often includes the initiation of opioids. 1 As practice has shifted to prioritize pain management over sedation, opioids have been administered in frequent and prolonged dosages, making the critically ill patient susceptible to iatrogenic opioid withdrawal syndrome (IOWS). This article provides an overview of IOWS to alert clinicians to the diagnosis of IOWS in ICU patients.
{"title":"Iatrogenic opioid withdrawal syndrome presentation and considerations","authors":"Abbie Evans, K. Nugent","doi":"10.12746/swrccc.v10i45.1093","DOIUrl":"https://doi.org/10.12746/swrccc.v10i45.1093","url":null,"abstract":"The 2018 Critical Care Medicine Guidelines for Analgesia and Sedation in the ICU Good Practice Statement emphasized the importance in the treatment of pain taking precedence over sedation. Within these guidelines, a multimodal analgesia approach is standard of care in the ICU, which often includes the initiation of opioids. 1 As practice has shifted to prioritize pain management over sedation, opioids have been administered in frequent and prolonged dosages, making the critically ill patient susceptible to iatrogenic opioid withdrawal syndrome (IOWS). This article provides an overview of IOWS to alert clinicians to the diagnosis of IOWS in ICU patients. ","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"38 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84403351","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-10-21DOI: 10.12746/swrccc.v10i45.1109
Mahmoud Abdelnabi, C. Morataya, N. Mittal
Plasmacytoma is a tumor of monoclonal plasma cells of bone or soft tissue that can occur anywhere in the body without evidence of systemic multiple myeloma. It may present as solitary or multiple masses and is classified as osseous if arising from bone or extraosseous if arising from soft tissue. Osseous plasmacytoma is the most common form of plasmacytoma with predominance in active hematopoietic bones, including vertebrae, femur, pelvis, and ribs. The diagnosis is made with a tissue biopsy. Different imaging modalities allow for tumor localization, and magnetic resonance imaging (MRI) is the gold standard to detect spinal cord compression. Corticosteroids provide analgesia, reduce vasogenic edema, and have anti-myeloma activity which may result in better neurological outcomes in cases of acute spinal cord compression. Corticosteroids should be started promptly once cord compression is suspected. We report a case of progressive lower extremity weakness as the initial presentation of a thoracic plasmacytoma. The patient was started on a high-dose corticosteroid after acute cord compression was suspected. Magnetic resonance imaging confirmed cord compression. T1-T2 corpectomy with C5-T5 posterior spinal fusion for decompression and stabilization was done. He was successfully discharged to an inpatient rehabilitation facility with plans for definitive radiotherapy. Worsening back pain and lower extremity weakness in elderly patients should raise concerns for acute cord compression. Early intervention to relieve compression is crucial to preserve neurological functions. Keywords: plasmacytoma, weakness, steroids, multiple myeloma
{"title":"Progressive lower extremity weakness as the initial presentation of isolated large thoracic plasmacytoma","authors":"Mahmoud Abdelnabi, C. Morataya, N. Mittal","doi":"10.12746/swrccc.v10i45.1109","DOIUrl":"https://doi.org/10.12746/swrccc.v10i45.1109","url":null,"abstract":"Plasmacytoma is a tumor of monoclonal plasma cells of bone or soft tissue that can occur anywhere in the body without evidence of systemic multiple myeloma. It may present as solitary or multiple masses and is classified as osseous if arising from bone or extraosseous if arising from soft tissue. Osseous plasmacytoma is the most common form of plasmacytoma with predominance in active hematopoietic bones, including vertebrae, femur, pelvis, and ribs. The diagnosis is made with a tissue biopsy. Different imaging modalities allow for tumor localization, and magnetic resonance imaging (MRI) is the gold standard to detect spinal cord compression. Corticosteroids provide analgesia, reduce vasogenic edema, and have anti-myeloma activity which may result in better neurological outcomes in cases of acute spinal cord compression. Corticosteroids should be started promptly once cord compression is suspected. We report a case of progressive lower extremity weakness as the initial presentation of a thoracic plasmacytoma. The patient was started on a high-dose corticosteroid after acute cord compression was suspected. Magnetic resonance imaging confirmed cord compression. T1-T2 corpectomy with C5-T5 posterior spinal fusion for decompression and stabilization was done. He was successfully discharged to an inpatient rehabilitation facility with plans for definitive radiotherapy. Worsening back pain and lower extremity weakness in elderly patients should raise concerns for acute cord compression. Early intervention to relieve compression is crucial to preserve neurological functions. \u0000 \u0000Keywords: plasmacytoma, weakness, steroids, multiple myeloma","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-10-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88216999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-22DOI: 10.12746/swrccc.v10i44.965
C. Ramirez, A. AbdAlla, Alikhan Karimi, J. Rahesh, Brianna R Taylor, H. Ahmed, M. Nāẓim
Physicians diagnose cholecystitis using a variety of clinical signs and imaging modalities. Diagnoses are routinely confirmed with the gold-standard histopathological examination of the excised gallbladder. This study examines the correlation between the postoperative clinical diagnosis and postoperative pathology report findings. The clinical diagnosis of acute cholecystitis had a sensitivity of 58.8%, specificity of 75.2%, positive predictive value of 53.1%, and negative predictive value of 79.2% when compared to the final pathologic diagnosis. The clinical diagnosis of chronic cholecystitis agreed with the pathologic diagnosis of chronic cholecystitis in 45 of 54 cases (83.3%) but did not agree in 8 of 54 acute cases (14.8%); a clinical diagnosis of “symptomatic cholelithiasis” was associated with pathologic diagnosis of acute cholecystitis in 85 of 388 cases (21.9%). There was a statistically significant relationship between the clinical diagnosis and final pathologic diagnosis (chi-squared > 32.91, p-value <0.001). One incidental case of malignant neoplasm was found in a patient with gallstones. Surgeons made an accurate clinical diagnosis of acute cholecystitis in one third to one half of their surgical cases; they made an accurate clinical diagnosis of chronic cholecystitis 80% of the time and correctly diagnosed neoplasms in 3 out of 4 cases. These results suggest that the mismatch between the postoperative clinical diagnosis and postoperative pathology occurs frequently enough that pathologic assessment should occur routinely after cholecystectomy.
{"title":"Does the postoperative diagnosis correlate with the final pathologic diagnosis in cholecystectomy?","authors":"C. Ramirez, A. AbdAlla, Alikhan Karimi, J. Rahesh, Brianna R Taylor, H. Ahmed, M. Nāẓim","doi":"10.12746/swrccc.v10i44.965","DOIUrl":"https://doi.org/10.12746/swrccc.v10i44.965","url":null,"abstract":" Physicians diagnose cholecystitis using a variety of clinical signs and imaging modalities. Diagnoses are routinely confirmed with the gold-standard histopathological examination of the excised gallbladder. This study examines the correlation between the postoperative clinical diagnosis and postoperative pathology report findings. The clinical diagnosis of acute cholecystitis had a sensitivity of 58.8%, specificity of 75.2%, positive predictive value of 53.1%, and negative predictive value of 79.2% when compared to the final pathologic diagnosis. The clinical diagnosis of chronic cholecystitis agreed with the pathologic diagnosis of chronic cholecystitis in 45 of 54 cases (83.3%) but did not agree in 8 of 54 acute cases (14.8%); a clinical diagnosis of “symptomatic cholelithiasis” was associated with pathologic diagnosis of acute cholecystitis in 85 of 388 cases (21.9%). There was a statistically significant relationship between the clinical diagnosis and final pathologic diagnosis (chi-squared > 32.91, p-value <0.001). One incidental case of malignant neoplasm was found in a patient with gallstones. Surgeons made an accurate clinical diagnosis of acute cholecystitis in one third to one half of their surgical cases; they made an accurate clinical diagnosis of chronic cholecystitis 80% of the time and correctly diagnosed neoplasms in 3 out of 4 cases. These results suggest that the mismatch between the postoperative clinical diagnosis and postoperative pathology occurs frequently enough that pathologic assessment should occur routinely after cholecystectomy. ","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"302 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89045167","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-22DOI: 10.12746/swrccc.v10i44.1061
Avery Williams, K. Shrestha, Alexis Cruz, Anastazia Gilman, Jonathan Huynh, Justin G. Vaughan, Ariel P. Santos
Background: Surgical site infection (SSI) is one of the most common healthcare-associated infections. The use of negative pressure wound therapy (NPWT) has shown to decrease the overall rate of SSI, wound dehiscence, and length of hospital stay in surgical conditions. This study aims to determine the impact of NPWT applied on closed surgical incisions on patients with coexisting ostomy undergoing exploratory laparotomy. Methods: A retrospective study on patients who underwent exploratory laparotomies from 2017 to 2019 was conducted. NPWT was compared to standard post-operative surgical wound dressing. A sub-analysis of patients with ostomies was performed. Results: A total of 286 patients who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received standard dressing. The NPWT group had a higher percentage of patients with an ostomy (37.3% vs 20.4%, P=.016), of which 25.5% were colostomies (vs 12.3%) and 11.8% were ileostomies (vs 8.1%) with P=.002. No significant difference in the overall rate of SSI (7.8% vs 5.5%, P= .517), wound dehiscence (7.8% vs 2.1 %, P=.057), and seroma formation (3.9% vs 2.1%, P=.612) were observed. The mean length of ICU stay (3.5 vs 7.0, P=.051) and unplanned reoperation (5.9% vs 16.6%, P=.051) were lower in the NPWT group compared to the control group. Sub analysis of patients with stoma found no significant difference in SSI. Conclusions: In our study, the use of NPWT on closed surgical incision wound was not associated with the reduction of SSI in patients with ostomies. Large studies are needed to ascertain significant benefits in patients with ostomies. Keywords: negative pressure wound therapy, surgical site infection, ostomy, exploratory laparotomy
背景:手术部位感染(SSI)是最常见的卫生保健相关感染之一。负压伤口治疗(NPWT)的使用已被证明可以降低手术条件下SSI的总体发生率、伤口裂开和住院时间。本研究旨在确定NPWT应用于闭合性手术切口对合并造口患者行剖腹探查术的影响。方法:对2017 - 2019年剖腹探查术患者进行回顾性研究。将NPWT与标准术后外科创面敷料进行比较。对造口患者进行亚组分析。结果:共发现286例剖腹探查患者;51例患者接受NPWT, 235例患者接受标准敷料。NPWT组造口比例较高(37.3% vs 20.4%， P= 0.016)，其中结肠造口比例为25.5% (vs 12.3%)，回肠造口比例为11.8% (vs 8.1%)， P= 0.002。两组SSI发生率(7.8% vs 5.5%， P= 0.517)、创面裂开(7.8% vs 2.1%， P= 0.057)、血肿形成(3.9% vs 2.1%， P= 0.612)差异无统计学意义。NPWT组患者的平均ICU住院时间(3.5 vs 7.0, P= 0.051)和非计划再手术(5.9% vs 16.6%， P= 0.051)均低于对照组。对有造口的患者进行亚组分析，发现SSI无显著差异。结论:在我们的研究中，NPWT在闭合性手术切口伤口上的使用与造口患者SSI的减少无关。需要大量的研究来确定造口术对患者的显著益处。关键词:负压伤口治疗，手术部位感染，造口术，剖腹探查
{"title":"Effect of negative pressure wound therapy in exploratory laparotomies with coexisting ostomy","authors":"Avery Williams, K. Shrestha, Alexis Cruz, Anastazia Gilman, Jonathan Huynh, Justin G. Vaughan, Ariel P. Santos","doi":"10.12746/swrccc.v10i44.1061","DOIUrl":"https://doi.org/10.12746/swrccc.v10i44.1061","url":null,"abstract":"Background: \u0000Surgical site infection (SSI) is one of the most common healthcare-associated infections. The use of negative pressure wound therapy (NPWT) has shown to decrease the overall rate of SSI, wound dehiscence, and length of hospital stay in surgical conditions. This study aims to determine the impact of NPWT applied on closed surgical incisions on patients with coexisting ostomy undergoing exploratory laparotomy. \u0000 \u0000Methods: \u0000A retrospective study on patients who underwent exploratory laparotomies from 2017 to 2019 was conducted. NPWT was compared to standard post-operative surgical wound dressing. A sub-analysis of patients with ostomies was performed. \u0000 \u0000Results: \u0000A total of 286 patients who underwent exploratory laparotomy were identified; 51 patients received NPWT and 235 received standard dressing. The NPWT group had a higher percentage of patients with an ostomy (37.3% vs 20.4%, P=.016), of which 25.5% were colostomies (vs 12.3%) and 11.8% were ileostomies (vs 8.1%) with P=.002. No significant difference in the overall rate of SSI (7.8% vs 5.5%, P= .517), wound dehiscence (7.8% vs 2.1 %, P=.057), and seroma formation (3.9% vs 2.1%, P=.612) were observed. The mean length of ICU stay (3.5 vs 7.0, P=.051) and unplanned reoperation (5.9% vs 16.6%, P=.051) were lower in the NPWT group compared to the control group. Sub analysis of patients with stoma found no significant difference in SSI. \u0000 \u0000Conclusions: \u0000In our study, the use of NPWT on closed surgical incision wound was not associated with the reduction of SSI in patients with ostomies. Large studies are needed to ascertain significant benefits in patients with ostomies. \u0000 \u0000Keywords: negative pressure wound therapy, surgical site infection, ostomy, exploratory laparotomy","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"63 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88467545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-22DOI: 10.12746/swrccc.v10i44.1023
J. Rahesh, Layan Al-Sukhni, J. Griswold
Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis comprise a spectrum of severe hypersensitivity skin reactions. Stevens-Johnson Syndrome is the least severe on the spectrum of mucosal erosions, with Toxic Epidermal Necrolysis being the most severe. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis is a disease of keratinocytes and therefore any squamous cell epithelium is at risk. This includes the cornea, conjunctiva, oral mucosa, esophagus, urethra, and anal canal. This skin reaction is typically drug-induced and has a very poor prognosis. We present four different Stevens-Johnson Syndrome patients who managed solely in the burn intensive care unit at our facility. The mainstay of treatment included supportive care with an emphasis on fluid and electrolyte replacement. Transfer of patients to the burn unit is not the current standard of care, however could decrease the mortality and morbidity of patients. As seen in our centers burn intensive care unit patients only had a mortality rate of 17% over 5 years. Management of Stevens-Johnson Syndrome in the burn intensive care unit with a comprehensive interdisciplinary wound care team rather than solely dermatological intervention may improve outcomes.
{"title":"Stevens-Johnson syndrome/toxic epidermal necrolysis management in the burn intensive care unit: A case series","authors":"J. Rahesh, Layan Al-Sukhni, J. Griswold","doi":"10.12746/swrccc.v10i44.1023","DOIUrl":"https://doi.org/10.12746/swrccc.v10i44.1023","url":null,"abstract":"Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis comprise a spectrum of severe hypersensitivity skin reactions. Stevens-Johnson Syndrome is the least severe on the spectrum of mucosal erosions, with Toxic Epidermal Necrolysis being the most severe. Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis is a disease of keratinocytes and therefore any squamous cell epithelium is at risk. This includes the cornea, conjunctiva, oral mucosa, esophagus, urethra, and anal canal. This skin reaction is typically drug-induced and has a very poor prognosis. \u0000We present four different Stevens-Johnson Syndrome patients who managed solely in the burn intensive care unit at our facility. The mainstay of treatment included supportive care with an emphasis on fluid and electrolyte replacement. Transfer of patients to the burn unit is not the current standard of care, however could decrease the mortality and morbidity of patients. As seen in our centers burn intensive care unit patients only had a mortality rate of 17% over 5 years. Management of Stevens-Johnson Syndrome in the burn intensive care unit with a comprehensive interdisciplinary wound care team rather than solely dermatological intervention may improve outcomes.","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"8 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74981499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-22DOI: 10.12746/swrccc.v10i44.1063
E. Choi, Asher George, Silvia Jakubski, Mhd Hasan Almekdash, Pranav Sharma
Objective: The aim of this study is to analyze the association between the 11-item Modified Frailty Index (mFI) and 90-day post-operative complications in prostate cancer patients undergoing Robot-assisted Radical Prostatectomy (RARP). Methods: mFI was measured for 216 men who underwent RARP at a single institution. Mean ranks and proportions were compared with the Kruskal-Wallis test, Chi-square test of independence, and Fisher's exact test. Multivariate logistic regression was performed to determine predictors of 90-day post-operative complications after RARP. Results: Patients with higher pre-operative mFI (≥2) were more likely to be older in age (P= 0.047), have worse ECOG performance status (P=0.018), and worse ASA scores (P<0.01). Intra-operative variables and pathological characteristics were similar between mFI groups. Multivariate logistic regression showed that mFI ≥2 was a predictor of overall 90-day complications after surgery (OR=3.32, CI=1.16-9.54, P=0.026). Multivariate logistic regression also showed that mFI ≥2 was a predictor of high-grade 90-day complications after surgery (OR=2.69, CI=1.24-5.85, P=0.012). Conclusion: Prostate cancer patients with higher pre-operative mFI scores were more likely to have a 90-day complication after RARP. mFI should be assessed pre-operatively for prostate cancer patients to determine the risk of post-operative morbidity and the best treatment plan.
{"title":"Frailty is an independent predictor of 90-day complications following robot-assisted radical prostatectomy","authors":"E. Choi, Asher George, Silvia Jakubski, Mhd Hasan Almekdash, Pranav Sharma","doi":"10.12746/swrccc.v10i44.1063","DOIUrl":"https://doi.org/10.12746/swrccc.v10i44.1063","url":null,"abstract":"Objective: The aim of this study is to analyze the association between the 11-item Modified Frailty Index (mFI) and 90-day post-operative complications in prostate cancer patients undergoing Robot-assisted Radical Prostatectomy (RARP). Methods: mFI was measured for 216 men who underwent RARP at a single institution. Mean ranks and proportions were compared with the Kruskal-Wallis test, Chi-square test of independence, and Fisher's exact test. Multivariate logistic regression was performed to determine predictors of 90-day post-operative complications after RARP. Results: Patients with higher pre-operative mFI (≥2) were more likely to be older in age (P= 0.047), have worse ECOG performance status (P=0.018), and worse ASA scores (P<0.01). Intra-operative variables and pathological characteristics were similar between mFI groups. Multivariate logistic regression showed that mFI ≥2 was a predictor of overall 90-day complications after surgery (OR=3.32, CI=1.16-9.54, P=0.026). Multivariate logistic regression also showed that mFI ≥2 was a predictor of high-grade 90-day complications after surgery (OR=2.69, CI=1.24-5.85, P=0.012). Conclusion: Prostate cancer patients with higher pre-operative mFI scores were more likely to have a 90-day complication after RARP. mFI should be assessed pre-operatively for prostate cancer patients to determine the risk of post-operative morbidity and the best treatment plan. ","PeriodicalId":22976,"journal":{"name":"The Southwest Respiratory and Critical Care Chronicles","volume":"65 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76916698","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-07-22DOI: 10.12746/swrccc.v10i44.1069
M. Paz, Ana Cordón, Barbara Mora
Corresponding author: Miriam Paz Contact Information: Miriampazsierra@hotmail.com DOI: 10.12746/swrccc.v10i44.1069 A 35-year-old man who emigrated from Cameroon in 2008 with no past medical history presented to a local clinic complaining of a painless left finger mass which had been present for 5 years. The patient came to the outpatient clinic because the skin over his finger started to breakdown, especially with flexion, but there was no drainage. The patient’s vital signs were normal, and he was afebrile. On physical examination, he had severe swelling of the entire left third finger, worse over the dorsal aspect of the finger at the proximal interphalangeal joint (PIP) (Figure 1). There was a scaly plaque on the dorsal PIP but no warmth, erythema, or drainage. A CBC, rheumatoid factor, anticitrulline antibodies, HIV test, electrolytes, and ANA were normal or negative. A magnetic resonance image of the hand (Figure 2) showed an enhancing third finger mass seen around the third finger proximal and middle phalanges and the third finger flexor and extensor tendons, causing enlargement of the digit. This mass extended more proximally around the flexor tendons. A biopsy with cultures and stains for fungi, anaerobic and aerobic bacteria and mycobacteria grew Mycobacterium tuberculosis. The acid-fast bacillus stain was negative. His chest x-ray was clear without infiltrates, masses, or nodules. The patient started on antituberculous treatment through the Department of State Health Services.
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