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2.
Medicine (Baltimore) ; 99(15): e19656, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32282716

RESUMO

To determine the influence of puncture site on aspiration in dealing with pneumothorax following CT-guided lung biopsy.Two hundred thirty-six pneumothorax patients after CT guided lung biopsies were retrospective analyzed from January 2013 to December 2018. Patients with minor asymptomatic pneumothorax were treated conservatively with monitoring of vital signs and follow-up CT to confirm stability. Ninety of the 236 pneumothorax patients, who underwent manual aspiration, were included in this analysis. In first manual aspiration, the needle from the lesion was retracted back into the pleural space after biopsy, and then aspiration treatment was performed. If the treatment is of unsatisfied result, a second attempt aspiration treatment, which puncture site away from initial biopsy one, was conducted. The efficacy of simple manual aspiration and the new method, changing puncture site for re-aspiration was observed.Immediate success was obtained in 62 out of the 90 patients in the first attempt. The effective rate and failure rate were 68.9% (62/90) and 31.1% (28/90), respectively. Twenty-eight patients in whom first attempt simple aspiration were unsuccessful underwent a second attempt aspiration, which puncture site away from initial biopsy one, was successful in 13 patients with 15 patients undergoing chest tube placement. The effective rate and failure rate were 46.4% (13/28) and 53.6% (15/28), respectively. Applying the modified procedure, total effective rate of aspiration elevated significantly from 68.9% (62/90) to 83.3% (75/90) (P < .05). No serious side effects were detected in the period of aspiration procedure.Manual aspiration with puncture site away from initial biopsy one is worth trying to deal with post-biopsy pneumothorax. This modified procedure improved the efficiency of treatment significantly, and reduced the rate of pneumothorax requiring chest tube placement.


Assuntos
Biópsia Guiada por Imagem/efeitos adversos , Pulmão/patologia , Pneumotórax/etiologia , Punções/efeitos adversos , Idoso , Tubos Torácicos/estatística & dados numéricos , Feminino , Humanos , Biópsia Guiada por Imagem/instrumentação , Pulmão/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Cavidade Pleural/patologia , Pneumotórax/terapia , Punções/métodos , Estudos Retrospectivos , Sucção/efeitos adversos , Sucção/métodos , Tomografia Computadorizada por Raios X/métodos , Falha de Tratamento
3.
Isr Med Assoc J ; 22(2): 89-93, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32043325

RESUMO

BACKGROUND: There are several ways to remove silicone oil (SO) from the vitreous cavity. OBJECTIVES: To describe a simple, safe and inexpensive method of 2-port SO removal. METHODS: Medical charts of 33 patients who underwent SO removal combined with cataract extraction were retrospectively reviewed, from a cohort of 119 patients who had silicone oil removal. The primary outcome was the rate of re-detachment, secondary outcomes included visual acuity (VA) and intraoperative and postoperative complications. RESULTS: Mean follow-up time was 27.6 months (0.25-147 ± 33.1), and mean tamponade duration prior to SO removal was 16.77 months (4-51.5 ± 14.6). The re-detachment rate was 3% (one patient). Postoperatively, seven patients (20%) had epiretinal membrane (ERM), eight patients had posterior capsule opacification (24%), and proliferative vitreoretinopathy (PVR) was diagnosed in two patients (6%). Compared to the mean VA (logarithm of the minimum angle of resolution [LogMAR]) at the preoperative examination, the mean VA (LogMAR) improved significantly at the last visit when including all ranges of VA (n=32, LogMAR 1.52 vs. 1.05 P = 0.0002 [Student's t-test] and P = 0.001 [Wilcoxon test]). CONCLUSIONS: The technique described is fast and simple, keeping the posterior capsule intact in pseudophakic patients, which is advantageous in the event of future re-detachment necessitating SO reinjection. Rates of re-detachment and postoperative ERM and PVR were low. Furthermore, our method does not require the use of a surgical microscope with posterior segment viewing systems, or opening a full disposable vitrectomy set, thus drastically reducing the procedure's cost.


Assuntos
Tamponamento Interno/métodos , Complicações Pós-Operatórias , Descolamento Retiniano , Óleos de Silicone/uso terapêutico , Sucção , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/cirurgia , Recidiva , Reoperação/métodos , Reoperação/estatística & dados numéricos , Descolamento Retiniano/diagnóstico , Descolamento Retiniano/fisiopatologia , Descolamento Retiniano/cirurgia , Estudos Retrospectivos , Sucção/efeitos adversos , Sucção/métodos , Resultado do Tratamento , Acuidade Visual , Cirurgia Vitreorretiniana/métodos
5.
Eur J Ophthalmol ; 30(1): 224-228, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30871372

RESUMO

AIM: The aim of this study was to study the safety and efficacy of posterior capsulorhexis in vitrectomized eyes undergoing combined phacoemulsification or irrigation/aspiration and silicone oil removal. METHODS: This prospective non-randomized interventional study involved 115 silicone-filled eyes of 115 previously vitrectomized patients. All patients underwent combined phacoemulsification or underwent irrigation/aspiration and silicone oil removal, followed by foldable intraocular lens implantation combined with primary posterior trans-scleral capsulorhexis. A 23-gauge trans-scleral vitrectomy probe was used to form the posterior capsulorhexis (vitrectorhexis). Patients were followed for 6 months. RESULTS: Intraocular lenses maintained good centration in the capsular bag during and after trans-scleral posterior capsulorhexis. No complications were observed in the postoperative period regarding lens centration or size of the posterior capsulorhexis. No included eyes needed YAG laser posterior capsulotomy and no recurrent retinal detachment was reported during follow-up. CONCLUSION: Performing primary trans-scleral capsulorhexis in patients undergoing combined phacoemulsification, or irrigation/aspiration and silicone oil removal, enabled achievement of an early postoperative clear visual axis and prevented the onset of dense postoperative posterior capsular opacification in previously silicone-filled eyes. This technique is reproducible and may facilitate additional intra-operative procedures and uncomplicated postoperative follow-up of retinal detachment patients without requiring YAG laser capsulotomy.


Assuntos
Capsulorrexe/métodos , Facoemulsificação/métodos , Óleos de Silicone , Sucção/métodos , Adulto , Idoso , Feminino , Humanos , Implante de Lente Intraocular , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Descolamento Retiniano/cirurgia , Acuidade Visual , Vitrectomia
6.
World Neurosurg ; 134: e460-e468, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31669243

RESUMO

BACKGROUND: Surgical closed suction drain (SCSDs) are used in a variety of surgical disciplines to prevent postoperative fluid collections. Use of SCSDs has not been well studied in the neurosurgical literature. Practice patterns have varied within our institution with respect to SCSDs after craniotomies for neurotrauma. In this study we describe SCSD use for patients undergoing evacuation of supratentorial epidural hematomas (EDHs) and examine the effect on patient outcomes and length of hospital stay. METHODS: We performed a retrospective review of craniotomies for supratentorial EDH performed at our Level I trauma center between May 2015 and May 2018. Imaging and clinical data were obtained from chart review. RESULTS: Fifty-two patients with EDH received operations from 8 attending surgeons. The number of drains used was 0 or 1 in 36 cases and 2 or more in 16 cases. Drain location was subgaleal in 25 cases, epidural in 8 cases, and both subgaleal and epidural in 13 cases. Attending preference (P < 0.001) but not hematoma size was associated with use of an epidural drain and use of 2 or more drains. After controlling for age, initial neurologic exam, and presence of other injuries, use of more drains was associated with longer intensive care unit lengths of stay. Drain use pattern was not associated with patient outcome measures, and no return to the operating room was necessary for residual or recurrent EDH. CONCLUSIONS: Use of fewer SCSDs did not affect radiographic outcome after evacuation of epidural hematomas but was associated with decreased intensive care unit length of stay.


Assuntos
Craniotomia/métodos , Drenagem/métodos , Hematoma Epidural Craniano/diagnóstico por imagem , Hematoma Epidural Craniano/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Tempo de Internação/tendências , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Estudos Retrospectivos , Sucção/métodos , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto Jovem
7.
Anaesthesia ; 75(3): 323-330, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31802485

RESUMO

We aimed to compare the reliability of aspiration via a nasogastric tube with ultrasound for assessment of residual gastric volume. Sixty-one adult patients who were mechanically ventilated and received continuous enteral feeding through a nasogastric tube for > 48 h were included. A first qualitative and quantitative ultrasound examination of the gastric antrum was followed by gastric suctioning, performed by an operator blinded to the result of the ultrasound examination. A second ultrasound examination was performed thereafter, followed by re-injection of the aspirated gastric contents (≤ 250 ml) into the stomach. A third ultrasound assessment was then immediately performed. If the suctioned volume was ≥ 250 ml, 250 mg erythromycin was infused over 30 min. A fourth ultrasound was performed 90 min after the third. Sixty (98%) patients had a qualitatively assessed full stomach at first ultrasound examination vs. 52 (85%) after gastric suctioning (p = 0.016). The calculated gastric volume significantly decreased after gastric suctioning, without a significant decrease in the number of patients with volume ≥ 250 ml. Four of the nine patients with calculated gastric volume ≥ 250 ml had vomiting within the last 24 h (p = 0.013). The antral cross-sectional area significantly decreased between the third and the fourth ultrasound examination (p = 0.015). Erythromycin infusion did not make a significant difference to gastric volume (n = 10). Our results demonstrate that gastric suctioning is not a reliable tool for monitoring residual gastric volume. Gastric ultrasound is a feasible and promising tool for gastric volume monitoring in clinical practice.


Assuntos
Aspiração Respiratória de Conteúdos Gástricos/diagnóstico por imagem , Estômago/diagnóstico por imagem , Sucção/métodos , Adulto , Idoso , Antibacterianos/efeitos adversos , Estudos de Coortes , Eritromicina/efeitos adversos , Feminino , Esvaziamento Gástrico , Conteúdo Gastrointestinal , Humanos , Intubação Gastrointestinal , Masculino , Pessoa de Meia-Idade , Monitorização Intraoperatória , Estudos Prospectivos , Reprodutibilidade dos Testes , Estômago/anatomia & histologia , Estômago/efeitos dos fármacos , Ultrassonografia , Vômito/etiologia
8.
J Neurointerv Surg ; 12(1): 72-76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31273074

RESUMO

INTRODUCTION: Improved functional outcomes after mechanical thrombectomy for emergent large vessel occlusion depend on expedient reperfusion after clinical presentation. Device technology has improved substantially over the years, and several commercial options exist for both large-bore aspiration catheters and suction pump systems. OBJECTIVE: To compare various vacuum pumps and examine the aspiration forces they generate as well as the force of catheter tip detachment from an artificial thrombus. METHODS: Using an artificial thrombus made from polyvinyl alcohol gel, we tested various mechanical characteristics of commercially available suction pumps, including the Penumbra Jet Engine, Penumbra Max, Stryker Medela AXS, Microvention Gomco, and a 60 cc syringe. Both aspiration pressure and tip force generated were analyzed. Subsequently, a cohort of thrombectomy catheters were assessed using the Penumbra Jet Engine to determine tip forces generated on an artificial thrombus. One-way analysis of variance was used to assess statistical significance. RESULTS: The Penumbra Jet Engine system generated both the highest maximum aspiration pressures (28.8 inches Hg) and the highest tip force (23.68 grams force (gf)) on an artificial thrombus, with statistical significance compared with the other pump systems. Using the Jet Engine, the largest-bore catheter was associated with the highest tip force (32.12 gf). The overall correlation coefficient between catheter inner diameter and tip force was 0.98. CONCLUSIONS: The Penumbra Jet Engine pump generates significantly higher vacuum pressures and tip forces than the other commercially available aspiration pump systems. Furthermore, catheters with a larger inner diameter generate higher tip suction forces on aspiration. Whether these mechanical features lead to improved clinical outcomes is yet to be determined.


Assuntos
Trombectomia/instrumentação , Trombectomia/métodos , Curetagem a Vácuo/instrumentação , Curetagem a Vácuo/métodos , Cateteres , Humanos , Sucção/instrumentação , Sucção/métodos , Seringas , Resultado do Tratamento
9.
BMC Musculoskelet Disord ; 20(1): 583, 2019 Dec 04.
Artigo em Inglês | MEDLINE | ID: mdl-31801510

RESUMO

BACKGROUND: There is a concern regarding the use of a closed-suction drain (CSD) in two-stage exchange arthroplasty for periprosthetic joint infection as it may decrease the antibiotic concentrations in the joint fluids. The purpose of this study was to identify whether the use of a CSD could reduce local antibiotic concentrations following spacer implantation. METHODS: A prospective, randomized, controlled trial was conducted at our institution between January 2018 and November 2018. We enrolled 32 patients undergoing two-stage exchange arthroplasty for periprosthetic hip infection with an interim cement spacer containing 4-g vancomycin and 2-g meropenem per 40-g methyl-methacrylate cement polymer. Patients were randomized and evenly divided into the study group (non-CSD) and control group (CSD group) by sealed envelopes. Drainage samples of joint fluids (n = 160) were collected every 24 h for the first five days following spacer implantation. The antibiotic concentrations of drainage samples were measured by high-performance liquid chromatography, and the bioactivities of the drainage samples against methicillin-sensitive and methicillin-resistant Staphylococcus aureus (MSSA and MRSA) and E. coli were assessed. RESULTS: There was no significant difference in the decrease of vancomycin (study group vs. control group: 163.20 ± 77.05 vs. 162.39 ± 36.31; p = 0.917) and meropenem concentration (123.78 ± 21.04 vs. 117.27 ± 19.38; P = 0.548) between the two groups during the first five days following spacer implantation. All joint drainage samples in each group exhibited antibacterial activity against MSSA, MRSA and E. coli. CONCLUSIONS: The use of CSD following the implantation of an antibiotic-loaded cement spacer does not reduce the effectiveness of such a spacer in two-stage exchange arthroplasty. (Chinese Clinical Trial Registry, ChiCTR-INR-17014162. Registered 26 December 2017.).


Assuntos
Antibacterianos/administração & dosagem , Artrite Infecciosa/cirurgia , Artroplastia de Quadril/métodos , Prótese de Quadril/efeitos adversos , Infecções Relacionadas à Prótese/cirurgia , Idoso , Antibacterianos/química , Artroplastia de Quadril/efeitos adversos , Artroplastia de Quadril/instrumentação , Cimentos para Ossos/química , Feminino , Articulação do Quadril/microbiologia , Articulação do Quadril/cirurgia , Prótese de Quadril/microbiologia , Humanos , Masculino , Meropeném/administração & dosagem , Meropeném/química , Metilmetacrilato/química , Pessoa de Meia-Idade , Estudos Prospectivos , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/prevenção & controle , Sucção/efeitos adversos , Sucção/métodos , Resultado do Tratamento , Vancomicina/administração & dosagem , Vancomicina/química
10.
Medicine (Baltimore) ; 98(51): e18511, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31861038

RESUMO

BACKGROUND: Peri-prosthetic seroma after implant insertion for breast reconstruction is a common but difficult-to-manage complication. This study aimed to compare peri-prosthetic seroma duration and the number of aspirations associated with intravenous cannula with those associated with conventional needle. METHODS: Seventy-one patients who underwent skin- or nipple-sparing mastectomy and implant insertion were treated for peri-prosthetic seroma. When peri-prosthetic seroma was detected, ultrasound-guided aspiration was performed either by using an intravenous cannula (n = 35) or a conventional needle (n = 36); however, the method adopted was randomly selected. We analyzed the participants' clinicopathologic factors after medical record review. RESULTS: There were no significant intergroup differences in mean age (P = .052), mean body mass index (P = .601), total clinical tumor size (P = .107), pathologic tumor size (P = .269), specimen weight (P = .147), implant size (P = .313), or operation time (P = .595). However, the mean total peri-prosthetic seroma volume was significantly higher (105.80 vs 88.58, P = .015) but the number of aspirations was lower (4.48 vs 5.80, P = .043) in the intravenous cannula group than in the conventional needle group. Mean peri-prosthetic seroma volume per aspiration was nonsignificantly higher in the intravenous cannula group (26.92 vs 19.14, P = .291). CONCLUSION: Ultrasound-guided aspiration performed using an intravenous cannula was comparable to the procedure performed using a conventional needle. Furthermore, the former method can be safer and effective alternative to manage peri-prosthetic seroma.


Assuntos
Doenças Mamárias/cirurgia , Implante Mamário/efeitos adversos , Seroma/cirurgia , Ultrassonografia de Intervenção/instrumentação , Adulto , Doenças Mamárias/etiologia , Feminino , Humanos , Pessoa de Meia-Idade , Seroma/etiologia , Sucção/instrumentação , Sucção/métodos
11.
Medicine (Baltimore) ; 98(51): e18061, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860955

RESUMO

Close suction drainage systems are widely used in orthopedics and spine surgeries. There are less studies investigating the outcomes of using subfascial closed suction drains in adolescent patients who had undergone idiopathic scoliosis surgery. We evaluated the outcomes of patients with and without closed suction drainage and to investigate whether close suction drainage is needed after adolescent idiopathic scoliosis (AIS) surgery.We retrospectively investigated 63 patients, who underwent posterior spinal surgery for AIS from January 2015 to January 2018. The patients were divided into the following groups: Groups A (drainage group) and B (nondrainage group). We evaluated the wound drainage (wound oozing), need for transfusion, preoperative and postoperative hemoglobin levels, length of hospital stay, and postoperative blood loss from closed suction drains. Patients' scoliosis was categorized according to the Lenke Classification System for Scoliosis. The level of instrumentations was also evaluated.The median postoperative hemoglobin level was lower in group A than in group B. Postoperatively, group A underwent more blood transfusions than group B. Postoperative hospital stay was also significantly longer in group A than in group B. There was no statistical difference in the infection rate between the two groups.Using drains after AIS surgery increases hospital stay duration, blood transfusion rate and patients' anxiety of drain tube removal. Thus, closed suction drainage may not be suitable after AIS surgery.


Assuntos
Procedimentos Ortopédicos/métodos , Escoliose/cirurgia , Sucção/efeitos adversos , Sucção/métodos , Infecção da Ferida Cirúrgica/diagnóstico , Adolescente , Estudos de Coortes , Feminino , Seguimentos , Humanos , Tempo de Internação , Masculino , Valores de Referência , Estudos Retrospectivos , Medição de Risco , Escoliose/diagnóstico por imagem , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Infecção da Ferida Cirúrgica/epidemiologia
12.
Rev. bras. cir. plást ; 34(4): 546-551, oct.-dec. 2019. ilus, tab
Artigo em Inglês, Português | LILACS | ID: biblio-1047923

RESUMO

Introdução: A abdominoplastia é um procedimento para a melhoria do contorno corporal e a técnica tem sido aprimorada pela associação da dissecção limitada do retalho cutâneo e pontos de adesão no mesmo ato operatório, evitando-se a formação de seroma pós-abdominoplastia, complicação que incomoda tanto o paciente quanto o cirurgião. Portanto, o objetivo é avaliar se o uso de pontos de adesão está associado a menor incidência de seroma após abdominoplastia quando comparado ao uso de drenos. Métodos: Revisão sistemática da literatura com metanálise, envolvendo as seguintes bases de dados: Science Direct, Scielo, Pubmed, Lilacs, CINAHL e Scopus. Para analisar os dados foi utilizado o programa Stata 12.0 e a estatística I² proposta por Higgins, com intervalo de confiança de 95% para o risco relativo para seroma, segundo o tipo de intervenção (dreno, ponto de adesão, dreno com ponto de adesão). Sendo registrado no PROSPERO sob o número CRD42019120399. Resultados: Cinco estudos preencheram os critérios de inclusão e foram incluídos na metanálise. Ao comparar o uso de dreno de sucção com pontos de adesão, os pontos de adesão mostraram um fator de proteção na prevenção do seroma (RR: 0,13; IC 95%: 0,02-0,66). Conclusão: Os achados sugerem que o uso de pontos de adesão em abdominoplastia em detrimento do uso de drenos pode ser uma técnica eficaz para prevenção da formação de seromas.


Introduction: Abdominoplasty, which aims to improve body contour, has been upgraded by its association with limited dissection of the cutaneous flap and quilting sutures in the same surgery to avoid the formation of postabdominoplasty seroma, a complication that troubles both patient and surgeon. Therefore, this study aimed to assess whether the use of quilting sutures is associated with a lower incidence of seroma after abdominoplasty than the use of drains. Methods: A systematic review of the literature and a meta-analysis were performed of the Science Direct, Scielo, Pubmed, Lilacs, CINAHL, and Scopus databases. The data analysis was performed using the Stata 12.0 program and the I² statistic proposed by Higgins, with a 95% confidence interval for the relative risk for seroma by intervention type (drain, quilting sutures, drain with quilting sutures). The study was registered in PROSPERO (CRD42019120399). Results: Five studies met the inclusion criteria and were included in the meta-analysis. Quilting sutures showed a protective effect (versus use of drain with quilting sutures) in the prevention of seroma (relative risk, 0.13; 95% confidence interval, 0.02­0.66). Conclusion: These findings suggest that the use of quilting sutures instead of drains in abdominoplasty can effectively prevent seroma formation.


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , História do Século XXI , Sucção , Cirurgia Plástica , Drenagem , Metanálise como Assunto , Seroma , Abdome , Abdominoplastia , Sucção/métodos , Sucção/estatística & dados numéricos , Cirurgia Plástica/métodos , Cirurgia Plástica/estatística & dados numéricos , Drenagem/métodos , Drenagem/estatística & dados numéricos , Seroma/cirurgia , Seroma/terapia , Abdominoplastia/métodos , Abdominoplastia/estatística & dados numéricos , Abdome/cirurgia
13.
Medicine (Baltimore) ; 98(46): e17898, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725637

RESUMO

This study demonstrated a training program of the suction-assisted laryngoscopy assisted decontamination (S.A.L.A.D.) technique for emergency medical technician paramedic (EMT-P). The effectiveness of the training program on the improvements of skills and confidence in managing soiled airway was evaluated.In this pilot before-after study, 41 EMT-P participated in a training program which consisted of 1 training course and 3 evaluation scenarios. The training course included lectures, demonstration, and practice and focused on how to perform endotracheal intubation in soiled airway with the S.A.L.A.D technique. The first scenario was performed on standard airway mannequin head with clean airway (control scenario). The second scenario (pre-training scenario) and the third scenario (post-training scenario) were performed in airway with simulated massive vomiting. The post-training scenario was applied immediately after the training course. All trainees were requested to perform endotracheal intubation for 3 times in each scenario. The "pass" of a scenario was defined as more than twice successful intubation in a scenario. The intubation time, count of successful intubation, pass rate, and the confidence in endotracheal intubation were evaluated.The intubation time in the post-training scenario was significantly shorter than that in the pre-training scenario (P = .031). The pass rate of the control, pre-training, and post-training scenario was 100%, 82.9%, and 92.7%, respectively. The proportion of trainees reporting confident or very confident in endotracheal intubation in soiled airway increased from 22.0% to 97.6% after the training program. Kaplan-Meier analysis revealed that the adjusted hazard ratio of successful intubation for post-training versus pre-training scenario was 2.13 (95% confidence interval of 1.57-2.91).The S.A.L.A.D. technique training could efficiently help EMT-P performing endotracheal intubation during massive vomiting simulation.


Assuntos
Auxiliares de Emergência/educação , Intubação Intratraqueal/métodos , Laringoscopia/educação , Sucção/educação , Vômito/terapia , Adulto , Competência Clínica , Estudos Controlados Antes e Depois , Descontaminação , Desenho de Equipamento , Feminino , Humanos , Capacitação em Serviço , Laringoscopia/métodos , Masculino , Manequins , Pessoa de Meia-Idade , Projetos Piloto , Sucção/métodos
14.
Medicine (Baltimore) ; 98(46): e18010, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31725672

RESUMO

INTRODUCTION: Enterocutaneous fistula is considered one of the most serious complications in general surgery and is associated with high morbidity and mortality. Although various treatments are reported to have varying success, high-output enterocutaneous fistulas (output over 500 ml/day) continue to be associated with high mortality, and few papers on this topic exist in the literature. The aim of this study is to describe an effective multidisciplinary treatment method for postoperative high-output enterocutaneous fistula and discuss the clinical development of the therapeutic strategy. PATIENT CONCERNS: Three patients suffered high-output enterocutaneous fistulas, in which case 1 presented with duodenal fistula, case 2 with ileal fistula, and case 3 with small bowel fistula. DIAGNOSIS: All 3 cases were diagnosed with high-output enterocutaneous fistulas by drainage of intestinal contents. INTERVENTIONS: With the exception of routine treatment including fluid resuscitation, correction of the electrolyte balance, control of infection, and optimal nutrition, all the cases accepted continuous irrigation and suction with triple-cavity drainage tubes in combination with sequential somatostatin-somatotropin administration were given. With regard to establishing effective drainage, the triple-cavity tube placement was performed by insertion through the initial drainage channel in case 1, percutaneous puncture with dilation by graduated dilators in case 2, and tract reconstruction in case 3. The technical details of the approach are described and clinical characteristics including fistula location, defect size, output volume, approach of triple-cavity tube placement, length of fistula tract, somatostatin and somatotropin administration time, and fistula healing time were recorded and compared. In addition, other various techniques reported in the literature are reviewed and discussed. OUTCOMES: All the patients were cured by the multidisciplinary treatments and were followed up without fistula recurrence and other relevant complications at 1 week, 1 month, and 3 months after the treatments. CONCLUSION: The strategy involving continuous irrigation and suction with a triple-cavity drainage tube in combination with sequential somatostatin-somatotropin administration may be a safe and effective alternative treatment for postoperative high-output enterocutaneous fistula and a more practical method that is easy to execute to manage this problem. Long-term studies, involving more patients, are still necessary to confirm this suggestion.


Assuntos
Drenagem/métodos , Hormônio do Crescimento Humano/uso terapêutico , Fístula Intestinal/terapia , Somatostatina/uso terapêutico , Sucção/métodos , Irrigação Terapêutica/métodos , Adulto , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
15.
Int J Surg ; 72: 85-90, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31689555

RESUMO

BACKGROUND: Staghorn calculi remain a treatment challenge for urologists. The aim of the study was to compare the treatment outcomes of suctioning minimally invasive percutaneous nephrolithotomy (MPCNL) and traditional MPCNL for renal staghorn stones. MATERIALS AND METHODS: Between April 2018 and June 2019, we included patients suffering from renal staghorn stones who were treated with modified MPCNL with a suctioning system. The outcomes of these patients were compared with those of a cohort of patients undergoing traditional MPCNL (between January 2017 and March 2018) using a 1:1 scenario matched-pair analysis. Cases were matched sequentially according to stone burden, stone branches, and stone hardness as well as age and sex. RESULTS: A total of 512 patients were included in this study (256 patients in each group). The baseline characteristics were equally distributed between the two groups. The suctioning MPCNL group achieved a significantly higher stone-free rate (SFR) (78.5% vs 69.1%; P = 0.016) after a single procedure and had a significantly shorter operative time (106.2 ±â€¯18.4 vs. 132.1 ±â€¯22.2 min; P < 0.001) than the traditional MPCNL group. The traditional MPCNL group experienced a significantly higher rate of overall complications than the suctioning MPCNL group (27.3% vs. 16.8%; P = 0.004). Regarding individual complications, a significantly higher rate of fever (13.7% vs. 7.4%; P = 0.021) and urosepsis requiring only additional antibiotics (8.2% vs. 3.5%; P = 0.024) was observed in the traditional MPCNL group than in the suctioning MPCNL group; there was a trend that the suctioning MPCNL group conferred a decreased risk of urosepsis shock (1.2% vs. 2.3%), but this trend failed to achieve statistical significance (P = 0.313). There was no significant difference between the two groups regarding the incidence of severe hemorrhage, the mean number of tracts used during a single procedure and the postoperative hospital stay. CONCLUSIONS: The use of suctioning MPCNL for staghorn calculi had advantages over the use of traditional MPCNL in terms of a higher SFR after a single procedure and fewer postoperative infectious complications. Further well-designed studies are needed to confirm the results.


Assuntos
Nefrolitotomia Percutânea/métodos , Cálculos Coraliformes/cirurgia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/efeitos adversos , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Nefrolitotomia Percutânea/efeitos adversos , Nefrolitotomia Percutânea/instrumentação , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Choque Séptico/etiologia , Sucção/instrumentação , Sucção/métodos , Resultado do Tratamento , Infecções Urinárias/etiologia
16.
Metas enferm ; 22(9): 64-74, nov. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185042

RESUMO

Objetivo: analizar los cuidados enfermeros dirigidos a garantizar la seguridad del paciente neurocrítico portador de drenaje ventricular externo (DVE) tras haber sufrido un traumatismo craneoencefálico grave. Método: revisión narrativa mediante búsqueda bibliográfica en bases de datos de la Ciencias de la Salud: PubMed, CINAHL y la Biblioteca Cochrane, así como en los metabuscadores Dialnet Plus y Google Académico. Resultados: se seleccionaron 14 artículos por su idoneidad para abordar el objetivo principal del trabajo, analizando los cuidados generales de Enfermería que afectan a la presión intracraneal: cuidado bucal, aspiración de secreciones endotraqueales, elevación del cabecero de la cama, reposicionamiento y movilización temprana, administración de medicación sedativa y estimulación auditiva e interacción con el paciente. Conclusiones: la excelencia en el cuidado y la seguridad de los pacientes con traumatismo craneoencefálico radica en una indicación fundamentada para monitorizar la presión intracraneal y un equipo de enfermeras cuyas intervenciones se establezcan sobre la base de la evidencia científica. Para reducir la incidencia de complicaciones relacionadas con el drenaje intraventricular se han de protocolizar los cuidados. Como principales limitaciones de los estudios analizados están la heterogeneidad, el reducido tamaño muestral, la escasez de ensayos clínicos y estudios multicéntricos y la ausencia de protocolos y guías de práctica clínica para el manejo de estos pacientes


Objective: to analyze the nursing care required in order to ensure safety in neurocritical patients with an external ventricular drain after suffering a severe traumatic brain injury. Method: a narrative review through bibliographic search in Health Sciences databases: PubMed, CINAHL and the Cochrane Library, as well as the metasearch engines Dialnet Plus and Academic Google. Results: fourteen (14) articles were selected because they were adequate to address the primary objective of the study, analyzing the general Nursing care regarding intracranial pressure: mouth care, aspiration of endotracheal secretions, elevation of the head end of the bed, repositioning and early mobilization, administration of sedative medication, and auditory stimulation and interaction with the patient. Conclusions: excellence in care and safety of patients with traumatic brain injury lies in a well-founded indication to monitor intracranial pressure, and a team of nurses with specific interventions based on scientific evidence. In order to reduce the incidence of complications associated with intraventricular drain, there must be a protocol of care. The main limitations in the studies analyzed were: heterogeneity, reduced sample size, the limited number of clinical trials and multicenter studies, and the lack of protocols and clinical practice guidelines for the management of these patients


Assuntos
Humanos , Enfermagem de Cuidados Críticos , Segurança do Paciente , Lesões Encefálicas Traumáticas/enfermagem , Sucção/métodos , Hipertensão Intracraniana/complicações , Movimentação e Reposicionamento de Pacientes , Relações Enfermeiro-Paciente
17.
Adv Clin Exp Med ; 28(11): 1531-1535, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31660708

RESUMO

BACKGROUND: The widespread availability of ultrasonography means that transvaginal ultrasonography has become a routine procedure during gynecological examinations, even in asymptomatic patients. Nowadays the imaging technology offered by ultrasonography and tumor biomarkers give us an opportunity to implement transvaginal ultrasound-guided aspiration as a less radical treatment of simple ovarian cysts (SOC). OBJECTIVES: The aim of the study was a retrospective evaluation of the diagnostic and therapeutic efficacy of transvaginal ultrasound-guided aspiration of SOC in postmenopausal and premenopausal patients. MATERIAL AND METHODS: A total of 84 women, divided into a premenopausal group (38/84) and a postmenopausal group (46/84), underwent transvaginal ultrasound-guided aspiration of small SOC (40-80 mm in diameter). Simple cysts were defined ultrasonographically according to the International Ovarian Tumor Analysis (IOTA) guidelines as cysts with negative risk of ovarian malignancy algorithm (ROMA) scores and CA125 levels. Simple ovarian cyst-related data was obtained from medical documentation (diagnostic tests, medical reproductive and surgical history, and clinical status during SOC aspiration). Follow-up data was collected by means of a telephone interview and medical database. The survey included questions focused on cyst recurrence during the 24-month period following the aspiration of SOC. RESULTS: We had 100% compatibility with ultrasound diagnosis and cytological examination of aspirated fluid. The cumulative rate of cyst recurrence among 84 patients was 20.2% (17/84). There was a higher percentage of cyst recurrence in the premenopausal group: 27% (10/38) vs 15.2% (7/46) in the postmenopausal group, but the difference was not statistically significant (hazard ratio (HR) = 1.89, 95% confidence interval (95% CI) = 0.72-4.97; p = 0.19). Recurrent cysts were treated with laparoscopic cystectomy, adnexectomy or a second aspiration in accordance with individual indications. CONCLUSIONS: Ultrasound-guided aspiration of small (<80 mm) adnexal SOC is a diagnostic and alternative therapeutic procedure, which allows cytological examination and may reduce the need for surgery, which is especially beneficial for women of reproductive age.


Assuntos
Biópsia por Agulha/métodos , Cistos Ovarianos/terapia , Neoplasias Ovarianas , Sucção/métodos , Ultrassonografia/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Cistos Ovarianos/diagnóstico por imagem , Pós-Menopausa , Pré-Menopausa , Estudos Retrospectivos , Resultado do Tratamento , Ultrassonografia de Intervenção/métodos , Vagina
18.
J Bone Joint Surg Am ; 101(19): 1732-1740, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577678

RESUMO

BACKGROUND: Closed-suction drains are frequently used following posterior spinal surgery. The optimal timing of antibiotic discontinuation in this population may influence infection risk, but there is a paucity of evidence. The aim of this study was to determine whether postoperative antibiotic administration for 72 hours (24 hours after drain removal as drains were removed on the second postoperative day) decreases the incidence of surgical site infection compared with postoperative antibiotic administration for 24 hours. METHODS: Patients undergoing posterior thoracolumbar spinal surgery managed with a closed-suction drain were prospectively randomized into 1 of 2 groups of postoperative antibiotic durations: (1) 24 hours, or (2) 24 hours after drain removal (72 hours). Drains were discontinued on the second postoperative day. The duration of antibiotic administration was not blinded. All subjects received a single dose of preoperative antibiotics, as well as intraoperative antibiotics if the surgical procedure lasted >4 hours. The primary outcome was the rate of complicated surgical site infection (deep or organ or space) within 1 year of the surgical procedure. RESULTS: The trial was terminated at an interim analysis, when 552 patients were enrolled, for futility with respect to the primary outcome. In this study, 282 patients were randomized to postoperative antibiotics for 24 hours and 270 patients were randomized to postoperative antibiotics for 72 hours. A complicated infection developed in 17 patients (6.0%) in the 24-hour group and in 14 patients (5.2%) in the 72-hour group (p = 0.714). The superficial infection rate did not differ between the groups (p = 0.654): 9.6% in the 24-hour group compared with 8.1% in the 72-hour group. Patients in the 72-hour group had a median hospital stay that was 1 day longer (p < 0.001). At 1 year, patient-rated outcomes including leg and back pain and physical and mental functioning were not different between the groups. CONCLUSIONS: The extension of postoperative antibiotics for 72 hours, when a closed-suction drain is required, was not associated with a reduction in the rate of complicated surgical site infection after posterior thoracolumbar spinal surgery. LEVEL OF EVIDENCE: Therapeutic Level I. See Instructions for Authors for a complete description of Levels of Evidence.


Assuntos
Antibacterianos/administração & dosagem , Cefazolina/administração & dosagem , Doenças da Coluna Vertebral/cirurgia , Infecção da Ferida Cirúrgica/prevenção & controle , Vancomicina/administração & dosagem , Descompressão Cirúrgica , Esquema de Medicação , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Cuidados Pós-Operatórios/métodos , Fusão Vertebral/métodos , Sucção/métodos , Vértebras Torácicas/cirurgia
19.
Eur J Pediatr ; 178(12): 1825-1832, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31588974

RESUMO

The current version of Neonatal Resuscitation Program no longer favors routine endotracheal suctioning (ETS) in non-vigorous newborns with meconium-stained amniotic fluid (MSAF) due to possibility of procedure-related harms and questionable benefits. However, it calls for additional research on this procedure to provide a definitive answer. The present study was conducted to evaluate the role of ETS in non-vigorous neonates of ≥ 34 weeks' gestation born through MSAF on the incidence of meconium aspiration syndrome (MAS). In this open-label randomized controlled trial, 132 non-vigorous neonates with MSAF were randomized to receive ETS (n = 66) or no-ETS (n = 66) during delivery room resuscitation (DRR). Primary outcome variable was incidence of MAS. Secondary outcome variables were requirement of DRR, need of respiratory support, development of complications, duration of hospitalization, and mortality. Both the groups were comparable with respect to maternal and neonatal characteristics. Incidence of MAS was 21 (31.8%) and 15 (22.7%) cases in ETS and no-ETS groups, respectively (relative risk (RR), 1.400, 95% confidence interval (CI), 0.793-2.470). The two groups did not differ with regard to DRR, need for respiratory support, and development of complications. Nine (13.6%) neonates in ETS group, and 5 (7.5%) in no-ETS group died (p > 0.05). Median (interquartile range) duration of hospital stay was 54 (31-141) h and 44 (26-102) h in ETS and no-ETS groups, respectively (p > 0.05).Conclusions: Routine ETS at birth is not useful in preventing MAS in non-vigorous neonates of ≥ 34 weeks' gestation born through MSAF.Trial registration: Clinical Trials Registry of India (CTRI/2015/04/008819).What is Known:• Routine endotracheal suctioning is of questionable benefit in non-vigorous newborns with meconium stained amniotic fluid and may have a possibility of procedure-related harms.What is New:• Routine endotracheal suctioning at birth is not useful in preventing meconium aspiration syndrome in non-vigorous newborns of ≥ 34 weeks' gestation born through meconium stained amniotic fluid.


Assuntos
Intubação Intratraqueal , Síndrome de Aspiração de Mecônio/prevenção & controle , Sucção/métodos , Feminino , Idade Gestacional , Humanos , Índia , Recém-Nascido , Tempo de Internação/estatística & dados numéricos , Masculino , Síndrome de Aspiração de Mecônio/complicações , Síndrome de Aspiração de Mecônio/mortalidade
20.
BMC Neurol ; 19(1): 248, 2019 Oct 23.
Artigo em Inglês | MEDLINE | ID: mdl-31646974

RESUMO

BACKGROUND: Migraine is a primary headache disorder, which cause significant disability in adolescence. This double blind, randomized clinical trial assessed the immediate effects of suction of paranasal sinus air during an acute migraine episode. METHODS: A randomized, double blind study was conducted with 56 selected Sri Lankan school children of 16-19 years of age. Participants who met International Headache Society criteria for migraine (with or without aura) were included in the study. Subjects were randomly allocated into 2 groups where one group was subjected to three intermittent 10 sec paranasal air suctions with a ten sec suction free interval between two suctions for each nostril and the other group was subjected to placebo air suction (no paranasal air suction) in similar arrangement. Severity of headache and sub-orbital tenderness before and after suction were recorded using standard pain rating scale. RESULTS: After dropouts, treated and placebo groups consisted of 27 and 23 subjects respectively. The mean headache pain score drop in the treated group was significantly higher compared to that of the control group. Moreover, there was a difference in the treatment response between the types of headache (with or without aura). With respect to tenderness there was a statistically significant drop in the treated group compared to the control. In general, airflow rates in left and right nostrils were different in these subjects. However such difference was not seen in the tenderness on two sides. Nevertheless it was revealed that airflow rate has a slight negative correlation with the tenderness irrespective of the side. CONCLUSION: Sixty-second paranasal air suction can provide an immediate pain relief for acute migraine in adolescents. We did not assess pain outcomes beyond 60 s, but the initial responses suggests the need to further study the efficacy of paranasal suction in migraine. A further study is suggested to evaluate the acute effects, efficacy and side effects of paranasal air suction using follow up over a prolong period. TRIAL REGISTRATION: Sri Lanka Clinical Trials Registry SLCTR/2017/018 , 29 Jun 2017. Retrospectively registered.


Assuntos
Transtornos de Enxaqueca/terapia , Manejo da Dor/métodos , Seios Paranasais , Sucção/métodos , Adolescente , Método Duplo-Cego , Feminino , Humanos , Masculino , Projetos Piloto , Sri Lanka , Adulto Jovem
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