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1.
J Surg Res ; 246: 591-598, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31648813

RESUMO

BACKGROUND: Currently, several initiatives have emerged to empower the public to act as immediate responders in front of hemorrhaging victims. We aimed to evaluate the effectiveness of implementing the Stop the Bleed campaign and the association between the instructors' background and the theoretical and practical competences achieved by the participants in Latin America. METHODS: Medical students and general surgeons taught both allied health students and nonallied health students at a local university; the training had a master class followed by a practical component and a written test, as well as tourniquet placement was tested. RESULTS: 265 individuals received the training, and data were available for 243. Of these, 126 (52.07%) were women and the median age was 21 (IQR: 20-22) years. 121 (49.79%) were trained by general surgeons (group A) and 122 (50.21%) by medical students (group B). After the training, more than 98% of all participants perceived that they would most likely be capable of aiding correctly a bleeding victim by applying direct pressure and more than 90% of them felt confident in being able to apply a tourniquet. There were no statistically significant differences among both groups when comparing their post-training competence evaluations [Theoretical test score: group A = 5 (IQR: 4-5); group B = 5 (IQR: 4-5); P = 0.41] and [Practical competency of tourniquet deployment: group A = 119 (66.39%) versus group B = 120 (65.83%); P = 0.93]. CONCLUSIONS: The Stop the Bleed campaign can be effectively implemented in Latin America, and it can be taught by prequalified medical students without altering the learning objectives of the course.


Assuntos
Educação não Profissionalizante/organização & administração , Primeiros Socorros/métodos , Conhecimentos, Atitudes e Prática em Saúde , Hemorragia/terapia , Técnicas Hemostáticas/instrumentação , Participação da Comunidade , Feminino , Primeiros Socorros/instrumentação , Implementação de Plano de Saúde , Humanos , América Latina , Masculino , Fatores de Tempo , Torniquetes , Adulto Jovem
2.
J Vasc Access ; 21(1): 79-85, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31232151

RESUMO

PURPOSE: To retrospectively assess the efficacy and safety of FemoSeal® vascular closure device to achieve hemostasis following antegrade common femoral artery puncture after lower limb revascularization using vascular sheaths from 5 to 8 Fr. METHODS: We reviewed the hemostatic outcome achieved with FemoSeal in 103 consecutive patients (mean age: 69 ± 8 years, 71 males) that undergone to 111 antegrade common femoral artery accesses for percutaneous lower limbs revascularization using 5- to 8-Fr vascular sheaths. We used FemoSeal in an unselected population, without exclusion criteria. The primary outcome was the technical success, meant as achieving complete hemostasis without immediate complications. RESULTS: Hemostasis was achieved in all 111 puncture sites (100% technical success). We observed eight (7%) puncture site minor complications (hematomas), none of which affecting the patients' outcome or requiring further therapies or increasing the hospital stay. There were no statistically significant differences between the variables potentially related to the occurrence of complications (age, international normalized ratio, platelet count, partial thromboplastin time ratio, body mass index, and common femoral arteries calcification grade) in patients with and without complications. Complications group mean body mass index was 26.4 ± 2.8 kg/m2 versus non-complications group 26.6 ± 4.4 kg/m2, p = 0.92. Mean international normalized ratio and partial thromboplastin time ratio were 1.05 ± 0.01 and 1.05 ± 0.14 versus 1.13 ± 0.2 (p = 0.39) and 1.12 ± 0.23 (p = 0.53), respectively. Common femoral arteries calcification grade was the same (mean: 1, p = 1). Platelet count was 202 × 103/mL ± 66.7 versus 226 × 103/mL ± 91.2, p = 0.55. Mean age was 72.3 ± 10 years versus 72.8 ± 8 years, p = 0.86. CONCLUSION: The low rate (7%) and grading of the adverse events, combined with the high technical success rate (100%), in an unselected group of patients treated in daily routine, suggest high safety and efficacy of FemoSeal vascular closure device in antegrade common femoral artery puncture site hemostasis when using vascular sheaths ranging from 5 to 8 Fr. Therefore, FemoSeal could be considered as a first-line hemostasis strategy in such cases.


Assuntos
Cateterismo Periférico , Artéria Femoral , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular , Idoso , Cateterismo Periférico/efeitos adversos , Desenho de Equipamento , Feminino , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Estudos Retrospectivos , Resultado do Tratamento
3.
Ann Vasc Surg ; 62: 191-194, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31449950

RESUMO

BACKGROUND: Percutaneous endovascular aortic repairs (pEVARs) are associated with access site complications. Two-device technique using 2 Perclose devices has been well established. Combined Perclose and Angioseal technique has been described as well. We sought to determine whether a hybrid Perclose and Angioseal closure technique would safely and effectively establish hemostasis in large-bore arteriotomies up to 20F. METHODS: Patients were identified as candidates for percutaneous access based on preoperative computed tomography findings, perioperative ultrasound of femoral vessels, or a combination of the 2 modalities. Prior to sheath insertion, 1 Perclose device was predeployed. At the end of pEVAR, device sheath and introducer were withdrawn over a 0.035″ wire, and partially deployed Perclose was fully deployed. The sheath and introducer were fully withdrawn and the arteriotomy was closed with a 6F Angioseal vascular closure device and completion deployment of the Perclose. Patients were followed at day 1 and day 30 and at least 1 year postintervention. RESULTS: A composite end point of complications was defined as an access site-related bleed or hematoma that required blood transfusion or an extended hospital stay, pseudoaneurysm, arteriovenous fistula, dissection, or retroperitoneal hematoma. The combined technique was initially successful in 44/45 arteriotomies (97.8%) in 24/25 patients (96.0%) with no conversions to cutdown. Sheath sizes ranged from 10F to 20F outer diameter (OD), with an average of 15.89F OD. The single-device failure was caused by a failure of the footplate to catch during deployment in the Angioseal with a 20F arteriotomy. Consequently, that was the only patient in which this closure was attempted for an arteriotomy larger than 19F. There were no early or late complications in this series. CONCLUSIONS: Large-bore arteriotomies may be safely and effectively closed using a hybrid percutaneous closure technique for sheaths up to 19F OD. Evaluation of this technique in closure of large-bore arteriotomies is ongoing and further investigation is needed to assess the value of this closure in 20F OD sheaths and above.


Assuntos
Doenças da Aorta/cirurgia , Cateterismo Periférico , Procedimentos Endovasculares , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Dispositivos de Oclusão Vascular , Doenças da Aorta/diagnóstico por imagem , Transfusão de Sangue , Cateterismo Periférico/efeitos adversos , Procedimentos Endovasculares/efeitos adversos , Desenho de Equipamento , Hematoma/etiologia , Hematoma/prevenção & controle , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Tempo de Internação , Punções , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Lesões do Sistema Vascular/etiologia , Lesões do Sistema Vascular/prevenção & controle
4.
Vasc Endovascular Surg ; 54(3): 220-224, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31884881

RESUMO

PURPOSE: For transradial interventions, most published studies report an initial Terumo Radial (TR) band placement time of 60 minutes, with gradual deflation over 30 to 90 minutes. We aimed to determine, retrospectively, whether TR band removal time could be expedited to 45 to 60 minutes, without adverse effects via an expedited single-step deflation protocol. METHODS: A total of 115 consecutive noncoronary visceral interventions that utilized TR band from September 2017 till February 2019 were retrospectively reviewed. Alternative single-step deflation protocol was utilized where the nursing staff was instructed to deflate the TR band in 1 step between 45 and 60 minutes; 79 patients (43 men, 36 women, mean age of 55.3 ± 13.6 years) underwent 115 transradial interventions. Mean procedure time was 49.8 ± 22.1 minutes, and mean fluoroscopy time was 18.5 ± 10.6 minutes. Data collected included patient demographics, procedure details, and nursing notes on complications including bleeding and reinflation of the TR band. Univariate and Multivariate analyses of independent variables were performed using a binary logistic regression model. All patients were followed up postoperatively before discharge and in clinic upon follow-up. RESULTS: The TR band was deflated at 51.3 ± 14.5 minutes, with successful removal achieved on the first attempt in 103 cases (90.3% primary technical success rate). In 12 cases, bleeding was noted upon initial deflation, secondary technical success was achieved when the band was reinflated for an additional mean time of 37.0 ± 19.1 minutes. There was 1 incidence of radial artery occlusion (0.8%) and 1 incidence of a grade 1 hematoma (0.8%). The only variable predictive of technical outcome upon initial band deflation on univariate binomial logistic regression was initial TR band removal time (P = .019). CONCLUSIONS: A single-step deflation protocol for TR band placement may be safe for nonocclusive patent hemostasis and may translate to even further shorten postprocedural hospital times for patients and cost savings for hospitals.


Assuntos
Cateterismo Periférico , Hemorragia/prevenção & controle , Técnicas Hemostáticas/instrumentação , Artéria Radial , Adulto , Idoso , Cateterismo Periférico/efeitos adversos , Desenho de Equipamento , Feminino , Hemorragia/etiologia , Técnicas Hemostáticas/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Punções , Artéria Radial/diagnóstico por imagem , Radiografia Intervencionista , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
5.
J Surg Res ; 245: 636-642, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31525629

RESUMO

BACKGROUND: Bystanders play a significant role in the immediate management of life-threatening hemorrhage. The Stop the Bleed (STB) program was designed to train lay rescuers (LRs) to identify and control life-threatening bleeding. The aim of this study was to evaluate the efficacy of STB training for rescuers from different backgrounds. We hypothesized that STB training would be appropriate to increase skills and knowledge of bleeding control techniques for all providers, regardless of level of medical training. STUDY DESIGN: Course participants anonymously self-reported confidence in six major areas. A five-point Likert scale was used to quantitate participant's self-reported performance. Results were stratified into medical rescuers (MR) and LRs. Students' ability to perform STB skills were objectively assessed using an internally validated 15-point objective assessment tool. Data were pooled and analyzed using Student's t-test and chi-Squared test with P < 0.05 considered significant. Results are presented as average with standard deviation (SD) unless otherwise stated. RESULTS: A total of 1974 participants were included in the study. Precourse confidence was lowest for both groups in management of active severe bleeding and ability to pack a bleeding wound. Postcourse confidence improved significantly for both groups in all 6 core areas measured (P < 0.001). The most significant increases were reported in the two previous areas of lowest precourse confidence-management of active severe bleeding-LRs 2.0 (SD 1.2) versus 4.2 (SD 0.9) and MRs 2.6 (SD 1.4) versus 4.6 (SD 0.6), P < 0.001-and ability to pack a bleeding wound-LR 2.1 (SD 1.3) versus 4.4 (SD 0.8) and MR 2.7 (SD 1.3) versus 4.7 (SD 0.05), P < 0.001. Objective assessment of LR skills at the end of the course demonstrated combined 99.3% proficiency on postcourse objective assessments. CONCLUSIONS: This study provides quantitative evidence that Stop the Bleed training is effective, with both LRs and MRs demonstrating improved confidence and skill proficiency after a 1-h course. Future program development should focus on building a pool of instructors, continued training of LRs, and determining how often skills should be recertified.


Assuntos
Competência Clínica , Medicina de Emergência/educação , Conhecimentos, Atitudes e Prática em Saúde , Hemorragia/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Avaliação Educacional , Feminino , Técnicas Hemostáticas , Humanos , Masculino , Pessoa de Meia-Idade , Estudantes de Medicina , Adulto Jovem
6.
Gastroenterology ; 158(1): 160-167, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31562847

RESUMO

BACKGROUND & AIMS: Scoring systems are suboptimal for determining risk in patients with upper gastrointestinal bleeding (UGIB); these might be improved by a machine learning model. We used machine learning to develop a model to calculate the risk of hospital-based intervention or death in patients with UGIB and compared its performance with other scoring systems. METHODS: We analyzed data collected from consecutive unselected patients with UGIB from medical centers in 4 countries (the United States, Scotland, England, and Denmark; n = 1958) from March 2014 through March 2015. We used the data to derive and internally validate a gradient-boosting machine learning model to identify patients who met a composite endpoint of hospital-based intervention (transfusion or hemostatic intervention) or death within 30 days. We compared the performance of the machine learning prediction model with validated pre-endoscopic clinical risk scoring systems (the Glasgow-Blatchford score [GBS], admission Rockall score, and AIMS65). We externally validated the machine learning model using data from 2 Asia-Pacific sites (Singapore and New Zealand; n = 399). Performance was measured by area under receiver operating characteristic curve (AUC) analysis. RESULTS: The machine learning model identified patients who met the composite endpoint with an AUC of 0.91 in the internal validation set; the clinical scoring systems identified patients who met the composite endpoint with AUC values of 0.88 for the GBS (P = .001), 0.73 for Rockall score (P < .001), and 0.78 for AIMS65 score (P < .001). In the external validation cohort, the machine learning model identified patients who met the composite endpoint with an AUC of 0.90, the GBS with an AUC of 0.87 (P = .004), the Rockall score with an AUC of 0.66 (P < .001), and the AIMS65 with an AUC of 0.64 (P < .001). At cutoff scores at which the machine learning model and GBS identified patients who met the composite endpoint with 100% sensitivity, the specificity values were 26% with the machine learning model versus 12% with GBS (P < .001). CONCLUSIONS: We developed a machine learning model that identifies patients with UGIB who met a composite endpoint of hospital-based intervention or death within 30 days with a greater AUC and higher levels of specificity, at 100% sensitivity, than validated clinical risk scoring systems. This model could increase identification of low-risk patients who can be safely discharged from the emergency department for outpatient management.


Assuntos
Hemorragia Gastrointestinal/diagnóstico , Aprendizado de Máquina , Modelos Biológicos , Adulto , Idoso , Idoso de 80 Anos ou mais , Transfusão de Sangue/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hemorragia Gastrointestinal/terapia , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Curva ROC , Medição de Risco/métodos
7.
West J Emerg Med ; 20(5): 770-783, 2019 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-31539334

RESUMO

Owing to the propensity of anticoagulated patients to bleed, a strategy for reversal of anticoagulation induced by any of the common agents is essential. Many patients are anticoagulated with a variety of agents, including warfarin, low molecular weight heparin, and the direct oral anticoagulants such as factor Xa and factor IIa inhibitors. Patients may also be using antiplatelet agents. Recommendations to reverse bleeding in these patients are constantly evolving with the recent development of specific reversal agents. A working knowledge of hemostasis and the reversal of anticoagulation and antiplatelet drugs is required for every emergency department provider. This article reviews these topics and presents the currently recommended strategies for dealing with bleeding in the anticoagulated patient.


Assuntos
Anticoagulantes/efeitos adversos , Emergências , Serviço Hospitalar de Emergência , Inibidores do Fator Xa/efeitos adversos , Hemorragia/terapia , Técnicas Hemostáticas , Inibidores da Agregação de Plaquetas/efeitos adversos , Hemorragia/induzido quimicamente , Humanos
9.
Arch Orthop Trauma Surg ; 139(12): 1785-1796, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31541274

RESUMO

PURPOSE: To investigate the efficacy of non-tranexamic acid (TXA) on reducing blood loss and requirements of allogeneic blood transfusion (ABT) in total knee arthroplasty (TKA). METHODS: The PubMed, EMBASE, and the Cochrane Library databases were researched since incipiency to June 2018. Only randomized controlled trials (RCTs) involved with non-TXA hemostatic techniques in TKA met the inclusion criteria. RESULTS: A total of 36 RCTs, including 1511 patients, were recruited for analysis. The results of subgroup analysis revealed that hemostatic techniques, which could substantially decrease the rate of ABT, were cell salvage with the transfusion trigger of 9 mg/dl, fibrin sealant with a dosage of 10 ml, and postoperative flexion position. CONCLUSION: The available evidence in this meta-analysis suggests that postoperative flexion position, fibrin sealant, and cell salvage can substantially decrease the rate of ABT in TKA. Further studies, including more hemostatic methods and high-quality research, are expected.


Assuntos
Antifibrinolíticos/uso terapêutico , Artroplastia do Joelho/métodos , Perda Sanguínea Cirúrgica/prevenção & controle , Adesivo Tecidual de Fibrina/uso terapêutico , Técnicas Hemostáticas , Posicionamento do Paciente/métodos , Ácido Tranexâmico/uso terapêutico , Administração Intravenosa , Transfusão de Sangue/estatística & dados numéricos , Humanos , Cuidados Pós-Operatórios/métodos
10.
Am J Disaster Med ; 14(1): 17-23, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31441025

RESUMO

OBJECTIVE: Compare QuikClot Combat Gauze (QCG) and Celox Rapid (CR) for initial hemostasis and over a 1-hour period. DESIGN: Experimental study. SETTING: Approved animal laboratory. SUBJECTS: Twenty-one Yorkshire swine. INTERVENTIONS: Subjects were randomly assigned to either the QCG (n = 11) or CR (n = 10) group. An arteriotomy was made in the right femoral artery with a 6-mm vascular punch. Bleeding was allowed for 45 seconds. QCG or CR was applied followed by firm pressure for 3 minutes according to Committee on Tactical Combat Casualty Care guidelines. A 10-pound weight simulating a pressure dressing was applied, and the wound was observed for 1 hour. Dressing failure was bleeding > 2 percent of blood volume. MAIN OUTCOME MEASURES: Achievement and maintenance of hemostasis and amount of hemorrhage during observation. Odds of successful hemostasis. RESULTS: QCG was significantly better than CR in initial hemostasis (p = 0.049) and maintaining hemostasis over 1 hour (p = 0.020). One hundred percent of QCG subjects and 70 percent of CR subjects achieved initial hemostasis. During the 1-hour observation, one additional CR subject failed to maintain hemostasis. CR had significantly more hemorrhage than QCG during the 1-hour observation (p = 0.027). QCG had no bleeding compared to CR that had a mean of 162 ± 48 mL (standard error of mean) over 2 minutes. QCG had 15.9 times greater odds of success compared to CR over a period of 1 hour. Over the 1-hour observation time, 100 percent of QCG achieved hemostasis compared to 60 percent of CR.


Assuntos
Bandagens , Hemorragia/terapia , Hemostáticos/administração & dosagem , Ferimentos e Lesões/terapia , Animais , Biopolímeros , Modelos Animais de Doenças , Artéria Femoral/lesões , Hemostasia , Técnicas Hemostáticas/instrumentação , Distribuição Aleatória , Suínos , Fatores de Tempo , Resultado do Tratamento
11.
J Vet Emerg Crit Care (San Antonio) ; 29(5): 535-541, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31423720

RESUMO

OBJECTIVE: To describe the technique and outcome of temporary abdominal packing for control of persistent hemorrhage from liver lobectomy sites in 3 dogs with hepatic neoplasia. SERIES SUMMARY: Three dogs were treated with massive transfusion for hemoperitoneum secondary to bleeding hepatic tumors. Surgical resection of the affected liver lobe(s) was performed but hemostasis could not be achieved through conventional methods. All 3 dogs demonstrated acidosis, hypothermia, and coagulopathy. Temporary abdominal packing of liver lobectomy sites was performed and hemostasis was achieved in all dogs. One dog died prior to removal of the packing. The other 2 dogs had the packing removed with no evidence of rebleeding. One dog was euthanized after removal of the packing due to acute kidney injury and the remaining dog survived to discharge. NEW OR UNIQUE INFORMATION PROVIDED: Temporary abdominal packing combined with medical management was successful in achieving hemostasis in all 3 dogs, however, 2 dogs died of complications related to multiple organ dysfunction syndrome. Temporary abdominal packing may be considered when definitive surgical hemostasis cannot be achieved or in unstable patients not able to tolerate prolonged surgical times. Further research is needed to better define efficacy, optimal patient selection, packing technique, timing of removal, and complications associated with temporary abdominal packing.


Assuntos
Doenças do Cão/cirurgia , Hemoperitônio/veterinária , Técnicas Hemostáticas/veterinária , Neoplasias Hepáticas/veterinária , Hemorragia Pós-Operatória/veterinária , Animais , Cães , Feminino , Hemoperitônio/terapia , Neoplasias Hepáticas/cirurgia , Masculino , Hemorragia Pós-Operatória/terapia
13.
Acta otorrinolaringol. esp ; 70(4): 185-191, jul.-ago. 2019. tab, ilus, graf
Artigo em Espanhol | IBECS | ID: ibc-185394

RESUMO

Introducción y objetivos: El objetivo fue determinar los resultados del tratamiento de las epistaxis graves y/o refractarias que requirieron ingreso hospitalario. Además se compararon los resultados del tratamiento mediante ligadura arterial o embolización. Material y método: Se incluyeron de forma prospectiva 63 pacientes con epistaxis grave y/o refractaria que requirieron ingreso hospitalario entre agosto de 2014 y diciembre de 2016. Resultados: En 11 pacientes (17%) se realizó embolización, 5 (8%) fueron intervenidos mediante endoscopia y en los 47 restantes (75%) se realizó tratamiento conservador. La edad media de los pacientes en los que las medidas conservadoras fueron suficientes fue de 72 años, mientras que la edad de aquellos tratados con embolización fue de 71 años y de los que fueron intervenidos quirúrgicamente fue de 53 años. En los pacientes sometidos a tratamiento conservador o a cirugía la estancia media fue de 6 días, frente a 9 días en aquellos en los que se realizó embolización. Un paciente sufrió un ictus hemisférico tras la embolización. No se observaron complicaciones posquirúrgicas. Conclusiones: La mayoría de los pacientes con epistaxis graves y/o refractarias se resuelven mediante taponamiento convencional. El tratamiento mediante ligadura arterial está asociado a una disminución de la estancia hospitalaria, sin observarse complicaciones graves. Es aconsejable disponer de todas las opciones terapéuticas posibles para lo cual la presencia de radiólogos intervencionistas y cirujanos experimentados es fundamental para evitar complicaciones y decidir el tratamiento a realizar de forma individual en cada paciente


Objective: The objective was to determine the results of the treatment of severe and/or refractory epistaxis requiring hospital admission. In addition, the results of arterial ligation versus embolization were compared. Material and method: Sixty-three patients with severe and/or refractory epistaxis requiring hospital admission between August 2014 and December 2016 were included prospectively. Results: Eleven patients (17%) underwent embolization, 5 (8%) endoscopy ligation and the remaining 47 (75%) underwent conservative treatment with tamponade. The mean age of the patients in which conservative measures were sufficient was 72 years, while the age of those treated with embolization was 71 years and of those who underwent surgery was 53 years. For the patients who underwent conservative treatment or surgery, the average stay was 6 days, compared to 9 days for those who underwent embolization. One patient suffered a hemispheric stroke after embolization. No post-surgical complications were observed. Conclusions: Most cases of severe and/or refractory epistaxis are resolved by conventional tamponade. Endoscopy ligation is associated with a decrease in hospital stay, without serious complications. It is advisable to have all the possible therapeutic options available, for which the presence of interventional radiologists and experienced surgeons is essential to avoid complications and decide the treatment to be performed individually for each patient


Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Epistaxe/terapia , Técnicas Hemostáticas , Comorbidade , Tratamento Conservador , Embolização Terapêutica/efeitos adversos , Endoscopia/métodos , Endoscopia/estatística & dados numéricos , Epistaxe/cirurgia , Técnicas Hemostáticas/estatística & dados numéricos , Hospitalização , Tempo de Internação/estatística & dados numéricos , Ligadura/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Estudos Prospectivos , Recidiva , Acidente Vascular Cerebral/etiologia , Tampões Cirúrgicos , Resultado do Tratamento
14.
Arch Ital Urol Androl ; 91(2)2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31266270

RESUMO

OBJECTIVE: To estimate the efficacy of our technique of zero ischemia time partial nephrectomy (ZTPN) with hemostatic running suture and compare it to the standard technique, in terms of perioperative complications, operative time (OT) and estimated blood loss (EBL). MATERIALS AND METHODS: We retrospectively analysed 180 consecutive patients who underwent ZTPN using a supra 11th or supra 12th rib mini flank approach. First group numbered 90 patients treated with running suture hemostatic technique (RSHT), while the control group enrolled 90 patients in whom we performed standard reconstruction technique (SRT). According the propensity score, both groups were similar in terms of tumor size, age and PADUA score. Patients with solitary tumour limited to the kidney (T1-T2a) were included. Our technique included a running suture of surgical bed edges and closure of the renal cortex by the positioning of peri-renal fat within the cortical bed and fixation with interrupted sutures. RESULTS: PADUA score and tumor size were comparable between groups (7.12 ± 1.33 vs 7.1 ± 2.11, p = 0.4 and 52.9 ± 14.8 vs 50.0 ± 13.2, p = 0.3). The mean operative time (OT) was significantly longer in first group (165.2 vs 95, p = 0.04), while median estimated blood loss (EBL) was significantly reduced (250 vs 460 ml, p = 0.02). Surgical resection margins were negative in 100% of cases and no patient developed a local or distant recurrence during follow up. There was significant difference in postoperative GFR value between groups (p < 0.05). CONCLUSIONS: Our technique could be safely performed in local, low volume facilities, thus reducing the need for expensive and more challenging minimal invasive surgical techniques..


Assuntos
Técnicas Hemostáticas , Neoplasias Renais/cirurgia , Nefrectomia/métodos , Técnicas de Sutura , Adulto , Idoso , Perda Sanguínea Cirúrgica , Estudos de Casos e Controles , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Duração da Cirurgia , Complicações Pós-Operatórias/epidemiologia , Estudos Retrospectivos
15.
Trials ; 20(1): 410, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288827

RESUMO

BACKGROUND: Laparoscopic cystectomy is currently considered the gold standard for the treatment of ovarian endometrioma, resulting in an improvement in symptoms, a lower recurrence rate, and a higher pregnancy rate among infertile patients. However, this treatment is not free from risk, since it is associated with a reduction in ovarian reserve. There is still controversy in the literature regarding whether the cause of the reduction in ovarian reserve is due to damage caused by the coagulation energy during hemostasis or whether the procedure itself is the cause of the damage irrespective of the hemostatic method used. The aim of this study is to compare the effects of different hemostatic methods on the ovarian function of women subjected to laparoscopic surgery for ovarian endometrioma. METHODS: An open-label randomized clinical trial to be conducted at the Lauro Wanderley University Hospital between December 2017 and August 2020. Eighty-four patients will be randomly allocated to three groups according to the hemostatic technique used during laparoscopic surgery for ovarian endometrioma: bipolar coagulation; laparoscopic suture; and hemostatic matrix. Ovarian function will be assessed by serum anti-Müllerian hormone measurement and by performing an antral follicle count using ultrasound before surgery and one, three, and six months after surgery. The internal review board of the Medical Sciences Center, Federal University of Paraíba approved the study protocol under reference CAAE 71621717.9.0000.8069. DISCUSSION: Bearing in mind the need for more randomized clinical trials to clarify this issue, we hope to contribute with data that will determine whether there is any difference between hemostatic methods despite the rational use of bipolar energy or whether the procedure itself explains the ovarian damage irrespective of the hemostatic technique used. TRIAL REGISTRATION: ClinicalTrials.gov, NTC03430609 . Registered on XX.10/31/2017. ISRCTN Registry, ISRCTN11469394 . Registered on XX.17/12/2017. Unique Protocol ID: U1111-1203-2508.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Endometriose/cirurgia , Procedimentos Cirúrgicos em Ginecologia , Técnicas Hemostáticas , Laparoscopia , Cistos Ovarianos/cirurgia , Reserva Ovariana , Hormônio Antimülleriano/sangue , Biomarcadores/sangue , Brasil , Endometriose/diagnóstico por imagem , Endometriose/fisiopatologia , Feminino , Procedimentos Cirúrgicos em Ginecologia/efeitos adversos , Técnicas Hemostáticas/efeitos adversos , Humanos , Laparoscopia/efeitos adversos , Cistos Ovarianos/diagnóstico por imagem , Cistos Ovarianos/fisiopatologia , Folículo Ovariano/diagnóstico por imagem , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo , Resultado do Tratamento
16.
J Trauma Acute Care Surg ; 87(1): 117-124, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31260426

RESUMO

BACKGROUND: Hemodynamically unstable patients with severe pelvic fracture are a significant challenge to trauma surgeons and have high mortality. Significant variability across institutions in hemorrhage control adjuncts used to quell pelvic bleeding has been demonstrated. However, the effect of these methods on time to definitive bleeding control, type of resuscitation given, and outcomes remains unknown. We sought to elucidate those effects. METHODS: This was a multicenter retrospective review of severe pelvic fracture patients in shock between 2011 and 2016. Shock was defined as systolic blood pressure less than 90 mm Hg, heart rate greater than 120 beats per minute, or base deficit less than -5. Definitive bleeding control was defined as time to surgical control in the operating room or embolization by interventional radiology. Significance level was at p less than 0.05. RESULTS: A total of 279 severe pelvic fracture patients with shock on admission from 12 trauma centers were included. The cohort was primarily male (62%) with median (interquartile range) age of 40 years (28-54 years), Injury Severity Score of 38 (29-50), and Glasgow Coma Scale score of 13 (3-15). Overall mortality was 32%. The most common adjunct used was pelvic binder (50%) followed by no adjunct (30.5%); least common was resuscitative balloon occlusion of the aorta (REBOA) (2.5%). Preperitoneal packing alone and REBOA alone/with other adjunct(s) resulted in the fastest times to operating room/interventional radiology but also had the highest blood utilization and mortality rates. Resuscitative balloon occlusion of the aorta was most often used along with pelvic binder (6 of 13; 46%). CONCLUSION: Marked variation in management of severe pelvic fracture patients in shock indicates the need for a standardized approach to maximize outcomes and minimize transfusion requirements. The use of preperitoneal packing and/or REBOA yielded fastest times to definitive bleeding control. However, REBOA continues to be infrequently used. Future prospective analysis of this combination needs further validation in patients with severe pelvic hemorrhage. LEVEL OF EVIDENCE: Therapeutic study, level IV.


Assuntos
Fraturas Ósseas/complicações , Ossos Pélvicos/lesões , Choque Hemorrágico/terapia , Adulto , Feminino , Fraturas Ósseas/terapia , Técnicas Hemostáticas/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Choque Hemorrágico/etiologia , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento
17.
Eur Arch Otorhinolaryngol ; 276(10): 2819-2826, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31332548

RESUMO

BACKGROUND: The discomfort and complications have always been problems for nasal packing materials. This study provided a new nasal packing material called high expansion degradable cotton (HEDC). METHODS: Nasal endoscopic surgery was used to establish a dog model of nasal bleeding, and wound surfaces were filled with Merocel, Nasopore and HEDC, respectively. Intraoperative and postoperative bleeding of 24 h was calculated. We evaluate the absorbability score, adhesion score, infection sore and nasal mucosal epithelium in postoperative 3, 7, 14 and 28 days. HE staining and electron microscopy were used to evaluate the recovery of nasal mucosa. RESULTS: There was no significant difference in nasal bleeding between HEDC, Merocel and Nasopore. Nasal endoscopic examination revealed HEDC absorbability of score, adhesion score, infection score were significantly lower than Merocel and Nasopore. The epithelialization time of HEDC was significantly shorter than that of Merocel and Nasopore. HE staining showed that HEDC and Nasopore could significantly reduce scar hyperplasia on the wound surface. The results of electron microscopy suggested that HEDC could protect the edge cilia of the wound. CONCLUSION: HEDC could be used as new choice for hemostasis after nasal endoscopic surgery, which could reduce nasal epithelialization time, and protect wound edge cilia.


Assuntos
Epistaxe/terapia , Formaldeído/administração & dosagem , Procedimentos Cirúrgicos Nasais/efeitos adversos , Cirurgia Endoscópica por Orifício Natural/efeitos adversos , Álcool de Polivinil/administração & dosagem , Hemorragia Pós-Operatória/terapia , Animais , Cães , Técnicas Hemostáticas , Hemostáticos/administração & dosagem , Humanos , Modelos Animais , Procedimentos Cirúrgicos Nasais/métodos , Cirurgia Endoscópica por Orifício Natural/métodos , Aderências Teciduais , Resultado do Tratamento
18.
Medicine (Baltimore) ; 98(29): e16505, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31335721

RESUMO

Prior studies have demonstrated positive impacts of antibiotic use on reducing mortality, rebleeding events, and length of hospitalization in adult cirrhotic patients with acute upper gastrointestinal bleeding (UGIB). We aimed to investigate the use of antibiotics in cirrhotic children with acute UGIB and its impact on patient outcomes.This was a retrospective study using the Pediatric Health Information System database. Cirrhotic patients aged 0 to 18 years with acute UGIB, admitted between October 2005 and September 2015, were identified based on ICD-9 codes. Patients with no documented endoscopy during admission were excluded.Forty-four (23 females) cirrhotic children were eligible for data analysis. The median patient age was 6 years. Etiology of acute UGIB included esophageal varices (n = 37), non-variceal bleeding (n = 4), and both (n = 3). A significant proportion of cirrhotic children with acute UGIB (n = 30, 68%) were given intravenous antibiotics within 48 hours of admission. Among children who did not develop bacteremia, 68% received antibiotics vs. 32% who did not (P = .6). The rate of readmission within 30 days of discharge was 7% in patients with antibiotics vs. 21% in those without antibiotics (P = .3).This study suggested that antibiotic use within 48 hours of admission in cirrhotic children with acute UGIB might have a positive impact on the percentage of children free of bacteremia and the readmission rate. A prospective study should investigate whether prophylactic antibiotics should be targeted only to a subgroup of cirrhotic children with acute UGIB who are particularly at high risk for bacterial infection.


Assuntos
Antibacterianos/uso terapêutico , Bacteriemia/prevenção & controle , Hemorragia Gastrointestinal/complicações , Hemorragia Gastrointestinal/terapia , Cirrose Hepática/complicações , Adolescente , Criança , Pré-Escolar , Bases de Dados Factuais , Endoscopia Gastrointestinal , Feminino , Hemorragia Gastrointestinal/etiologia , Técnicas Hemostáticas , Humanos , Lactente , Kansas , Tempo de Internação , Masculino , Readmissão do Paciente , Estudos Retrospectivos , Prevenção Secundária
19.
J Trauma Acute Care Surg ; 87(2): 420-429, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31348403

RESUMO

Over the past decade, the shift toward damage control surgery for bleeding trauma patients has come with an increased emphasis on optimal resuscitation. Two lifesaving priorities predominate: to quickly stop the bleed and effectively resuscitate the hemorrhagic shock. Blood is separated into components for efficient storage and distribution; however, bleeding patients require all components in a balanced ratio. A variety of blood products are available to surgeons, and these products have evolved over time. This review article describes the current standards for resuscitation of bleeding patients, including characteristics of all available products. The relevant details of blood donation and collection, blood banking, blood components, and future therapies are discussed, with the goal of guiding surgeons in their emergency transfusion practice.


Assuntos
Transfusão de Sangue , Serviços Médicos de Emergência , Hemorragia/terapia , Técnicas Hemostáticas , Emergências , Serviços Médicos de Emergência/métodos , Humanos , Ressuscitação/métodos
20.
J Trauma Acute Care Surg ; 87(2): 342-349, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31349348

RESUMO

BACKDROP: Clinicians intuitively recognize that faster time to hemostasis is important in bleeding trauma patients, but these times are rarely reported. METHODS: Prospectively collected data from the Pragmatic Randomized Optimal Platelet and Plasma Ratios trial were analyzed. Hemostasis was predefined as no intraoperative bleeding requiring intervention in the surgical field or resolution of contrast blush on interventional radiology (IR). Patients who underwent an emergent (within 90 minutes) operating room (OR) or IR procedure were included. Mixed-effects Poisson regression with robust error variance (controlling for age, Injury Severity Score, treatment arm, injury mechanism, base excess on admission [missing values estimated by multiple imputation], and time to OR/IR as fixed effects and study site as a random effect) with modified Bonferroni corrections tested the hypothesis that decreased time to hemostasis was associated with decreased mortality and decreased incidence of acute kidney injury (AKI), acute respiratory distress syndrome (ARDS), multiple-organ failure (MOF), sepsis, and venous thromboembolism. RESULTS: Of 680 enrolled patients, 468 (69%) underwent an emergent procedure. Patients with decreased time to hemostasis were less severely injured, had less deranged base excess on admission, and lower incidence of blunt trauma (all p < 0.05). In 408 (87%) patients in whom hemostasis was achieved, every 15-minute decrease in time to hemostasis was associated with decreased 30-day mortality (RR, 0.97; 95% confidence interval [CI], 0.94-0.99), AKI (RR, 0.97; 95% CI, 0.96-0.98), ARDS (RR, 0.98; 95% CI, 0.97-0.99), MOF (RR, 0.94; 95% CI, 0.91-0.97), and sepsis (RR, 0.98; 95% CI, 0.96-0.99), but not venous thromboembolism (RR, 0.99; 95% CI, 0.96-1.03). CONCLUSION: Earlier time to hemostasis was independently associated with decreased incidence of 30-day mortality, AKI, ARDS, MOF, and sepsis in bleeding trauma patients. Time to hemostasis should be considered as an endpoint in trauma studies and as a potential quality indicator. LEVEL OF EVIDENCE: Therapeutic/care management, level III.


Assuntos
Hemorragia/terapia , Técnicas Hemostáticas/mortalidade , Ferimentos e Lesões/terapia , Adulto , Hemorragia/sangue , Hemorragia/mortalidade , Humanos , Escala de Gravidade do Ferimento , Pessoa de Meia-Idade , Transfusão de Plaquetas/métodos , Distribuição de Poisson , Indicadores de Qualidade em Assistência à Saúde , Ressuscitação/métodos , Fatores de Tempo , Ferimentos e Lesões/sangue , Ferimentos e Lesões/mortalidade , Adulto Jovem
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