Autologous Blood Patch for Persistent Ascites Leak from Non-Closing Paracentesis Tracts.

Ascites, the fluid accumulation in the peritoneal cavity, is most commonly seen in patients with end-stage liver disease (ESLD). Evaluating ascites or providing symptomatic relief for patients is accomplished by performing a paracentesis. Ascites leak from a paracentesis site can be a complication of the procedure and is associated with increased morbidity. Currently, the best options for these patients include medical management or surgical abdominal wall layer closure. Utilizing a blood patch provides an alternative approach to managing such patients. A two-center prospective case series was performed evaluating the efficacy of the blood patch in patients with significant persistent ascites leak following a paracentesis. About 30 mL of the patients' peripheral blood was used for the blood patch. Subjects were recruited over a period of one year and followed for 30 days after the procedure. A total of six patients were recruited for this study. Subjects underwent placement of autologous blood patch at the site of the ascites leak and 100% had resolution of the leak within 24 hours. None of the subjects developed any complications of the procedure. This study shows that an autologous blood patch is an effective, low-risk treatment method for ascites leaks following a paracentesis. It is a simple bedside procedure that can reduce morbidity in patients with end-stage liver disease.

Cocaine-induced diffuse alveolar hemorrhage: A case report and review of the literature.

Cocaine is one of the most commonly abused drugs in the United States. Ingestion of cocaine may result in a wide array of disease processes due to its stimulant properties, contaminants, or to downstream effects, such as myo- cardial infarction, stroke, or cardiac arrest. Pulmonary complaints are common in patients seeking treatment for cocaine-associated medical problems and include acute eosinophilic pneumonia, pneumothorax, pneumomediastium, diffuse alveolar hemorrhage (DAH), pulmonary hypertension and granulomatosis. We present a case of DAH due to cocaine abuse and rapid resolution with mechanical ventilation and supportive care. [Full article available at http://rimed.org/rimedicaljournal-2016-08.asp, free with no login].

Comparison of sudden cardiac arrest resuscitation performance data obtained from in-hospital incident chart review and in situ high-fidelity medical simulation.

INTRODUCTION: High-fidelity medical simulation of sudden cardiac arrest (SCA) presents an opportunity for systematic probing of in-hospital resuscitation systems. Investigators developed and implemented the SimCode program to evaluate simulation's ability to generate meaningful data for system safety analysis and determine concordance of observed results with institutional quality data. METHODS: Resuscitation response performance data were collected during in situ SCA simulations on hospital medical floors. SimCode dataset was compared with chart review-based dataset of actual (live) in-hospital resuscitation system performance for SCA events of similar acuity and complexity. RESULTS: 135 hospital personnel participated in nine SimCode resuscitations between 2006 and 2008. Resuscitation teams arrived at 2.5+/-1.3 min (mean+/-SD) after resuscitation initiation, started bag-valve-mask ventilation by 2.8+/-0.5 min, and completed endotracheal intubations at 11.3+/-4.0 min. CPR was performed within 3.1+/-2.3 min; arrhythmia recognition occurred by 4.9+/-2.1 min, defibrillation at 6.8+/-2.4 min. Chart review data for 168 live in-hospital SCA events during a contemporaneous period were extracted from institutional database. CPR and defibrillation occurred later during SimCodes than reported by chart review, i.e., live: 0.9+/-2.3 min (p<0.01) and 2.1+/-4.1 min (p<0.01), respectively. Chart review noted fewer problems with CPR performance (simulated: 43% proper CPR vs. live: 98%, p<0.01). Potential causes of discrepancies between resuscitation response datasets included sample size and data limitations, simulation fidelity, unmatched SCA scenario pools, and dissimilar determination of SCA response performance by complementary reviewing methodologies. CONCLUSION: On-site simulations successfully generated SCA response measurements for comparison with live resuscitation chart review data. Continued research may refine simulation's role in quality initiatives, clarify methodologic discrepancies and improve SCA response.

Clinical concise review: Mechanical ventilation of patients with chronic obstructive pulmonary disease.

OBJECTIVE: To summarize the current literature on mechanical ventilation of patients with chronic obstructive pulmonary disease (COPD) using published data to augment commonly accepted principles of clinical practice. DATA SOURCE: A MEDLINE/PubMed search from 1966 to November 2006 using the search terms mechanical ventilation, respiratory failure, noninvasive positive pressure ventilation (NIPPV), and COPD, and weaning. Subsequent searches were done on more specific issues such as heliox. Additionally, prominent researchers in this field were interviewed for knowledge of ongoing or unpublished data and their clinical practice. DATA EXTRACTION AND SYNTHESIS: COPD is very common cause of respiratory failure and admission to the intensive care unit. Mechanical ventilation of patients with COPD presents a unique set of challenges compared with other patients. Care must be taken to avoid augmenting dynamic hyperinflation and acid/base disturbances resulting from chronic hypercapnic respiratory failure. Modalities such as NIPPV and helium/oxygen gas mixtures are increasingly being recognized for their ability to help prevent invasive ventilation and aid in getting patients off invasive ventilation. CONCLUSIONS: Despite decades of study, most of the principles of safe mechanical ventilation for patients with COPD such as low respiratory rates that maximize expiratory time and careful attention to air-trapping still hold true to this day. NIPPV appears to be the most important new modality in reducing the mortality, morbidity and incidence of invasive mechanical ventilation.

The National Organ Transplantation Breakthrough Collaborative--a Rhode Island hospital perspective.

Patients needing organ transplants still exceed the number of organs, and each year some patients on waiting lists die. A series of national collaborative meetings identified practices shown to increase organ donation consent rates and organs procured per donor. A partnership between the NEOB and donor hospitals is important to achieve these goals. By following best practices set forth by the Collaborative movement and put in place by NEOB, physicians can increase the supply of donor organs in New England and nationally.