The relationship between preinjury warfarin use and outcomes after traumatic brain injury in elderly trauma patients remains controversial. We hypothesized that, among users, the degree of anticoagulation, rather than therapy itself, would predict severity injury.Retrospective study (2004-2006) all (age >/=65 years) who were evaluated by service at a Level I center underwent computed tomography head for suspicion an intracranial was performed. Three cohorts grouped: (1) users with admission...

Conceptually, appropriateness of antibiotic therapy includes choice agent relative to susceptibility pathogens as well dosing, timing onset, and duration therapy, but is most commonly considered in terms antibiotic. It has been suggested that inappropriate selection can result increased mortality. This study was performed elucidate the role scheduled, rotating defining mortality among febrile, infected surgical ICU patients.Prospective inception-cohort 356 patients during their initial...

Background: Ventilator-associated pneumonia (VAP) is a leading cause of mortality in critically ill patients. Although previous studies have shown that de-escalation therapy (DT) antibiotics may decrease costs and the development resistant pathogens, minimal data its effect surgical patients or any with septic shock. We hypothesized DT for VAP was not associated an increased rate recurrent (RP) high acuity cohort Methods: All intensive care unit (SICU) from January 2005 to May 2007 diagnosed...

Previous studies addressing the relationship between anticoagulation and risk of traumatic intracranial hemorrhage (ICH) have provided conflicting results, examined infrequently elderly patients after falls. We used a statewide hospital discharge database to test hypothesis that long-term (LTA) increases likelihood ICH subsequent mortality in this patient population.Patients aged 65 years or older hospitalized as result fall were extracted from New York State Statewide Planning Cooperative...

Background: Critical illness is characterized by hypoferremia, iron-deficient erythropoiesis (IDE), and anemia. The relative risks benefits of iron supplementation in this setting are unknown. Methods: Anemic, critically ill surgical patients with an expected intensive care unit length stay (ULOS) ≥ 5 days were randomized to either enteral (ferrous sulfate 325 mg three times daily) or placebo until hospital discharge. Outcomes included hematocrit, markers (i.e., serum concentrations iron,...

Elderly patients have become an increasingly prevalent proportion of the intensive care unit population. Outcomes with acute respiratory distress syndrome (ARDS) been improving in recent years, but studies ARDS rarely include substantial numbers elderly patients. Historically, mortality rate for has 69% to 80% among We reviewed our experience determine whether outcomes were over time, and particular equally favorable aged 65 years or older.Patients who developed a university surgical from...

Objective: Despite improved resuscitation and sepsis care, acute renal failure (ARF) remains common in critically ill surgical patients. New methods of replacement therapy (RRT) are being used intensive care units (SICUs), including high-flux hemodialysis (HD) continuous RRT (CRRT). is increasingly early the course ARF, but data scant to suggest that mortality improved. Consequently, we determined whether outcomes were with CRRT SICU patients, hypothesized lowers for patients ARF. Methods:...

Objectives: To describe the predictive utility of d -dimer assay among patients with coronavirus disease 2019 syndrome for unprovoked lower extremity deep venous thrombosis. Design: Prospective observational study retrospective data analysis. Setting: Academic medical center surgical ICU. Patients: Seventy-two intubated critical illness from 2019. Interventions: Therapeutic anticoagulation after imaging diagnosis first three thrombosis cases was confirmed; therapeutic as prophylaxis...

Emergency surgery patients are older, often critically ill, and at high risk of morbidity mortality. We studied factors associated with issuance a do-not-resuscitate (DNR) order impact on mortality in emergency patients.Prospective study all since January 1, 2000 who underwent before admission to the intensive care unit. Data collected were: age, sex, diagnosis (case-mix), raw- (AIII) age-adjusted (aAIII) APACHE III scores, DNR order, Primary outcomes were status Groups stratified by age...

We defined the contemporary conversion rate from laparoscopic appendectomy (LA) to open and identified pre-operative factors associated with conversion.Retrospective review of 941 consecutive LAs performed for suspected acute appendicitis in a single urban university hospital between 2000 2007. Patient characteristics, clinical features, physical examination findings, laboratory values, computed tomography (CT) surgeon identity, operative pathologic results were assessed. Categorical...

Abstract: We report a case of Strongyloides stercoralis hyperinfection syndrome in renal transplant recipient complicated by septic shock, acute respiratory distress syndrome, and Klebsiella pneumoniae superinfection. The patient was treated successfully with drotrecogin alfa (activated), parenteral ivermectin, albendazole, piperacillin/tazobactam. This outcome suggests that (activated) may be useful therapy for recipients who develop severe sepsis or shock secondary to potentially lethal...

Background: Strict glycemic control in critically ill patients has been an important advance surgical critical care, as hyperglycemia is associated with a higher likelihood of death, complications, and nosocomial infections. Insulin resistance particularly common obese patients, but the impact body mass index (BMI) on insulin requirements, ability to achieve euglycemia, infectious outcomes not studied. We hypothesized that would incur infection if euglycemia was maintained. Methods:...

Background: Multiple organ dysfunction syndrome (MODS) remains prevalent and the leading cause of mortality in surgical intensive care unit (ICU). Improvements ICU last 10 years (e.g., tight glycemic control, activated protein C, fewer transfusions causing nosocomial infections) may have decreased incidence, magnitude, MODS, as hypothesized this study. Methods: Longitudinal 17-year prospective study 11,314 patients (academic/tertiary unit, Level I trauma center), 5,157 (45.5%) whom developed...

Ventilator-associated pneumonia (VAP) is one of the leading causes morbidity in critically ill surgical patients. Certain pathogens (e.g., methicillin-resistant Staphylococcus aureus, Pseudomonas aeruginosa) have been associated with an excess mortality rate from sepsis several studies, but not setting specifically or when protocol-driven antibiotic therapy administered.We sought to determine which factors and, particular, whether individual pathogen affected our intensive care unit (ICU),...

Sepsis is the leading cause of death in critically ill patients United States. Current diagnosis sepsis relies heavily on patient's manifestation septic symptoms, which occur at life-threatening late stage sepsis. Because underlying biological changes hours to days before clinical presentation early detection will provide crucial opportunities for and effective treatment As an candidate detection, we propose using a novel quantitative susceptibility mapping (QSM) MRI that quantifiably...

Background: Septic shock causing or complicating critical surgical illness results in high mortality. Drotrecogin alfa (activated), known also as recombinant human activated protein C (rhAPC) has become controversial therapy, owing to persisting questions of efficacy and safety. We hypothesized rhAPC be effective therapy for critically ill patients with septic shock. Methods: Open-label (by predefined criteria) 108 patients. Treated were matched individually prospect age, gender, Acute...

To investigate the knowledge, attitudes, and practices of healthcare professionals (HCPs) working in prenatal diagnosis toward expanded non-invasive testing (NIPT) China.We conducted a national online survey among HCPs diagnosis, including specialists foetal medicine, obstetricians gynaecologists, nurses obstetrics gynaecology, obstetric ultrasound doctors, technicians laboratories. A total 1882 questionnaires were collected, which 1822 met research criteria included analysis.More than 99%...

Surgical InfectionsVol. 21, No. 8 Letters to the EditorFree AccessA Simple Three-Tier Classification System for Triage, Communication, and Resource Utilization by Patients Afflicted with COVID-19 DiseasePhilip S. Barie, Matthew Bronstein, Cameron J. Gibson, Anton G. Kelly, Christina Lee, Mayur Narayan, Jian Shou, Kira E. Smith, Cassandra Villegas, Robert WinchellPhilip BarieAddress correspondence to: Dr. Philip Departments of Surgery Medicine, Weill Cornell 525 East 68th Street, New York, NY...