Background: Maxillofacial surgery for free flap reconstructions is associated with many complications due to technical complexity and comorbidity of patients. With a focus on critical care, the authors studied the impact of complications to highlight predictors of poor postoperative outcomes in order to implement optimization protocols.
Methods: This case-control study analyzed the relationship between perioperative variables and postoperative medical and surgical complications of patients who underwent head and neck surgery using fibular and forearm free flaps. The primary objective was the incidence of prolonged intensive care unit (ICU) length of stay (LOS). Secondary objectives were the incidence of ICU readmissions, postoperative infections, and 1-year mortality. A univariable logistic regression model was used. A study of mortality was performed with survival analysis. Regarding our primary objective, we performed a Benjamini-Hochberg procedure and a multivariable Poisson regression with defined variables of interest.
Results: The data of 118 hospital stays were included. Prolonged ICU LOS was observed in 47% of cases and was associated with chronic obstructive pulmonary disease, pneumopathies, intraoperative blood transfusion, and surgical duration. Medical and surgical complications were associated with prolonged ICU LOS. After the Benjamini-Hochberg procedure, infectious complications, complications, major complications, total number of pneumopathies, and operative time remained significant. At least one complication was experienced by 71% of patients during the hospitalization, and 33% of patients suffered from major complications. Infectious complications were the most common (40% of patients) and were mainly caused by pneumonia (25% of patients); these complications were associated with low preoperative hemoglobin level, intraoperative blood transfusion, accumulation of reversible cardiovascular risk factors, chronic alcohol consumption, and duration of surgery. Pneumonia was specifically associated with chronic obstructive pulmonary disease. The ICU readmission rate was 10% and was associated with lower preoperative hemoglobin level, pneumopathies, surgical duration, and use of a fibular flap. The 1-year mortality was 12%, and the survival analysis showed no association with prolonged ICU LOS. Poisson regression showed that ICU LOS was prolonged by smoking history, lower preoperative hemoglobin level, intraoperative blood transfusion, major complication, and pneumopathies.
Conclusions: Practices such as blood management and respiratory prehabilitation could be beneficial and should be evaluated as a part of global improvement strategies.
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http://dx.doi.org/10.1186/s13741-022-00244-5 | DOI Listing |
Asia Pac J Clin Nutr
February 2025
Department of Clinical Nutrition, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China. Email:
Background And Objectives: This study aimed to investigate the respiratory quotient (RQ) levels and its trend in the early postoperative period of patients with heart disease. Additionally, we explored factors influencing RQ and evaluated the predictive capabilities of RQ and lactic acid for various outcomes.
Methods And Study Design: In this prospective observational study, participants included were heart disease patients aged 18-80 years who underwent elective open-heart surgery and were subsequently admitted to the cardiothoracic surgery ICU post-operation.
Enferm Intensiva (Engl Ed)
January 2025
Centro Puentes de Investigación en Salud, Universidad de Aysén, Aysén, Chile.
Introduction: Critically ill patients and their families benefit from spiritual care. There is limited evidence on how spiritual care is delivered in intensive care units (ICUs).
Aim: The objective of this review was to determine how nurses include spiritual care for patients and families in ICUs.
J Paediatr Child Health
January 2025
WHO Collaborating Centre for Reference and Research on Influenza, VIDRL, Doherty Institute, Melbourne, Victoria, Australia.
Aims: Primary aim was to review severe acute respiratory infections (SARI) hospitalisations caused by respiratory syncytial virus (RSV) in children aged < 2 years in paediatric hospitals in Australia. Secondary aims included RSV subtyping, assessing RSV seasonality and contributing to the World Health Organisation's RSV surveillance programme.
Methods: We prospectively reviewed the medical records of children (< 2 years of age) with a confirmed SARI who were admitted to one of four major Australian paediatric hospitals and had a respiratory sample analysed by Polymerase Chain Reaction (PCR).
Pediatr Qual Saf
January 2025
From the Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tenn.
Introduction: Weight is vital for tracking fluid status and nutrition and assuring patients have accurate dosing weights in the pediatric intensive care unit (PICU). Challenges in acquiring weights in critically ill patients include clinical instability, limited equipment, and lack of appropriate orders in the electronic medical record (EMR).
Methods: We implemented interventions that targeted EMR weight orders and actual collection of weights in the 42-bed PICU of a children's hospital.
Neurocrit Care
January 2025
Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Background: Family caregivers of patients with severe acute brain injury (SABI) are at risk for clinically significant chronic emotional distress, including depression, anxiety, and posttraumatic stress. Existing psychosocial interventions for caregivers of intensive care unit (ICU) patients are not tailored to the unique needs of caregivers of patients with SABI, do not demonstrate long-term efficacy, and may increase caregiver burden. In this study, we explored the needs and preferences for psychosocial services among SABI caregivers to inform the development and adaptation of interventions to reduce their emotional distress during and after their relative's ICU admission.
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