Postoperative sepsis

Halpern, Neil A.; McElhinney, A. James; Greenstein, Robert J.

doi:10.1097/00003246-199107000-00010

Cited by 9 publications

(5 citation statements)

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“…Abdominal ultrasonography and CT scans identified relevant abnormalities in roughly 50% (47.6% and 54.5%, respectively) of these patients. This is similar to the accuracy reported previously [13], although others have suggested greater accuracy with CT scans [11] or ultrasonography [2]. Thus when the initial clinician assessment was uncertain about relaparotomy, abdominal imaging contributed relevant information in roughly 50% of cases.…”

Section: Discussionsupporting

confidence: 83%

“…Reliable tests are needed to differentiate the early features of intraabdominal sepsis from the evolution of conditions that may be exacerbated by relaparotomy, such as myocardial ischemia, pulmonary embolism, or bronchopneumonia. Halpern et al suggested [13] that examining abdominal paracentesis fluid early after abdominal surgery (for the number of white blood cells, the character of the effluent, and bacteria) identifies patients who can benefit from relaparotomy.…”

Section: Discussionmentioning

confidence: 99%

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Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery

et al. 2004

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Relaparotomy may be beneficial in patients developing intraperitoneal sepsis after abdominal procedures. We determined whether joint clinical assessment by intensivist and surgeon (clinician assessment) identified patients with surgically correctable intraperitoneal sepsis. We also assessed the effect of patient age and sex, disease presentation and severity, interval to relaparotomy, and the number of relaparotomies on survival after relaparotomy. Data on clinical, laboratory, and radiologic abnormalities prior to relaparotomy, relaparotomy findings, and in-hospital survival were prospectively collected on a general hospital intensive care unit (ICU) database between January 1997 and January 2002. Altogether, 65 of 1482 (4.4%) patients admitted to the ICU after abdominal surgery underwent relaparotomy at a median of 5 days after the initial procedure. There was an 83% probability of identifying surgically treatable sepsis and 43% in-hospital mortality. Abdominal imaging contributed accurate information in 50% of cases where clinician assessment was uncertain. Patient age and multiorgan failure prior to relaparotomy-but not urgency of initial laparotomy or the acute physiology and chronic health evaluation (APACHE II) score prior to relaparotomy, interval to relaparotomy, or number of relaparotomies-affected the outcome. Clinician assessment after abdominal surgery had a high probability of predicting intraperitoneal sepsis at relaparotomy. The 43% mortality after relaparotomy was unlikely to be greater than with nonoperative treatment of intraabdominal sepsis, but the 78% mortality after relaparotomy in patients older than 75 years of age raised doubts about this approach in the elderly. The identification of intraperitoneal sepsis and performance of relaparotomy earlier after the initial abdominal surgery might reduce the high rate (60%) of multiorgan failure prior to relaparotomy and improve survival after it.

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Section: Discussionsupporting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery

et al. 2004

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“…Early proning has emerged as a powerful therapy for managing patients with ARDS and COVID-19 11 . Research has demonstrated that PIs are one of the complications reported in association with prone positioning, although the highest-risk body parts and most effective strategies and products to mitigate PIs during proning have not yet been elucidated 12,13 .…”

Section: Introductionmentioning

confidence: 99%

Pressure Injury Development, Mitigation, and Outcomes of Patients Proned for Acute Respiratory Distress Syndrome

Capasso

Snydeman

Miguel

et al. 2022

Adv Skin Wound Care

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OBJECTIVE:To describe trends and risk factors for pressure injuries (PIs) in adult critical care patients proned to alleviate acute respiratory distress syndrome secondary to COVID-19 and examine the effectiveness of products and strategies used to mitigate PIs. METHODS:The authors conducted a retrospective chart review between April 9 and June 8, 2020. Demographic data were analyzed using descriptive statistics. Differences between groups with and without PIs were analyzed.RESULTS: Among 147 patients, significant PI risk factors included male sex ( P = .019), high body mass index (>40 kg/m 2 ; P = .020), low Braden Scale score (<12; P = .018), and low-dose vasopressor therapy ( P = .020). Taping endotracheal tubes (ETTs) caused significantly fewer facial PIs than commercial ETT holders ( P < .0001). Maximum prone duration/session was a significant risk factor for anterior PIs ( P = . 016), which dropped 71% with newer pressure redistribution products. D-Dimer greater than 3,200 μg/mL ( P = .042) was a significant risk factor for sacrococcygeal PIs while supine. Mortality was 30%; significant risk factors included age older than 60 years (P = .005), Sequential Organ Failure Assessment score greater than 11 ( P = .003), and comorbid congestive heart failure ( P = .016). CONCLUSIONS:Taping the ETT, limiting the maximum duration of prone positioning to less than 32 hours, and frequent repositioning while supine may reduce the number of modifiable risk factors for PIs. Standardized methods for testing products for PI prevention will inform individualized patient care.

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“…Our literature search indicated that at least some hospitals allowed IV tubing to be placed on the floor,6, 8 which raised safety concerns among many of our clinicians.…”

Section: Safety Concerns About Tubing On the Floormentioning

confidence: 99%

“…Covering tubing with incontinence pads, though intended as a visual reminder to reduce the risk of tripping, might actually increase the risk that staff would not see the tubing and would walk on or roll a portable device, such as a radiograph or dialysis machine, over it, thus disrupting flow through IV lines and compromising tubing integrity, introducing the additional risk of central line–associated bloodstream infection (CLABSI) 7, 8…”

Section: Safety Concerns About Tubing On the Floormentioning

confidence: 99%

CE: Using Smart IV Infusion Pumps Outside of Patient Rooms

Messing

Abraham²,

Quinn³

et al. 2022

AJN, American Journal of Nursing

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The COVID-19 pandemic has created unique challenges for health care workers, who have demonstrated dedication, collaboration, and innovation in response. In this article, the authors describe an important nursing innovation they employed at Montefiore Medical Center in the Bronx, New York, during the spring 2020 COVID-19 surge: the relocation of smart IV infusion pumps outside of patient rooms. The goals of this innovation were to improve delivery of care, conserve personal protective equipment, limit the spread of the virus, and protect staff from exposure. The authors discuss the initial concerns that arose regarding the safety and efficacy of this practice; the research they conducted with other colleagues in nursing, pharmacy, infection control, and patient safety in the face of scant clinical literature relevant to the difficult circumstances the pandemic created; and the strategies they ultimately employed to ensure that this practice maintained safety and efficacy.

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Postoperative sepsis

Cited by 9 publications

References 0 publications

Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery

Relaparotomy for suspected intraperitoneal sepsis after abdominal surgery

Pressure Injury Development, Mitigation, and Outcomes of Patients Proned for Acute Respiratory Distress Syndrome

CE: Using Smart IV Infusion Pumps Outside of Patient Rooms

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