Factors influencing the development of decubitus ulcers in critically ill surgical patients.

Introduction: Decubitus ulcers confer significant morbidity to critically ill patients. We sought to determine which patient factors contributed to the formation of decubitus ulcers in our critically ill patients, and hypothesized that these ulcers occurred most often in elderly patients with lengths of stay >7 days and high severity of illness.

Methods: This study was conducted prospectively in two phases.

Relationship of hypolipidemia to cytokine concentrations and outcomes in critically ill surgical patients.

Objective: To determine the relationship of hypolipidemia to cytokine concentrations and clinical outcomes in critically ill surgical patients.

Design: Consecutive, prospective case series.

Setting: Surgical intensive care unit of an urban university hospital.

Elevation of IL-18 in human sepsis.

Interleukin-18 (IL-18) is a recently identified immunoregulatory cytokine that shares biochemical features with IL-1beta and acts in part by inducing interferon-gamma (IFN-gamma). Endotoxic bacterial lipopolysaccharide (LPS) (1 or 2 ng/kg) was insufficient to increase plasma IL-18 in five healthy adults measured 3, 12, and 24 hr following challenge. In contrast, in the first 96 hr of admission to the surgical intensive care unit, mean maximal serum IL-18 was elevated (1,122 +/- 259 pg/ml) in nine septic patients compared to six healthy adults (191 +/- 42 pg/ml), P < 0.

Interpretation of computed tomography does not correlate with laboratory or pathologic findings in surgically confirmed acute appendicitis.

Background: Computed tomography (CT) is used increasingly to diagnose acute appendicitis, despite variable technique and interpretation. We hypothesized that CT interpretation would not reflect actual clinical-pathologic findings in all demographic patient groups.

Methods: A prospective university hospital database of 625 consecutive patients (1995-1999), all of whom were operated on for appendicitis (261, or 41.

The contemporary surgical intensive care unit. Structure, staffing, and issues.

Modern ICUs present unique challenges to physician-administrators in the current health care environment. Several models of care (e.g.

Importance, morbidity, and mortality of pneumonia in the surgical intensive care unit.

Surgical patients are at high risk to develop nosocomial pneumonia, although an accurate diagnosis is difficult to make. Staphylococcus aureus and Pseudomonas aeruginosa are the most common pathogens, but Acinetobacteris emerging as an important pathogen. Because affected patients are often critically ill with multisystem pathology, it can be difficult to ascribe morbidity or mortality directly to the infection.

Large-volume liposuction complicated by retroperitoneal hemorrhage: management principles and implications for the quality improvement process.

Large-volume liposuction can be associated rarely with major medical complications and death. The case of exsanguinating retroperitoneal hemorrhage that led to cardiopulmonary arrest in an obese 47-year-old woman who underwent large-volume liposuction is described. Extensive liposuction is not a minor procedure.

Secretory leukocyte protease inhibitor, an inhibitor of neutrophil activation, is elevated in serum in human sepsis and experimental endotoxemia.

Objectives: To document changes in serum secretory leukocyte protease inhibitor (SLPI) in human sepsis and in experimental endotoxemia in vivo. To compare changes in serum SLPI in human sepsis with changes in interleukin (IL)-6, IL-10, and tumor necrosis factor (TNF)-alpha. To determine whether or not changes in SLPI correlate with the severity of multiple organ dysfunction syndrome as measured by the maximal multiple organ dysfunction score.

Importance, morbidity, and mortality of pneumonia in the surgical intensive care unit.

Surgical patients are at high risk to develop nosocomial pneumonia, although an accurate diagnosis is difficult to make. Staphylococcus aureus and Pseudomonas aeruginosa are the most common pathogens, but Acinetobacteris emerging as an important pathogen. Because affected patients are often critically ill with multisystem pathology, it can be difficult to ascribe morbidity or mortality directly to the infection.

Alterations of preliminary readings on radiographic examinations minimally affect outcomes of trauma patients discharged from the emergency department.

Background: We hypothesized that trauma patients could be discharged safely from the emergency department (ED) before the availability of official readings for their radiologic examinations. We also sought to determine whether trauma patients were more prone to alterations of preliminary interpretations than other ED patients.

Methods: Alterations of preliminary readings (PR) for patients discharged from the ED were reviewed.

Management of complicated intra-abdominal infections.

Complicated intra-abdominal infections are defined by the U.S. Food and Drug Administration as those in which an operation would not remove all of the infected tissue.

Gender-based differences in outcome in patients with sepsis.

Hypothesis: Among factors postulated to affect outcome in sepsis is the gender of the patient, with a suggestion that females may have lower mortality. This study tested the hypothesis that female patients admitted to the surgical intensive care unit with a documented infection have a lower mortality rate.

Design: Retrospective analysis of a prospectively collected data set.

Minimally invasive and noninvasive diagnosis and therapy in critically ill and injured patients.

In this review, both the newer noninvasive (ie, those that pose no breach of an epithelial barrier) and minimally invasive techniques relevant to the treatment of the critically ill or injured patient will be discussed. In some cases, the development of the technology is so recent that published data describing their clinical applications may be scant. The emphasis herein is on newer technologies; therefore, the discussion of certain established noninvasive techniques, such as pulse oximetry, and minimally invasive therapies, such as percutaneous abscess drainage, will be deferred.

Spontaneous rupture of the urinary bladder in the alcoholic patient.

A case of a young man with an acute abdominal condition and hematuria is presented. BUN and SCr levels were markedly elevated. Retrograde cystography revealed intraperitoneal extravasation of contrast material.