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1.
Br J Anaesth ; 124(3): 314-323, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32000978

RESUMO

BACKGROUND: In surgical patients undergoing general anaesthesia, coughing at the time of extubation is common and can result in potentially dangerous complications. We performed a systematic review and meta-analysis to assess the efficacy and safety of i.v. lidocaine administration during the perioperative period to prevent cough and other airway complications. METHODS: We searched Medical Literature Analysis and Retrieval System, Excerpta Medica database, and Cochrane Central Register of Controlled Trials for RCTs comparing the perioperative use of i.v. lidocaine with a control group in adult patients undergoing surgery under general anaesthesia. The RCTs were assessed using risk-of-bias assessment, and the quality of evidence was assessed using Grading of Recommendations, Assessment, Development and Evaluations (GRADE). RESULTS: In 16 trials (n=1516), the administration of i.v. lidocaine compared with placebo or no treatment led to large reductions in post-extubation cough (risk ratio [RR]: 0.64; 95% confidence interval [CI]: 0.48-0.86) and in postoperative sore throat at 1 h (RR: 0.46; 95% CI: 0.32-0.67). There was no difference in incidence of laryngospasm (risk difference [RD]: 0.02; 95% CI: -0.07 to 0.03) or incidence of adverse events related to the use of lidocaine. CONCLUSIONS: The use of i.v. lidocaine perioperatively decreased airway complications, including coughing and sore throat. There was no associated increased risk of harm.


Assuntos
Anestesia Geral/efeitos adversos , Anestésicos Locais/administração & dosagem , Tosse/prevenção & controle , Lidocaína/administração & dosagem , Complicações Pós-Operatórias/prevenção & controle , Anestésicos Locais/uso terapêutico , Tosse/etiologia , Remoção de Dispositivo/efeitos adversos , Humanos , Injeções Intravenosas , Intubação Intratraqueal/efeitos adversos , Lidocaína/uso terapêutico , Assistência Perioperatória/métodos , Faringite/etiologia , Faringite/prevenção & controle
2.
Medicine (Baltimore) ; 99(5): e19010, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-32000443

RESUMO

Previous studies indicated that hardware removal may lead to increased morbidity and therefore, at least in adults, remains questionable for certain indications. However, risks such as corrosion or local reactions may be less likely in younger patients with current, improved hardware materials. We sought to retrospectively determine complication rates of hardware removal in pediatric upper limb surgery, and establish potential risk factors for increased morbidity.All children and adolescents who underwent inpatient hardware removal under anesthesia after previous upper limb surgery between 2002 and 2016 were retrospectively evaluated. The following details were extracted at the latest follow-up: demographics, implant location, hardware material, duration of surgery, duration of hardware in situ, and any complications graded according to Goslings et al (grade 0-5) and Sink et al (grade 1-5), respectively. Correlations were calculated to establish potential relationships between specific outcome parameters (e.g., location, duration of surgery etc.) and complication grades.A total of 2089 children were evaluated of whom 317 patients with 449 interventions (mean age 9.4 years) fulfilled the inclusion criteria for this study. Overall, 203 K-wires (46%), 97 plates (22%), 102 external fixators (23%), 32 intramedullary nails (7%), 6 screws (1%), 4 cerclages (1%) and 1 pin (0.2%) were removed; most common locations were the forearm (34%) and humerus (24%). The mean duration of surgery was 40 minutes (± 50.9), mean time in situ was 194 days (± 319.6). Complication rates were low overall, with most being grade 0 (n = 372; 83%) or 1 (n = 60; 13%) according to Goslings et al and grade 1 (n = 386; 86%) and 2 (n = 42; 9%) according to Sink et al. No severe complications were observed. The following predictors were related to the severity of the complications in linear regression analysis: more distal localizations, external fixators, longer duration of surgery and female sex.Hardware removal under anesthesia in the pediatric upper extremity has produced a low complication rate with no severe complications and can thus be considered to be safe. Increased morbidity occurred in more distal localizations, external fixators, longer surgeries and females.Level of Evidence: Therapeutic, Level IV.


Assuntos
Remoção de Dispositivo/efeitos adversos , Próteses e Implantes , Extremidade Superior/cirurgia , Adolescente , Criança , Feminino , Humanos , Masculino , Reoperação , Estudos Retrospectivos , Fatores de Risco
3.
Medicine (Baltimore) ; 99(2): e18710, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914080

RESUMO

The present study aimed to assess the effect of removing an indwelling urinary catheter at different times on urinary retention and urinary infection in patients undergoing gynecologic surgery.Electronic databases including PubMed, EMbase, the Cochrane Central Register of Controlled Trials, and Ovid from inception to June 2018 were searched. Relevant randomized controlled trials (RCTs) of removal the indwelling urinary catheter in different time were included.Eight RCTs were included. Data were analyzed by RevMan 5.3 version. There was significant difference in urinary retention (relative risk [RR] 2.46, 95% confidence intervals [CIs] 1.10-5.53), P = .03) between the ≤6 hours and >6 hours indwelling urinary catheter removal groups, while no significant differences were found in the gynecologic surgery excluded the vaginal surgery group and vaginal surgery group. When compared with >6 hours indwelling urinary catheter removal group, the incidence of urinary infection was significantly reduced at the ≤6 hours removal group (RR = 0.66, 95% CI 0.48-0.89, P = .007). The urinary catheter removal time at ≤6 hours also significantly reduced the incidence of urinary retention (RR = 5.06, 95%CI 1.74-14.69, P = .003), and did not statistically increase the incidence of urinary infection (RR = 0.30, 95%CI 0.08 to 1.20, P = .09), compared with immediate urinary catheter removal after surgery.Removal time of the urinary catheter at ≤6 hours postoperatively seems to be more beneficial than immediate or >6 hours for patients undergoing gynecologic surgery which excluded the vaginal surgery.


Assuntos
Remoção de Dispositivo/métodos , Procedimentos Cirúrgicos em Ginecologia/métodos , Cuidados Pós-Operatórios/métodos , Cateteres Urinários , Remoção de Dispositivo/efeitos adversos , Humanos , Cuidados Pós-Operatórios/efeitos adversos , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Retenção Urinária/etiologia , Infecções Urinárias/etiologia
4.
Int Heart J ; 61(1): 89-95, 2020 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-31956149

RESUMO

Thrombocytopenia is a frequent complication in patients requiring intra-aortic balloon pumping (IABP) counterpulsation. However, its prognostic impact has not been fully addressed. The objective of this study is to evaluate the impact of the change in the platelet number during IABP use on the prognosis after device removal.This is a retrospective observational study. Patients in the intensive cardiac care unit at three Juntendo University hospitals who underwent percutaneous implantation of IABP with or without veno-arterial extracorporeal membrane oxygenation (V-A ECMO), since 2012-2016, were enrolled in the study (n = 439). Patients who died during mechanical circulatory support (n = 47) were excluded. We evaluated the prognostic impact of the ratio of platelet reduction from the baseline (% PLT reduction) during IABP use on cardiovascular mortality after device removal.The median and the range of follow-up period were 298 days and 0-1,869 days, respectively. Unadjusted Kaplan-Meier analysis demonstrated that patients with a higher % PLT reduction had higher cardiovascular (CV) mortality. An adjusted Cox proportional hazard analysis demonstrated that a 10% higher % PLT reduction was associated with higher cardiovascular (CV) mortality (Hazard ratio: 1.3, 95% Confidence interval: 1.1-1.6, P < 0.001). Moreover, % PLT reduction and the maximum C-reactive protein (CRP) level during IABP use were positively correlated (r = 0.326, P < 0.001).The reduced number of platelets during IABP use was associated with an increased risk of CV mortality.


Assuntos
Remoção de Dispositivo/efeitos adversos , Oxigenação por Membrana Extracorpórea/métodos , Balão Intra-Aórtico/efeitos adversos , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/mortalidade , Oxigenação por Membrana Extracorpórea/mortalidade , Feminino , Humanos , Unidades de Terapia Intensiva , Balão Intra-Aórtico/mortalidade , Masculino , Pessoa de Meia-Idade , Contagem de Plaquetas , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Resultado do Tratamento
5.
J Vasc Access ; 21(1): 86-91, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31328625

RESUMO

PURPOSE: In an effort to reduce catheter-related bloodstream infection's incidence rates in an intensive care unit, several evidence-based procedures recommended by the Centers for Disease Control and Prevention for centrally inserted central catheters were implemented. A failure to fully comply with the recommendation for prompt removal of the centrally inserted central catheters was attributed, mainly to the difficulties and inadequacies raised from establishing peripheral venous access. METHODS: The ultrasound-guided peripheral venous cannulation method as a supplementary intervention to the Centers for Disease Control and Prevention's recommendations was incorporated and examined during the subsequent year. RESULTS: A significant reduction on catheter-related bloodstream infection incidence rates out of the expected range was found. Centrally inserted central catheters utilization ratios were reduced by 10.7% (p < 0.05; 58%-47%) and the catheter-related bloodstream infection incidence rate was reduced by 11.7 per thousand device-days (15.9-4.16/1000 centrally inserted central catheters days (2015-2016 group, respectively)). CONCLUSION: The reduction of catheter-related bloodstream infection was higher than that described in the published literature. This probably shows that the combination of the five evidence-based procedures recommended by the Centers for Disease Control and Prevention together with that of ultrasound-guided peripheral venous cannulation method can increase the compliance with the Category IA recommendation for removal or avoidance of unnecessary placement of centrally inserted central catheters and decrease the catheter-related bloodstream infections in a more effective way, by affecting the patients' centrally inserted central catheter exposure.


Assuntos
Infecções Relacionadas a Cateter/prevenção & controle , Cateterismo Venoso Central/instrumentação , Cateterismo Periférico/instrumentação , Cateteres de Demora , Cateteres Venosos Centrais , Remoção de Dispositivo , Ultrassonografia de Intervenção , Idoso , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Venoso Central/normas , Cateterismo Periférico/efeitos adversos , Cateterismo Periférico/normas , Chipre/epidemiologia , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/normas , Desenho de Equipamento , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Guias de Prática Clínica como Assunto , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Tempo para o Tratamento , Resultado do Tratamento , Ultrassonografia de Intervenção/normas , Estados Unidos
7.
J Matern Fetal Neonatal Med ; 33(1): 68-72, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29886771

RESUMO

Purpose: We conducted a prospective randomized controlled trial to compare postoperative urinary catheter removal 2 versus 12 h after elective cesarean section in terms of irritative symptoms, first void time, incidence of urinary tract infection, postoperative mobilization time, and hospitalization time.Methods: A total of 134 women admitted to Duzce University Hospital for primary or recurrent elective cesarean section were randomized into two groups. A total of 62 women were enrolled in the early group, with indwelling catheter removal 2 h after cesarean section; 74 women were enrolled in the delayed group, with catheter removal 12 h after the cesarean section. The groups were prospectively compared in terms of irritative urinary symptoms, bacteriuria, hematuria, length of hospital stay, and mobilization time.Results: Urinary frequency (p = .04), microscopic hematuria incidence (p = .04), postoperative mobilization time (p = .01), and length of hospital stay (p = .009) were significantly lower in the early group than in the delayed group. There were no significant differences in terms of bacteruria, urinary retention, dysuria, and first postoperative voiding time.Conclusions: Early removal of urinary catheters after elective cesarean section is associated with reduced mobilization time and hospital stay.


Assuntos
Cateteres de Demora , Cesárea , Remoção de Dispositivo/métodos , Cateterismo Urinário , Cateteres Urinários/efeitos adversos , Adulto , Infecções Relacionadas a Cateter/epidemiologia , Cateteres de Demora/efeitos adversos , Cateteres de Demora/estatística & dados numéricos , Cesárea/efeitos adversos , Cesárea/instrumentação , Cesárea/métodos , Cesárea/estatística & dados numéricos , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/efeitos adversos , Procedimentos Cirúrgicos Eletivos/instrumentação , Procedimentos Cirúrgicos Eletivos/métodos , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Paridade/fisiologia , Cuidados Pós-Operatórios/efeitos adversos , Cuidados Pós-Operatórios/métodos , Cuidados Pós-Operatórios/estatística & dados numéricos , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/etiologia , Gravidez , Fatores de Tempo , Resultado do Tratamento , Turquia/epidemiologia , Cateterismo Urinário/efeitos adversos , Cateterismo Urinário/estatística & dados numéricos , Cateteres Urinários/estatística & dados numéricos , Retenção Urinária/epidemiologia , Retenção Urinária/etiologia , Infecções Urinárias/epidemiologia , Infecções Urinárias/etiologia , Adulto Jovem
8.
BMC Musculoskelet Disord ; 20(1): 437, 2019 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-31554516

RESUMO

BACKGROUND: Anterior cervical discectomy and fusion (ACDF) is often performed for the treatment of degenerative cervical spine. While this procedure is highly successful, 0.1-1.6% of early and late postoperative infection have been reported although the rate of late infection is very low. CASE PRESENTATION: Here, we report a case of 59-year-old male patient who developed deep cervical abscess 30 days after anterior cervical discectomy and titanium cage bone graft fusion (autologous bone) at C3/4 and C4/5. The patient did not have esophageal perforation. The abscess was managed through radical neck dissection approach with repated washing and removal of the titanium implant. Staphylococcus aureus was positively cultured from the abscess drainage, for which appropriate antibiotics including cefoxitin, vancomycin, levofloxacin, and cefoperazone were administered postoperatively. In addition, an external Hallo frame was used to support unstable cervical spine. The patient's deep cervical infection was healed 3 months after debridement and antibiotic administration. His cervial spine was stablized 11 months after the surgery with support of external Hallo Frame. CONCLUSIONS: This case suggested that deep cervical infection should be considered if a patient had history of ACDF even in the absence of esophageal perforation.


Assuntos
Abscesso/terapia , Vértebras Cervicais/cirurgia , Discotomia/efeitos adversos , Infecções Relacionadas à Prótese/terapia , Fusão Vertebral/efeitos adversos , Abscesso/etiologia , Antibacterianos/uso terapêutico , Vértebras Cervicais/microbiologia , Desbridamento , Remoção de Dispositivo/efeitos adversos , Drenagem , Quimioterapia Combinada/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Esvaziamento Cervical , Aparelhos Ortopédicos , Próteses e Implantes/efeitos adversos , Infecções Relacionadas à Prótese/etiologia , Fusão Vertebral/instrumentação , Staphylococcus aureus/isolamento & purificação , Fatores de Tempo , Titânio/efeitos adversos , Resultado do Tratamento
9.
J Orthop Surg Res ; 14(1): 315, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533760

RESUMO

BACKGROUND: This study aimed to investigate the incidence and risk factors of postoperative urinary retention (POUR) among elderly patients who underwent hip fracture surgery and to evaluate the effect of indwelling catheterization on the occurrence of POUR. MATERIALS AND METHODS: From January 2012 to January 2015, consecutive patients aged over 70 years who underwent hip fracture surgery were enrolled in this study. All patients underwent indwelling catheterization due to voiding difficulty upon admission. Demographic data, perioperative variables, and postoperative duration of patient-controlled analgesia and indwelling catheterization, postoperative complications, and mortality were collected. The incidence of POUR was investigated, and the risk factors related to POUR were analyzed using a logistic regression analysis. The cutoff value for the timing of catheter removal was determined using receiver operating characteristic (ROC) curve analysis. RESULTS: POUR developed in 68 patients (31.8%) of the 214 patients. Of these, 24 (35.3%) were male. The indwelling catheter was left in place for an average of 3.4 days (range, 0-7 days) postoperatively. A significant difference was noted in gender and duration of indwelling catheterization between patients with POUR and without. The cutoff value for the timing of catheter removal as determined by ROC curve analysis was 3.5 postoperative day with 51.4% sensitivity and 71.5% specificity. Multiple logistic regression revealed that the duration of the indwelling catheter [odds ratios (OR), 0.31; p = 0.016)] and male gender (OR, 2.22; p = 0.014) were independent risk factors related to the occurrence of POUR. CONCLUSIONS: The significant risk factors of POUR among elderly patients undergoing hip fracture surgery were early indwelling catheter removal and male gender. Therefore, early removal of indwelling catheter in elderly patients following hip fracture surgery may increase the risk of POUR, especially in male patients.


Assuntos
Cateteres de Demora , Remoção de Dispositivo/efeitos adversos , Fraturas do Quadril/cirurgia , Complicações Pós-Operatórias/prevenção & controle , Cateteres Urinários , Retenção Urinária/prevenção & controle , Idoso , Idoso de 80 Anos ou mais , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/métodos , Feminino , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Humanos , Masculino , Cuidados Pós-Operatórios/métodos , Período Pós-Operatório , Estudos Retrospectivos , Fatores de Risco , Fatores Sexuais , Cateterismo Urinário , Retenção Urinária/etiologia , Retenção Urinária/terapia
11.
Int J Pediatr Otorhinolaryngol ; 125: 122-127, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31299421

RESUMO

OBJECTIVE: To determine the frequency and risk factors that lead to the development of persistent TCF (tracheocutaneous fistula) formation in children following tracheostomy decannulation at our institution. METHODS: A retrospective chart review of all pediatric patients at Children's Hospital Colorado who underwent tracheostomy decannulation and were being followed between January 1, 2007 and December 31, 2013. TCF was defined as a persistent fistula six months following decannulation. We determined patient demographics, age at tracheotomy, primary indication for tracheotomy, tracheostomy-tube size, medical comorbidities, age at decannulation, date of TCF closure, and method of TCF closure. RESULTS: One hundred twenty-nine patients ranging from 51 days to 19 years of age underwent tracheostomy decannulation. 63 (49%) patients underwent surgical closure of TCF. Compared to those with spontaneous closure by multivariable analysis, those with surgical closure were younger at tracheostomy placement (p = 0.0002), had a tracheostomy for a longer duration (p = 0.0025), and were diagnosed with tracheobronchomalacia (p = 0.0051). The likelihood of spontaneous closure decreased over time. Tracheostomy tube internal diameter correlated with age (R = 0.64, p < 0.0001). CONCLUSIONS: Approximately 50% of pediatric tracheostomy stoma sites will close spontaneously. Development of a persistent TCF was associated with younger age at placement, longer duration of tracheostomy, and the presence of tracheobronchomalacia. These observations may help clinicians anticipate outcomes following tracheostomy decannulation in children.


Assuntos
Extubação/efeitos adversos , Fístula Cutânea/cirurgia , Complicações Pós-Operatórias/cirurgia , Fístula do Sistema Respiratório/cirurgia , Doenças da Traqueia/cirurgia , Traqueostomia/efeitos adversos , Adolescente , Criança , Pré-Escolar , Colorado , Fístula Cutânea/etiologia , Remoção de Dispositivo/efeitos adversos , Feminino , Hospitais Pediátricos , Humanos , Lactente , Masculino , Complicações Pós-Operatórias/etiologia , Fístula do Sistema Respiratório/etiologia , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Doenças da Traqueia/etiologia , Traqueobroncomalácia/cirurgia , Traqueotomia/efeitos adversos , Adulto Jovem
12.
J Cardiovasc Med (Hagerstown) ; 20(8): 531-541, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31259858

RESUMO

AIMS: The aim of this survey was to assess the management and organization of cardiac implantable electronic device (CIED) replacement in Italy. METHODS: A questionnaire consisting of 24 questions on organizational aspects and on the peri-procedural management of anticoagulant therapies and antibiotic prophylaxis was sent via the Internet to 154 Italian arrhythmia centers. RESULTS: A total of 103 out of 154 centers completed the questionnaire (67% response rate). In 43% of the centers, the procedures were performed under day-case admission, in 40% under ordinary admission, and in 17% under either day-case or ordinary admission. The most frequent reason (66%) for choosing ordinary admission rather than day-case admission was to obtain full reimbursement. Although warfarin therapy was continued in 73% of the centers, nonvitamin K oral anticoagulants were discontinued, without bridging, 24 h or less prior to replacement procedures in 88%. Prophylactic antibiotic therapy was systematically administered in all centers; in 97%, the first antibiotic dose was administered 1-2 h prior to procedures. Local antibacterial envelopes were also used in 43% of the centers in patients with a higher risk of device infection. CONCLUSION: This survey provides a representative picture of how CIED replacements are organized and managed in current Italian clinical practice. The choice of the type of hospitalization (short versus ordinary) was more often motivated by economic reasons (reimbursement of the procedure) than by clinical and organizational factors. Peri-procedural management of anticoagulation and prophylactic antibiotic therapy was consistent with current scientific evidence.


Assuntos
Antibioticoprofilaxia/tendências , Anticoagulantes/administração & dosagem , Estimulação Cardíaca Artificial/tendências , Desfibriladores Implantáveis/tendências , Remoção de Dispositivo/tendências , Cardioversão Elétrica/tendências , Marca-Passo Artificial/tendências , Padrões de Prática Médica/tendências , Procedimentos Cirúrgicos Ambulatórios , Estimulação Cardíaca Artificial/economia , Desfibriladores Implantáveis/economia , Remoção de Dispositivo/efeitos adversos , Remoção de Dispositivo/economia , Esquema de Medicação , Cardioversão Elétrica/economia , Cardioversão Elétrica/instrumentação , Custos de Cuidados de Saúde , Pesquisas sobre Serviços de Saúde , Humanos , Itália , Tempo de Internação , Marca-Passo Artificial/economia , Admissão do Paciente , Padrões de Prática Médica/economia , Falha de Prótese , Fatores de Tempo , Resultado do Tratamento
13.
Semin Thorac Cardiovasc Surg ; 31(4): 674-678, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31271851
14.
Medicine (Baltimore) ; 98(30): e16548, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31348275

RESUMO

The available literature lacks data concerning direct comparison of the effectiveness and safety of single- versus dual-coil implantable cardioverter-defibrillator (ICD) leads transvenous extraction. Certainly, additional shocking coil in superior vena cava adds to the amount of metal in the vascular system. Adhesions developing around the superior vena cava coil add to the difficulty of extraction of ICD lead if lead removal is required. The aim of the study was to assess the effectiveness and safety of single- and dual-coil ICD leads transvenous extraction using mechanical systems. We performed transvenous lead extraction (TLE) of 197 ICD leads in 196 patients. There were 46 (23.3%) dual-coil leads removed from 46 (23.5%) patients. Cardiovascular implantable electronic device-related infection was an indication for TLE in 25.0% of patients. The following extracting techniques were used: manual direct traction, mechanical telescopic sheaths, controlled-rotation mechanical sheaths, and femoral approach. Complete ICD lead removal and complete procedural success in both groups were similar (99.3% in single-coil vs 97.8% in dual-coil, P = .41 and 99.3% in single-coil vs 97.8% in dual-coil, P = 0.41, respectively). We did not find significant difference between major and minor complication rates in both groups (2.0% in single-coil vs 4.3% in dual-coil, and 0.7% in single-coil vs 0.0% in dual-coil, P = .58, respectively). There was 1 death associated with the TLE procedure of single-coil lead.This study shows that extraction of dual-coil leads seems to be comparably safe and effective to extraction of single-coil leads. On the other hand, it requires longer fluoroscopy time and frequent utilization of advanced tools.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Remoção de Dispositivo/métodos , Desenho de Equipamento/efeitos adversos , Fluoroscopia/métodos , Procedimentos Cirúrgicos Vasculares/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Remoção de Dispositivo/efeitos adversos , Feminino , Fluoroscopia/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Aderências Teciduais/etiologia , Aderências Teciduais/cirurgia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Veia Cava Superior/patologia , Veia Cava Superior/cirurgia , Adulto Jovem
15.
J Invasive Cardiol ; 31(6): E159, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31158816

RESUMO

Utilization of large-bore sheaths has increased dramatically with the advancement of hemodynamic support devices. The pre-close technique is widely used to achieve hemostasis after device removal. However, this technique might fail or be deferred in certain situations, such as planned extended hemodynamic support or emergencies. Perclose employment in arteriotomies larger than 8 Fr might not be successful, as the device foot does not catch the vessel's anterior wall. We describe a simple "postclose" technique for large arteriotomies (13-14 Fr) after removal of Impella 2.5 or CP systems (Abiomed) from the common femoral artery, using two Perclose devices.


Assuntos
Remoção de Dispositivo/efeitos adversos , Artéria Femoral/cirurgia , Hemostasia Cirúrgica/métodos , Hemorragia Pós-Operatória/cirurgia , Cateterismo Periférico/métodos , Humanos , Hemorragia Pós-Operatória/etiologia
16.
Vasc Endovascular Surg ; 53(6): 501-506, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31159685

RESUMO

Inferior vena cava (IVC) filters are important devices for patients who are at high risk for developing thrombi and pulmonary embolism but have conditions that preclude the use of pharmacologic anticoagulants. IVC filter retrieval has become an important quality initiative backed by Food and Drug Administration guidelines for prompt removal after the filter is no longer indicated. Filter retrieval is a common procedure that usually has very few complications. However, when the filter is tilted or embedded in the caval wall, advanced techniques of retrieval may be necessary. These techniques have a higher rate of success but also a higher risk of complications such as injury to the IVC. Here, we describe a case of IVC filter retrieval resulting in formation of an arteriovenous fistula between the right renal artery and IVC and subsequent successful repair of this fistula using a vascular plug.


Assuntos
Fístula Arteriovenosa/etiologia , Remoção de Dispositivo/efeitos adversos , Implantação de Prótese/instrumentação , Artéria Renal/lesões , Lesões do Sistema Vascular/etiologia , Filtros de Veia Cava , Veia Cava Inferior/lesões , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Angiografia por Tomografia Computadorizada , Embolização Terapêutica , Feminino , Humanos , Pessoa de Meia-Idade , Flebografia/métodos , Artéria Renal/diagnóstico por imagem , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia , Veia Cava Inferior/diagnóstico por imagem
17.
BMJ Case Rep ; 12(6)2019 Jun 22.
Artigo em Inglês | MEDLINE | ID: mdl-31229983

RESUMO

We report a significant complication after tracheocutaneous fistula (TCF) excision with closure by secondary intention in a 4-year-old boy who had been tracheostomy dependent since infancy. He had a persistent 3 mm TCF one year after decannulation. On postoperative day 2 the patient developed profound subcutaneous emphysema and pneumomediastinum. He was extubated after 2 days and discharged from the hospital on postoperative day 7. At follow up he had complete resolution of subcutaneous emphysema and complete closure of the TCF. The main methods of TCF closure and management of subcutaneous emphysema are discussed along with the lessons learned from this case.


Assuntos
Fístula Cutânea/complicações , Enfisema Subcutâneo/etiologia , Traqueia/cirurgia , Pré-Escolar , Fístula Cutânea/etiologia , Fístula Cutânea/cirurgia , Remoção de Dispositivo/efeitos adversos , Humanos , Intubação Intratraqueal/métodos , Masculino , Enfisema Mediastínico/etiologia , Complicações Pós-Operatórias , Enfisema Subcutâneo/diagnóstico por imagem , Enfisema Subcutâneo/terapia , Doenças da Traqueia/complicações , Resultado do Tratamento
18.
Rev Esc Enferm USP ; 53: e03473, 2019 Jun 13.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31215614

RESUMO

OBJECTIVE: To estimate the prevalence of mechanical restraint in the hospital environment and the factors associated with its performance. METHOD: A cross-sectional, observational study with patients from a public hospital from the medical clinic, surgical clinic and intensive care unit evaluated by descriptive, univariate and multivariate analyses. RESULTS: One hundred eleven (111) patients participated in the study. The prevalence of mechanical restraint was 51.4%; bilateral rails on the bed were used in 100% of the restraints, and bilateral wrist restraints were also observed in 29.8%. The most common justifications were the risk of falls (100.0%) and the risk of non-scheduled removal of invasive devices (57.9%). The restrained patients differ significantly from those not restrained by the following associated factors: male gender; age; stroke diagnosis; the hospitalization unit; ambulation capacity; the use of sedative medication; and the use of invasive devices. CONCLUSION: This study estimated a high mechanical restraint prevalence in the hospital environment and determined factors associated with the risk of a patient being restrained. A medical restraint evaluation team is recommended for an in-depth analysis of indication and therapy.


Assuntos
Acidentes por Quedas/prevenção & controle , Remoção de Dispositivo/efeitos adversos , Restrição Física/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Fatores de Risco , Adulto Jovem
19.
Vasc Endovascular Surg ; 53(6): 446-451, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31046635

RESUMO

PURPOSE: To evaluate the safety and efficacy of retrieval of inferior vena cava filters (IVCF) temporarily placed in a suprarenal position. METHODS: Retrieval of IVCF placed in a suprarenal position was performed in 13 patients (5 men and 8 women; mean age: 45.1 ± 13.8 years) between July 2006 and May 2018 using either a loop snare technique or endobronchial forceps. Electronic medical records were reviewed for patient demographics and procedural information. RESULTS: Inferior vena cava filters retrieved included Option Elite (n = 9, 69%) and Günther Tulip (n = 4, 31%). Caval thrombosis was not detected in any patients on pre- or postretrieval cavogram. Eleven suprarenal IVCF (84%) were retrieved during the first retrieval attempt after a median indwelling time of 1.8 months (range, 0.03-12.10 months). Retrieval was initially unsuccessful in 2 (16%) patients with Option Elite filters, but both were successfully removed on second attempt using endobronchial forceps. Thirteen suprarenal IVCF (100%) were ultimately retrieved. CONCLUSION: Endovascular retrieval of IVCF temporarily placed in a suprarenal position is safe and efficacious.


Assuntos
Remoção de Dispositivo/métodos , Procedimentos Endovasculares/métodos , Implantação de Prótese/instrumentação , Filtros de Veia Cava , Veia Cava Inferior , Adulto , Angiografia por Tomografia Computadorizada , Remoção de Dispositivo/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Implantação de Prótese/efeitos adversos , Estudos Retrospectivos , Fatores de Risco , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem
20.
J Vasc Interv Radiol ; 30(7): 1069-1074, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31133452

RESUMO

PURPOSE: To compare the safety and effectiveness of different-site port placement versus same-site port salvage in adult patients with occluded ports. MATERIALS AND METHODS: Ninety-five occluded subcutaneous infusion ports (ports) in 95 patients presenting between July 1, 2002, and June 30, 2017, were retrospectively reviewed: 48 (51%) different-site placements (replacements; same-day indwelling port removal and different-site new port placement) and 47 (49%) same-site salvages (salvages; 35 fibrin sheath strippings, 12 over-the-wire exchanges). Demographic information, indication for initial placement and replacement or salvage, procedural details, post-intervention primary catheter patency, and post-intervention port sequelae were recorded. Post-intervention primary catheter patency, and malfunction and infection rates were compared with Kaplan-Meier estimation and the log-rank test, and Fisher exact test, respectively. The association of patient risk factors and port patency was assessed with Cox regression. RESULTS: Median primary catheter patency after replacement was 254 days (interquartile range [IQR], 297) and after salvage was 391 days (IQR, 906) (P = .25). Within the salvage group, median primary catheter patency after stripping was 391 days (IQR, 658) and after exchange was 666 days (IQR, 1412) (P = .08). There was no statistical difference in malfunction (P = .12) and infection (P = .74) rates between the replaced and salvaged groups or in malfunction (P = .09) and infection (P = .1) rates between the exchanged and stripped subgroups. None of the patient or catheter characteristics assessed were significantly associated with primary catheter patency. CONCLUSIONS: There was no statistical difference between patency, malfunctions, or infections after replacement and salvage, or after stripping and exchange, so technique selection should be based on the patient's estimated lifetime venous access requirements, cost, and physician preference.


Assuntos
Obstrução do Cateter/etiologia , Cateteres de Demora/efeitos adversos , Remoção de Dispositivo , Terapia de Salvação , Dispositivos de Acesso Vascular/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/etiologia , Remoção de Dispositivo/efeitos adversos , Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Terapia de Salvação/efeitos adversos , Resultado do Tratamento , Adulto Jovem
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