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Anesthesiology ; 129(6): 1101-1110, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30300157


WHAT WE ALREADY KNOW ABOUT THIS TOPIC: WHAT THIS ARTICLE TELLS US THAT IS NEW: BACKGROUND:: Beta (ß) blockers reduce the risk of postoperative atrial fibrillation and should be restarted after surgery, but it remains unclear when best to resume ß blockers postoperatively. The authors thus evaluated the relationship between timing of resumption of ß blockers and atrial fibrillation in patients recovering from noncardiothoracic and nonvascular surgery. METHODS: The authors evaluated 8,201 adult ß-blocker users with no previous history of atrial fibrillation who stayed at least two nights after noncardiothoracic and nonvascular surgery as a retrospective observational cohort. After propensity score matching on baseline and intraoperative variables, 1,924 patients who did resume ß blockers by the end of postoperative day 1 were compared with 973 patients who had not resumed by that time on postoperative atrial fibrillation using logistic regression. A secondary matched analysis compared 3,198 patients who resumed ß blockers on the day of surgery with 3,198 who resumed thereafter. RESULTS: Of propensity score-matched patients who resumed ß blockers by end of postoperative day 1, 4.9% (94 of 1,924) developed atrial fibrillation, compared with 7.0% (68 of 973) of those who resumed thereafter (adjusted odds ratio, 0.69; 95% CI, 0.50-0.95; P = 0.026). Patients who resumed ß blockers on day of surgery had an atrial fibrillation incidence of 4.9% versus 5.8% for those who started thereafter (odds ratio, 0.84; 95% CI, 0.67-1.04; P = 0.104). CONCLUSIONS: Resuming ß blockers in chronic users by the end of the first postoperative day may be associated with lower odds of in-hospital atrial fibrillation. However, there seems to be little advantage to restarting on the day of surgery itself.

Antagonistas Adrenérgicos beta/uso terapêutico , Fibrilação Atrial/prevenção & controle , Complicações Pós-Operatórias/prevenção & controle , Procedimentos Cirúrgicos Operatórios , Idoso , Fibrilação Atrial/epidemiologia , Estudos de Coortes , Feminino , Humanos , Incidência , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Pontuação de Propensão , Estudos Retrospectivos
Crit Care Med ; 31(11): 2677-83, 2003 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-14605541


OBJECTIVES: To describe three levels of hospital-based critical care centers to optimally match services and personnel with community needs, and to recommend essential intensive care unit services and personnel for each critical care level. PARTICIPANTS: A multidisciplinary writing panel of professionals with expertise in the clinical practice of critical care medicine working under the direction of the American College of Critical Care Medicine (ACCM). DATA SOURCES AND SYNTHESIS: Relevant medical literature was accessed through a systematic Medline search and synthesized by the ACCM writing panel, a multidisciplinary group of critical care experts. Consensus for the final written document was reached through collaboration in meetings and through electronic communication modalities. Literature cited included previously written guidelines from the ACCM, published expert opinion and statements from official organizations, published review articles, and nonrandomized, historical cohort investigations. With this background, the ACCM writing panel described a three-tiered system of intensive care units determined by service-based criteria. CONCLUSIONS: Guidelines for optimal intensive care unit services and personnel for hospitals with varying resources will facilitate both local and regional delivery of consistent and excellent care to critically ill patients.

Cuidados Críticos , Unidades de Terapia Intensiva/organização & administração , Guias de Prática Clínica como Assunto , Sociedades Médicas , Adulto , Cuidados Críticos/classificação , Cuidados Críticos/métodos , Humanos , Unidades de Terapia Intensiva/classificação , Recursos Humanos em Hospital , Estados Unidos
Crit Care Clin ; 19(1): 127-49, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12688581


The critical care aspects of obstetrics and pregnancy are varied and demand that critical care practitioners have a thorough knowledge of fetal and maternal changes in physiology as pregnancy progresses. Pregnancy can affect every organ system; and organ-specific conditions as well as syndromes that span multiple organ systems were described. Care of the critically ill, pregnant patient requires a true multidisciplinary approach for optimal outcomes. A review of the current concepts and suggestions for therapy were presented.

Complicações na Gravidez/terapia , Adulto , Doenças Autoimunes/fisiopatologia , Cuidados Críticos , Fenômenos Fisiológicos do Sistema Digestório , Eclampsia/fisiopatologia , Eclampsia/terapia , Desenvolvimento Embrionário e Fetal/fisiologia , Feminino , Síndrome HELLP/fisiopatologia , Síndrome HELLP/terapia , Hemodinâmica , Humanos , Incidência , Rim/fisiologia , Pré-Eclâmpsia/fisiopatologia , Pré-Eclâmpsia/terapia , Gravidez , Complicações na Gravidez/epidemiologia , Complicações Cardiovasculares na Gravidez/fisiopatologia , Prevalência , Doenças Respiratórias/fisiopatologia , Doenças Respiratórias/terapia , Procedimentos Cirúrgicos Operatórios , Ferimentos e Lesões
J Trauma ; 54(1): 161-3, 2003 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-12544912


BACKGROUND: The management of trauma patients has become increasingly nonoperative, especially for solid abdominal organ injuries. However, the Residency Review Committee (RRC) still requires an operative trauma experience deemed essential for graduating general surgical residents. The purpose of this study was to review the trauma volume and mix of patients at two trauma centers and determine the major operative trauma cases available to residents involved in the care of these patients. METHODS: A retrospective chart review was conducted at the two trauma centers used by the Michigan State University surgery residency. Both of the trauma centers are American College of Surgeons verified. Surgical residents are involved with the care of every trauma patient at each of the hospitals. Cumulative data were collected and analyzed from January 1, 1997, through December 31, 1999. Age, gender, mechanism of injury (blunt vs. penetrating), Injury Severity Score, length of stay, operative interventions, and patients managed nonoperatively were reviewed. RESULTS: There were 434 patients selected for this study from 2,340 patients admitted to the trauma services. Male patients accounted for 66% of patients and female patients accounted for 34% of patients. Blunt trauma was the mechanism in 89% of patients, with penetrating trauma accounting for the other 11% of patients. Of the total number of patients, motor vehicle crashes accounted for the majority of cases, 325 of 434 (75%). Overall, 85% (370 of 434) of patients were managed without an index trauma surgical procedure according to RRC guidelines. Only 14.7% (64 of 434) of patients underwent operative intervention that qualified as index trauma surgical cases identified by the RRC. The spleen and small bowel were the two most commonly injured organs found at laparotomy. Nonoperative intervention of many patients with solid abdominal organ injuries did not meet the operation requirements expected by the RRC. CONCLUSION: Our residency program had 10 graduating chief residents over the 3-year time period. With only 64 operative trauma cases, this yields an average of 6.4 trauma cases per resident. This falls significantly short of the 16-case minimum requirement in trauma surgery established by the RRC. The operative trauma requirements established by the RRC for graduating residents may be unattainable in many residency programs because of the high incidence of blunt trauma and the changing patterns of trauma management.

Educação de Pós-Graduação em Medicina/organização & administração , Cirurgia Geral/educação , Internato e Residência/organização & administração , Centros de Traumatologia/estatística & dados numéricos , Traumatologia/educação , Ferimentos não Penetrantes/cirurgia , Ferimentos Penetrantes/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Competência Clínica/normas , Feminino , Humanos , Incidência , Escala de Gravidade do Ferimento , Tempo de Internação/estatística & dados numéricos , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Vigilância da População , Sistema de Registros , Estudos Retrospectivos , Ferimentos não Penetrantes/epidemiologia , Ferimentos Penetrantes/epidemiologia
Curr Surg ; 60(3): 235-40, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-15212056
Curr Surg ; 60(5): 501, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-14972213
Curr Surg ; 59(5): 477-8, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-15727793
Curr Surg ; 59(4): 402-3, 2002.
Artigo em Inglês | MEDLINE | ID: mdl-16093175