Showing papers by "Lena M. Napolitano published in 2018"
Foothills Medical Centre1, Virginia Commonwealth University2, Denver Health Medical Center3, University of California, San Diego4, State University of Campinas5, United Arab Emirates University6, Harvard University7, University of California, Davis8, McGill University9, University of Pittsburgh10, Tbilisi State Medical University11, Cambridge University Hospitals NHS Foundation Trust12, Goethe University Frankfurt13, Stavanger University Hospital14, University of Bergen15, The Queen's Medical Center16, University of Western Ontario17, University of Paris18, University of Bologna19, University of Maryland, Baltimore20, Assuta Medical Center21, Memorial Hospital of South Bend22, University of Grenoble23, Örebro University24, Military Academy25, Kyoto University26, John Hunter Hospital27, Westchester Medical Center28, University of KwaZulu-Natal29, University of Western Australia30, University of Helsinki31, University of Southern California32, Taipei Medical University Hospital33, University of Toronto34, Medical College of Wisconsin35, Sher-I-Kashmir Institute of Medical Sciences36, University of Buea37, University of the Witwatersrand38, University of Michigan39
TL;DR: The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist and its use remains controversial.
Abstract: Damage control resuscitation may lead to postoperative intra-abdominal hypertension or abdominal compartment syndrome. These conditions may result in a vicious, self-perpetuating cycle leading to severe physiologic derangements and multiorgan failure unless interrupted by abdominal (surgical or other) decompression. Further, in some clinical situations, the abdomen cannot be closed due to the visceral edema, the inability to control the compelling source of infection or the necessity to re-explore (as a “planned second-look” laparotomy) or complete previously initiated damage control procedures or in cases of abdominal wall disruption. The open abdomen in trauma and non-trauma patients has been proposed to be effective in preventing or treating deranged physiology in patients with severe injuries or critical illness when no other perceived options exist. Its use, however, remains controversial as it is resource consuming and represents a non-anatomic situation with the potential for severe adverse effects. Its use, therefore, should only be considered in patients who would most benefit from it. Abdominal fascia-to-fascia closure should be done as soon as the patient can physiologically tolerate it. All precautions to minimize complications should be implemented.
165 citations
TL;DR: This review discusses the new Sepsis-3 definitions and guidelines and proposes a new screening tool for sepsis (quick Sequential Organ Failure Assessment [qSOFA]) to predict the likelihood of poor outcome in out-of-intensive care unit (ICU) patients with clinical suspicion of Sepsis.
Abstract: Background: Sepsis is a global healthcare issue and continues to be the leading cause of death from infection. Early recognition and diagnosis of sepsis is required to prevent the transiti...
156 citations
TL;DR: Overall survival from ECLS was 70% and survival to hospital discharge was 61% in the total cohort, similar to survival rates in other ELSO registry cohorts, and trauma should not be considered a contraindication for ECLs.
Abstract: BACKGROUNDThe use of extracorporeal life support (ECLS) in the trauma population remains controversial and has been reported only in small cohort studies. Recent ECLS technical advances have increased its use as an advanced critical care option in trauma. Given the degree of resource utilization, co
63 citations
Rambam Health Care Campus1, University of Brescia2, University of Colorado Denver3, Vanderbilt University Medical Center4, Harvard University5, Northwestern University6, University of New Mexico7, University of Michigan8, Western Michigan University9, United Arab Emirates University10, College of Health Sciences, Bahrain11, Medical University Plovdiv12, University Hospital Centre Zagreb13, Hebrew University of Jerusalem14, University of Santiago de Compostela15, Central University, India16, Mansoura University17, National and Kapodistrian University of Athens18, Jagiellonian University Medical College19, Edendale Hospital20, Immanuel Kant Baltic Federal University21, Universidad Nacional de Asunción22, University of Health Sciences Antigua23, University of the West Indies24, University of Ilorin25, Hospital Universitario La Paz26, Thammasat University Hospital27, University of Pécs28
TL;DR: The “surgeon champion” can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.
Abstract: Despite evidence supporting the effectiveness of best practices of infection prevention and management, many surgeons worldwide fail to implement them. Evidence-based practices tend to be underused in routine practice. Surgeons with knowledge in surgical infections should provide feedback to prescribers and integrate best practices among surgeons and implement changes within their team. Identifying a local opinion leader to serve as a champion within the surgical department may be important. The "surgeon champion" can integrate best clinical practices of infection prevention and management, drive behavior change in their colleagues, and interact with both infection control teams in promoting antimicrobial stewardship.
17 citations
University of Virginia Health System1, Vanderbilt University Medical Center2, University of North Texas3, University of Washington4, Beth Israel Deaconess Medical Center5, Brigham and Women's Hospital6, University of Michigan7, University of Miami8, University of South Carolina9, University of Minnesota10, Western Michigan University11
TL;DR: It is suggested that the presence of fungi in IAI may not indicate independently the need for a longer course of Antimicrobial therapy, and a shorter treatment course with fungal organisms randomized to a shorter course had no difference in the rate of treatment failure.
Abstract: Background: Fungi frequently are isolated in intra-abdominal infections (IAI). The Study to Optimize Peritoneal Infection Therapy (STOP-IT) recently suggested short-course treatment for pa...
15 citations
TL;DR: Acute kidney injury is common in patients with severe ARDS caused by pH1N1 infection, and CRRT is a significant risk factor for increased mortality, but most patients who survived experienced full renal recovery.
Abstract: Background The incidence and long-term outcomes of acute kidney injury in patients with severe acute respiratory distress syndrome (ARDS) due to influenza A(H1N1) pdm09 virus (pH1N1) have not been examined. Objective To assess long-term renal recovery in patients with acute kidney injury and severe ARDS due to pH1N1. Methods A retrospective observational cohort study of adults with severe pH1N1-associated ARDS admitted to a tertiary referral center. Baseline characteristics, acute kidney injury stage, continuous renal replacement therapy (CRRT), intermittent hemodialysis, extracorporeal membrane oxygenation, survival, and renal recovery (defined as dialysis independence) were evaluated. Results Fifty-seven patients, most with stage 3 acute kidney injury, were included. The 53% mortality rate among the 38 patients requiring CRRT was significantly higher than the 0% mortality rate among the 19 patients not requiring CRRT or intermittent hemodialysis. Increased duration of CRRT was not significantly associated with decreased survival. Fifteen CRRT patients required transition to intermittent hemodialysis. Of the CRRT patients who survived, 94% experienced renal recovery. Extracorporeal membrane oxygenation was instituted in 17 patients; 15 of these patients required CRRT. Conclusions Acute kidney injury is common in patients with severe ARDS caused by pH1N1 infection. CRRT is a significant risk factor for increased mortality, but most patients who survived experienced full renal recovery.
14 citations
TL;DR: In this paper, the authors provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care.
Abstract: Critical care fellowship training in the United States differs based on specific specialty and includes medicine, surgery, anesthesiology, pediatrics, emergency medicine, and neurocritical care training pathways. We provide an update regarding the number and growth of US critical care fellowship training programs, on-duty residents and certified diplomates, and review the different critical care physician training pathways available to residents interested in pursuing a fellowship in critical care. Data were obtained from the Accreditation Council for Graduate Medical Education and specialty boards (American Board of Internal Medicine, American Board of Surgery, American Board of Anesthesiology, American Board of Pediatrics American Board of Emergency Medicine) and the United Council for Neurologic Subspecialties for the last 16 years (2001-2017). The number of critical care fellowship training programs has increased 22.6%, with a 49.4% increase in the number of on-duty residents annually, over the last 16 years. This is in contrast to the period of 1995 to 2000 when the number of physicians enrolled in critical care fellowship programs had decreased or remained unchanged. Although more than 80% of intensivists in the US train in internal medicine critical care Accreditation Council for Graduate Medical Education-approved fellowships, there has been a significant increase in the number of residents from surgery, anesthesiology, pediatrics, emergency medicine, and other specialties who complete specialty fellowship training and certification in critical care. Matriculation in neurocritical care fellowships is rapidly rising with 60 programs and over 1,200 neurocritical care diplomates. Critical care is now an increasingly popular fellowship in all specialties. This rapid growth of all critical care specialties highlights the magnitude of the heterogeneity that will exist between intensivists in the future.
14 citations
TL;DR: Decreased hepcidin concentrations are associated with increased reticulocyte response and decreased inflammatory response reflected by decreased interleukin-6 and C-reactive protein concentrations, but not with anemia resolution.
Abstract: OBJECTIVE Because anemia of inflammation is common in ICU patients and hepcidin is the key regulator of iron homeostasis, we examined time-dependent changes in hepcidin, erythropoietin, iron, and inflammatory markers in surgical ICU patients with anemia. DESIGN Prospective single-center clinical noninterventional study. SETTING Surgical ICUs; U.S. university hospital. PATIENTS One hundred surgical adult ICU patients. MEASUREMENTS AND MAIN RESULTS Time-dependent changes in serum hepcidin, hematologic, and erythropoietic studies were performed on ICU admission and at serial time-points through day 28, and correlated with hematologic and iron parameters and inflammatory response. Median serum hepcidin levels were significantly increased at ICU admission and decreased over time (144-36 ng/mL; p < 0.0001). Despite increased reticulocyte counts (1.3-2.9%), mean serum erythropoietin levels remained low (29-44 mU/mL) and hemoglobin did not significantly change. Hepcidin was positively correlated with RBC transfusion, C-reactive protein, interleukin-6, ferritin, and negatively correlated with iron, total iron binding capacity, transferrin, and reticulocyte response. Hepcidin did not correlate with tumor necrosis factor-α serum concentrations. Regression analyses confirmed that ferritin, C-reactive protein, and reticulocyte number were predictive of same-day hepcidin; hepcidin and C-reactive protein were predictive of same-day reticulocyte count. CONCLUSIONS Hepcidin serum concentrations are markedly increased on ICU admission, and decrease significantly over the course of the ICU stay (28 d). Decreased hepcidin concentrations are associated with increased reticulocyte response and decreased inflammatory response reflected by decreased interleukin-6 and C-reactive protein concentrations, but not with anemia resolution.
10 citations
6 citations
1 citations
01 Jan 2018
TL;DR: All advanced ARDS treatment strategies (low tidal volume ventilation, restrictive fluid strategy, neuromuscular blockade, prone position, inhaled nitric oxide, and extracorporeal membrane oxygenation) will be considered.
Abstract: Lung contusion (or pulmonary contusion) is common in patients who have sustained blunt chest trauma. Lung contusion consists of pulmonary parenchymal abnormalities related to pulmonary tissue injury resulting in hemorrhage, edema, and inflammation. Diagnosis is confirmed by chest radiograph and thoracic CT scan imaging. The sequelae of the lung contusion pulmonary parenchymal abnormalities include pneumonia, acute respiratory insufficiency and failure with hypoxemia and/or hypercarbia, and acute respiratory distress syndrome which is associated with significant morbidity and mortality. Treatment of lung contusion is initially supportive care, adequate pain control, fluid restrictive strategy, and pulmonary toilet with optimization of oxygenation and ventilation. Management of the complications associated with lung contusion may include drainage of associated hemothorax, noninvasive vs. invasive mechanical ventilation, VATS, and rib fracture fixation. For ARDS due to lung contusion, all advanced ARDS treatment strategies (low tidal volume ventilation, restrictive fluid strategy, neuromuscular blockade, prone position, inhaled nitric oxide, and extracorporeal membrane oxygenation) will be considered.
01 Jan 2018
TL;DR: This chapter reviews epidemiology, risk factors, diagnosis, treatment, and prevention of pulmonary complications in geriatric patients.
Abstract: Pulmonary complications [atelectasis, pneumonia, pulmonary edema, COPD exacerbation, acute respiratory failure, acute respiratory distress syndrome (ARDS)] are common in geriatric trauma and acute care surgery patients. Pneumonia and acute respiratory failure are most common. Acute respiratory failure and ARDS are life-threatening pulmonary complications that require mechanical ventilation and intensive care unit admission, and are associated with increased risk for ventilator-associated pneumonia. This chapter reviews epidemiology, risk factors, diagnosis, treatment, and prevention of pulmonary complications in geriatric patients.
01 Jan 2018
TL;DR: Significant advances in trauma resuscitation are achieved, with the use of guideline-based recommendations for damage control resuscitation using early fixed-ratio 1:1:1 or 1: 1:2 blood component ratios, early prompt hemorrhage control, massive transfusion protocols, and viscoelastic testing to guide further trauma resuscitations.
Abstract: A significant hematologic challenge in trauma patients is the treatment of hemorrhage and hemorrhagic shock. Trauma patients with major hemorrhage have a 25% mortality in the most recent studies. Hemorrhagic shock is the leading cause of preventable mortality in both military and civilian trauma. Trauma-induced coagulopathy occurs early after injury and results in increased hemorrhage and increased mortality. We have a greater understanding of the mechanisms underlying trauma-induced coagulopathy, with hypoperfusion and increased injury severity inducing protein C activation and hyperfibrinolysis. Both hyperfibrinolysis and fibrinolysis shutdown are associated with increased mortality in trauma. We have achieved significant advances in trauma resuscitation, with the use of guideline-based recommendations for damage control resuscitation using early fixed-ratio 1:1:1 or 1:1:2 blood component ratios, early prompt hemorrhage control, massive transfusion protocols, and viscoelastic testing to guide further trauma resuscitation. We still have significant challenges related to which patients benefit from tranexamic acid administration and the need for additional studies to gain full mechanistic understanding of trauma-induced coagulopathy.