Jejunal diverticulitis is an uncommon pathology wherein a delay in diagnosis can lead to significant morbidity and mortality. We report a case of such diverticula requiring operative management, after patient failed non‐operative management, likely due to advanced jejunal inflammation from a delay in diagnosis and subsequent management.
Purpose of reviewThe decision to undergo early tracheostomy in critically ill patients has been the subject of multiple studies in recent years, including several meta-analyses and a large-scale examination of the National in-patient Sampling (NIS) database. The research has focused on different patient populations, and identified common outcomes measures related to ventilation. At the crux of the new research is the decision to undergo an additional invasive procedure, mainly tracheostomy, rather than attempt endotracheal tube ventilation with or without early extubation. Notably, recent research indicates that neurological and SARS-CoV-2 (COVID-19) patients seem to have an exaggerated benefit from early tracheostomy. Recent findingsRecent studies of patients undergoing early tracheostomy have shown decreases in ventilator associated pneumonia, ventilator duration and duration of ICU stay. However, these studies have shown mixed data with respect to mortality and length of hospitalization. Such advantages only become apparent with largescale examination. Confounding the overall discussion is that the research has focused on heterogeneous groups, including neurosurgical ICU patients, general ICU patients, and most recently, intubated COVID-19 patients.
A single-center retrospective cohort study was performed assessing outcomes of single-stage BT fistulas created by a single surgeon between January 1, 1999, and December 31, 2016. Demographic data, preoperative and postoperative vein and fistula flow velocity and volume metrics, and maturation rates and complications were recorded. Data were analyzed using descriptive statistics.Results: There were 247 patients who received BT fistulas, including 112 in patients aged $65. Overall successful maturation rate 68%. Older patients (>65 years) were more likely to have diabetes and coronary artery disease than younger patients; they were less likely to have had prior hemodialysis or to have had a previous AVF or AVG. Younger patients had higher average body mass index. There were no statistically significant differences between patient outcomes, including comorbidities, reoperation, and complication rates. Basilic vein diameter per preoperative mapping studies was comparable across groups (3.8 mm). Patient groups had similar arterial flow rates at the first postoperative assessment (230 vs 239 cm/s); younger patients tended to have higher outflow velocities (609 vs 521 cm/s). Mean volume flow across all patients was 1699 mL/min. Only one patient had a volume flow below the dialysis threshold of 600 mL/ min. Younger patients were more likely to require superficialization of their AVF due to difficult with access (13.7% vs 5%). Elderly patients were more likely to have a new AVF or AVG placed as their primary intervention. Data are presented in Tables I and II.Conclusions: This series demonstrates a maturation rate superior to much of what is reported in the medical literature for single-or doublestage BT. Single-stage BT yielded excellent flow volume rates across patient groups. These results suggest that a single-stage BT approach can have a high success rate and may therefore help patients avoid the complication risks of a two-step procedure or nonautologous hemodialysis access types.
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