https://journal.chestnet.org/article/S0012-3692(16)38415-X/pdf

Definitions for Sepsis and Organ Failure and Guidelines for the Use of Innovative Therapies in Sepsis

To develop management guidelines for severe sepsis and septic shock that would be of practical use for the bedside clinician, under the auspices of the Surviving Sepsis Campaign, an international effort to increase awareness and improve outcome in severe sepsis. The process included a modified Delphi method, a consensus conference, several subsequent smaller meetings of subgroups and key individuals, teleconferences, and electronic-based discussion among subgroups and among the entire committee. The modified Delphi methodology used for grading recommendations built upon a 2001 publication sponsored by the International Sepsis Forum. We undertook a systematic review of the literature graded along 5 levels to create recommendation grades from A–E, with A being the highest grade. Pediatric considerations were provided to contrast adult and pediatric management. Participants included 44 critical care and infectious disease experts representing 11 international organizations. A total of 46 recommendations plus pediatric management considerations. Evidence-based recommendations can be made regarding many aspects of the acute management of sepsis and septic shock that will hopefully translate into improved outcomes for the critically ill patient. The impact of these guidelines will be formally tested and guidelines updated annually, and even more rapidly when some important new knowledge becomes available.

/pdf/surviving-sepsis-campaign-guidelines-for-management-of-2my3xcb472.pdf

Surviving Sepsis Campaign guidelines for management of severe sepsis and septic shock

https://journal.chestnet.org/article/S0012-3692(16)52804-9/pdf

The APACHE III prognostic system. Risk prediction of hospital mortality for critically ill hospitalized adults.

A surgical stapling device particularly suited for endoscopic procedures is described The device includes a handle assembly and an elongated body extending distally from the handle assembly The distal end of the elongated body is adapted to engage a disposable loading unit A control rod having a proximal end operatively connected to the handle assembly includes a distal end extending through the elongated body A control rod locking member is provided to prevent movement of the control rod until the disposable loading unit is fully secured to the elongated body of the stapling device

Surgical Stapling Apparatus

A surgical stapling device for applying an array of surgical staples to tissue is provided. The stapling device includes an approximation mechanism for moving a cartridge assembly and an anvil assembly between spaced and approximated positions and a firing mechanism for ejecting the array of staples from the cartridge assembly. A single trigger is operable to effect approximation and firing of the device. The device also includes an alignment pin assembly which can be selectively manually or automatically advanced. The anvil assembly includes a stiffener plate which allows the device to have a reduced head portion profile.

Surgical stapling device

Embodiments of the invention provide a permanent implanted support for e.g. the urethral neck of the bladder, generally preventing urinary leakage caused by transmission of intra-abdominal pressure pulse waves. The support is implanted in a straightforward manner without the significant complexity and invasiveness associated with known surgical techniques. Pelvic trauma is dramatically reduced. Embodiments of the invention can be used in treatment of stress incontinence, and other types of incontinence, in both males and females.

Devices and methods for treating e.g. urinary stress incontinence

According to embodiments of the invention, an apparatus for moving a diseased portion of an anatomical structure with respect to a healthy portion of an anatomical structure includes a first vacuum section adapted to apply vacuum force to and hold the healthy portion, and a second vacuum section adapted to apply vacuum force to and hold the diseased portion, wherein the second vacuum section is adapted to withdraw within the first vacuum section.

Resection and anastomosis devices and methods

The hypothesis that optimizing hemodynamics using pulmonary artery (PA) catheter (preoperative 'tune-up') would improve outcome in patients undergoing limb-salvage arterial surgery was tested Eighty-nine patients were randomized to preoperative tune-up either in the surgical intensive care unit (SICU) (group 1) or the preinduction room (group 2) or to control (group 3) The tune-up consisted of fluid loading, afterload reduction, and/or inotropic support to achieve predetermined endpoints Patients with a PA catheter had significantly fewer adverse intraoperative events (p less than 005), less postoperative cardiac morbidity (p less than 005), and less early graft thrombosis (p less than 005) than the control group The overall study mortality rate was 34%, with a mortality rate of 95% in the control group and 15% in the PA catheter groups There were no differences in ICU length of stay (LOS), hospital LOS, or total hospital costs, although the percentage of cost from complications was higher in group 3 (p greater than 005) In this group of patients, preoperative cardiac assessment and optimization is associated with improved outcome

Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective, randomized clinical trial.

Surgical devices and methods achieve a desired configuration of one or more anatomical structures, e.g. by suction or inflation, and then optionally deploy a stabilizing or fastening agent or holding device, for example a helical staple, to stabilize the anatomical structure in the desired configuration. Aspects of the invention can be used in the treatment of incontinence, coronary artery blockage, and blockages or strictures in other anatomical structures. Additionally, embodiments of the invention also can be used to create anastomoses between anatomical structures, and/or to create or reverse functional vasectomies, tubal ligations and the like. Aspects of the invention are particularly (though not exclusively) applicable in minimally invasive surgical settings.

Surgical stabilizer devices and methods

• A clinical study was undertaken to evaluate the ability of the APACHE ( acute physiology and chronic health care ) II system to predict the development of multiple organ failure syndrome and subsequent mortality. The study was conducted in a university general surgery intensive care unit using the admission APACHE II score. Over a 1-year period, 92 patients qualified for the study, 24 of whom survived, 69 of whom suffered multiple organ failure syndrome, and 68 of whom died. The APACHE II score did not predict the development of multiple organ failure syndrome or mortality with clinical utility and significantly underestimated the potential for the development of multiple organ failure syndrome. Factors that did predict the development of multiple organ failure syndrome and mortality were the time-dependent changes in the Pao 2 -to-fraction of inspired oxygen ratio and serum lactate, creatinine, and bilirubin levels. Better markers of cell injury are needed for use in decision making and quality assurance analysis in surgical patients. ( Arch Surg . 1990;125:519-522)

Jerome H. Abrams

Papers

Devices and methods for treating e.g. urinary stress incontinence

Resection and anastomosis devices and methods

Preoperative optimization of cardiovascular hemodynamics improves outcome in peripheral vascular surgery. A prospective, randomized clinical trial.

Surgical stabilizer devices and methods

APACHE II score does not predict multiple organ failure or mortality in postoperative surgical patients.