Intesive Care Unit Research Articles

Explainable Machine Learning Approach to Prediction of Prolonged Intesive Care Unit Stay in Adult Spinal Deformity Patients: Machine Learning Outperforms Logistic Regression.

Retrospective cohort study. Prolonged ICU stay is a driver of higher costs and inferior outcomes in Adult Spinal Deformity (ASD) patients. Machine learning (ML) models have recently been seen as a viable method of predicting pre-operative risk but are often 'black boxes' that do not fully explain the decision-making process. This study aims to demonstrate ML can achieve similar or greater predictive power as traditional statistical methods and follows traditional clinical decision-making processes. Five ML models (Decision Tree, Random Forest, Support Vector Classifier, GradBoost, and a CNN) were trained on data collected from a large urban academic center to predict whether prolonged ICU stay would be required post-operatively. 535 patients who underwent posterior fusion or combined fusion for treatment of ASD were included in each model with a 70-20-10 train-test-validation split. Further analysis was performed using Shapley Additive Explanation (SHAP) values to provide insight into each model's decision-making process. The model's Area Under the Receiver Operating Curve (AUROC) ranged from 0.67 to 0.83. The Random Forest model achieved the highest score. The model considered length of surgery, complications, and estimated blood loss to be the greatest predictors of prolonged ICU stay based on SHAP values. We developed a ML model that was able to predict whether prolonged ICU stay was required in ASD patients. Further SHAP analysis demonstrated our model aligned with traditional clinical thinking. Thus, ML models have strong potential to assist with risk stratification and more effective and cost-efficient care.

Early social referencing predicts object mastery motivation in infancy: Social antecedents of object mastery motivation.

The researchers sought to understand the typical development of social referencing and object mastery motivation in infancy and to determine the relationship between social referencing and object mastery behaviors in infants from 7 to 22months of age. The study included 36 infants who were followed as part of a longitudinal study of at-risk infants but were not determined to need care in the neonatal intesive care unit at birth. Both mastery behaviors of persistence and success showed a statistically significant effect of age, while social behaviors remained stable from 7 to 22months. Social behaviors at 7 and 10months were correlated with persistence at 22months and success at 16 to 22months demonstrating that early social referencing predicts object mastery behaviors in later infancy. Further research should determine if this trend extends to early childhood.

End-of-life Care in the Intesive Care Unit and Nursing Roles in Communicating with Families.

Professionals in Intensive Care Units face death, shifting their role from therapists to caregivers in end-of-life management. The nursing attitude and response to death has been shown to affect the quality of palliative care and end-of-life services that are interrelated services. The aim of this research was to evaluate the professional attitude of nurses towards the care of the families of critically ill patients in the ICU, leading to the emergence of specific attitudes, relating them to their demographic and professional characteristics, with the aim of drawing conclusions for the improvement of quality in end-of-life care. The sample of the study was 81 nurses from a large tertiary hospital. Participants completed the "Nurse Activities for Communicating with Families" (NACF) questionnaire. The questions are about ways in which nurses can help the patient's family during the patient's stay in the ICU. The results revealed that the nurses took actions related to the information and psychological support of the patient's family. On the contrary, they did not focus on the spiritual / religious needs of the patient and the needs of the family based on their cultural background. The professional treatment of staff is characterized by compassion and empathy, but it is necessary to train them on important issues related to diversity, including the religious, spiritual values and beliefs of patients and their relatives.

OC-025 STRATEGY FOR SURGICAL TREATMENT OF GIANT INGUINOSCROTAL HERNIA - SERIES OF 21 CONSECUTIVE PATIENTS DURING 15 YEARS

Abstract Aim To present our strategy for surgical treatment of patients with giant inguinoscrotal hernia whose hernia defect is ≥10 cm or who have a loss of domain. Material and methods Between January 2006 - January 2022, 21 consecutive patients with giant inguinoscrotal hernia and high risk of postoperative intra-abdominal hypertension were managed. The hernia was repaired in the following manner: modified Rives technique performed through direct inguinal approach in 10 patients; additional procedures were needed to reduce the volume of organs returned to the abdomen in four patients; the primary abdominal cavity was enlarged by various components separation techniques with or without mesh hernioplasty in seven patients. Results The hernia defect size was in range 7–17 cm. In three patients the contents of the hernia sac accounted for more than 50% of the intestines: entire large bowel without the rectum, ileum, jejunum except proximal 15 cm and greater omentum). Postoperative complications occurred in eight patients were: scrotal hematoma, deep mesh infection, seroma and hydrocele. There were three postoperative deaths: 12 hours, 17 and 42 days after the surgery because ischemic enteritis, cerebrovascular stroke and heart failure, respectively. Conclusion Our strategy consisting of modified Rives technique performed through direct inguinal approach with or without additional procedures to reduce the volume of organs returned to the abdomen or to enlarge the primary abdominal cavity can be a good solution for giant inguinoscrotal hernias. Procedure is followed by the risk of deadly complications and requires trained team in intesive care unit.

Epidemiology and Clinical Evolution of Newborns with Acute Kidney Injury in Intesive Care Unit

Epidemiology and Clinical Evolution of Newborns with Acute Kidney Injury in Intesive Care Unit

Risk Factors for Central Venous Line Complications Versus Umbilical Veous Catheter in Premature Neonates Admitted to El Warak Centeral Hospital Neonatal Intesive Care Unit

peripherally inserted central catheters (PICCs) are routinely used in term and preterm infants to provide intravenous access for prolonged therapy and parenteral nutrition. They are known to reduce the complications associated with the conventionally used central catheters. PICCs can be conveniently inserted at the bedside without the need for surgical intervention. The point of the available investigation might have been with assess those danger figures to vital venous offering difficulties versus umber venous catheter over preterm neonates admitted to el Warak national clinic in neonatal seriousness Furthermore its result. This Prospective observational consider required been conveyed out in NICUs toward el Warak national clinic between December2018 Also december 2019, those ponder might have been conveyed out ahead 100 newborns ( preterm) that were admitted will nicu by diverse result in Also have focal embedded vascular catheter (Umbilical venous catheter Also vital veous cathter). Comes about of the study uncovered that crp Also PTT were altogether higher in CVC one assembly contrasted with UVC. However, TLC, platelets check Also HCT qualities were more level same time inr might have been higher On CVC gathering contrasted with UVC bunch without measurable hugeness distinction Also direct might have been the The greater part incessant condition around the two groups, In awful condition might have been All the more incessant over CVC assembly. However, there may be no huge Contrast the middle of the Assemblies in regards general condition. There might have been no noteworthy distinction in the occurrence about CABSI the middle of altogether preterm neonates who accepted a CVC alternately UVC Concerning illustration those elementary mode about venous get after conception. A prospective randomized regulated trial will be advocated will further aide act viewing essential venous get What's more diminishment from claiming spoiling.

A retrospective study on the oral health of patients in the intesive care unit

<p><strong>Introduction</strong>: the oral condition of patients in the Intensive Care Unit (ICU) is extremely important for clinical status monitoring,<br />as lesions in the oral mucosa may imply complications and worsening of the health status of these patients. A higher probability<br />of adherence, colonization, and bacterial infection in the oral cavity of patients in the ICU has also been reported. The poor oral<br />hygiene conditions of these patients may be related to the reduction of salivary flow and difficulties in maintaining oral hygiene in a<br />hospital environment, which rarely employs dentists on staff. <strong>Objective</strong>: to analyze the dental condition of patients admitted to the<br />ICU of Roberto Santos General Hospital, Salvador, Bahia, Brazil. <strong>Methodology</strong>: a total of 73 patients were evaluated through an oral<br />examination performed with a wooden spatula and sterile gauze under natural light, and data were collected and analyzed. <strong>Results</strong>:<br />The most commom oral lesions were tongue-coating (41%) and ulcerations in the oral mucosa caused by trauma or dehydration<br />(19.1%). The occurrence of pseudomembranous candidiasis (8.2%), dehydration of the lips and mucosa (26%), and angular cheilitis<br />(9.5%) was additionally recorded. It was observed that 31.5% patients had more than 10 days of hospitalization and of these, 26%<br />presented pseudomembranous candidiasis. This clinical condition was not seen in patients with a shorter hospital stay. <strong>Conclusions</strong>:<br />this study suggest a possible association between the length of stay of these patients and the clinical conditions presented. Thus, the<br />results of this study may guide preventive and curative measures implemented by dental surgeons who may, in the future, be part<br />of the multidisciplinary team of professionals working in the hospital environment, especially in ICUs.</p>

Use of REBOA to stabilize in-hospital iatrogenic intra-abdominal hemorrhage

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has become an increasingly popular alternative to emergency thoracotomy and aortic cross-clamping in patients with exsanguinating hemorrhage.1 This new capability is increasingly...

Su1980 - An Estimate of the Need for Intesive Care Unit Admissions in Adult Chronic Intestinal Failure Patients Treated with Home Parenteral Support at a Tertiary Referral Center

Su1980 - An Estimate of the Need for Intesive Care Unit Admissions in Adult Chronic Intestinal Failure Patients Treated with Home Parenteral Support at a Tertiary Referral Center

Evaluation of Nursing Workload in Intesive Care Unit

Evaluation of Nursing Workload in Intesive Care Unit

Evaluation of the effect of red cell distribution width on the development of acute renal failure in patients with sepsis

Objective: Acute kidney injury (AKI) is an important clinical entity that is known to increase mortality in patients with sepsis. Erythrocyte maturation and proliferation are inhibited by pro-inflammatory cytokines; these cytokines exert effects on red cell distribution width (RDW) well. Based on this knowledge; our aim in this study was to evaluate the impact of RDW on acute kidney injury in patients with sepsis. Methods: 120 patients diagnosed with sepsis and admitted to intesive care unit (ICU) and treated between 2009-2013 were retrospectively evaluated. Patients were divided into two groups as follows: group 1 (RDW≥16.8) and group 2 (RDW<16.8). Multiple logistic regression analysis was used to determine the association between RDW and AKI and mortality. Results: There was a statistically significant relationship between AKI and RDW (p<0.001, OR=11.52) but there were no statistically significant relationship between AKI and sex, age, serum lactate levels as well as SOFA score. Also, there were statistically significant relationship between mortality and RDW (p=0.044, OR=5), serum lactate levels (p=0.030) and SOFA score (p<0.001). RDW was found associated with both AKI and mortality. Conclusions: Results suggest that RDW is an important parameter for predicting development of AKI and mortality in ICU patients with sepsis.

A National Perspective on ECMO Utilization Use in Patients with Burn Injury.

Extracorporeal membranous oxygenation (ECMO) has become an increasingly utilized used strategy to support patients in cardiac and cardiopulmonary failure. The Extracorporeal Life Support Organization reports adult survival rates between 40 and 50%. Utilization Use and outcomes for burned patients undergoing ECMO are poorly understood. The National Burn Repository (version 8.0) was queried for patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9) procedure codes for ECMO. Demographics, comorbidities, mechanism, injury details, and clinical outcomes were recorded. ECMO patients were matched one-to-one to those not requiring ECMO based on age, gender, TBSA, and inhalation injury. Group comparisons were made utilizing using χ2 and Mann-Whitney U tests. Thirty ECMO-treated burn patients were identified. Patients were predominantly male (80.0%) and Caucasian (63.3%) with mean age 38.9 ± 20.3 years. The majority were flame injuries (80.0%) of moderate size (17.0 ± 18.7% TBSA), affecting predominantly upper limbs and trunk. Inhalation injury was reported in 26.7%. Respiratory failure was reported in nine, acute respiratory distress syndrome in three, and pneumonia in nine. Fourteen patients survived to discharge. The ECMO cohort had significantly higher rates of cardiovascular comorbidities, concomitant major thoracic trauma, pneumonia, acute renal failure, and sepsis than non-ECMO patients (P < .05). Ventilator usage, intesive care unit (ICU) length of stay, and mortality were also significantly higher in those treated by ECMO (P < .05). Although burn patients placed on ECMO have significantly higher rates of morbidity and mortality than those not requiring ECMO, the mortality rate is equivalent to patients reported by Extracorporeal Life Support Organization. ECMO is a viable option for supporting critically injured burn patients.

Antimicrobial Resistance Surveillance among Intensive Care Units of a Tertiary Care Hospital in Southern India.

Hospital Acquired Infections (HAIs) are the rising threat in the health care facilities across the globe. As most Intesive Care Unit (ICU) patients are frequently on broad spectrum antimicrobials, this induces selective antibiotic pressure which leads to development of Antimicrobial Resistance (AMR) among the microorganisms of ICUs. To study the occurrence of different types of HAIs in patients admitted to various ICUs of JIPMER and the AMR pattern of the bacterial pathogens isolated from them. The record based retrospective data of culture reports of the patients admitted to all the ICUs of JIPMER during the period from April 2015 to March 2016 were collected. A total of 3,090 isolates were obtained from the clinical specimens of 1,244 patients. Data on various factors like demographic characters, type of ICU, infecting organism, site of infection, type of HAI's and AMR including co-resistance were collected and analysed using Microsoft Excel. Most common culture positive clinical specimen received was tracheal aspirate (29.9%) followed by exudate (22.7%). Acinetobacter spp from tracheal aspirate and Pseudomonas spp from blood specimens were the most common organisms isolated; whereas Escherichia coli was the predominant organism found in urine, exudate and sterile fluid specimens. About 22.2% infections were HAIs, out of which pneumonia (6.24%) was the most common. Analysis of antimicrobial susceptibility pattern revealed that most of Gram-Negative Bacilli (GNB) was Multi Drug Resistant (MDR) i.e., resistant to three or more class of antibiotics such as cephalosporins, carbapenems, aminoglycosides, tetracyclines and fluoroquinolones. The prevalence of Methicillin- resistant Staphylococcus aureus (MRSA) and Vancomycin- resistant Enterococci (VRE) were found to be 40.6% and 11.9% respectively. The increasing trend AMR among the hospital acquired pathogens such as MDR-GNBs, MRSA and VRE pose a great threat to HCWs as well as to the other critically ill patients of the ICUs. Study on AMR surveillance is the need of the hour as it helps the centers to generate local antibiogram which further helps in formulating the national data. It also guides the clinicians to choose appropriate empirical therapy and assist escalation and de-escalation wherever possible. Hence, such studies will be a stepping stone in establishing antimicrobial stewardship and regulate the antimicrobial use.

Nosocomial infections in the Intesive care unit, University hospital for infectious and tropical diseases, Belgrade, Serbia

Nosocomial infections (NIs) are an important cause of morbidity, mortality and prolonged hospitalizations. Fifty percent of NIs have been reported in Intensive Care Units. The aim of this study was to determine the frequency and type of NIs among critically ill patients treated in the University Hospital for Infectious and Tropical Diseases, Clinical Centre of Serbia, as well as risk factors for acquiring them. This prospective cohort study included 52 patients treated in the Intensive Care Unit from January to June 2004. The diagnosis of NI was established according to the Centers for Disease Control and Prevention (CDC) definition, based on clinical presentation, radiological and microbiological findings, etc. Statistical data processing was done by using the electronic data base organized in SPSS for Windows version 10.0. The level of statistical significance was defined as p < 0.05. NIs were found in 33 (63.4%) of 52 inpatients. Urinary tract infections (UTIs), pneumonia, and soft tissue infections, the most common nosocomial infections in our setting, were recorded in 41.0%, 25.6%, and 23.1%, of patients, respectively. Several factors contributed to a high incidence of these infections: chronic comorbidities (p < 0.01), the presence of indwelling devices such as urinary tract catheters (p < 0.01), endotracheal tubes (p < 0.05) along with mechanical ventilation (p < 0.05). The majority of patients with NIs had chronic underlying comorbidities. All the patients with UTIs had urinary catheters. The most important risk factors for the development of nosocomial pneumonias were endotracheal intubation and mechanical ventilation. The patients with pneumonia had the highest mortality.

Trastornos del ánimo preoperatorios en cirugía cardiaca: factores de riesgo y morbilidad postoperatoria en la unidad de cuidados intensivos

Introduction and objectives To estimate the preoperative levels of anxiety and depression in patients awaiting heart surgery and to identify the risk factors associated with the development of these mood disorders. To evaluate the relationship between preoperative anxiety and depression and postoperative morbidity. Methods Prospective longitudinal study in a sample of 100 patients undergoing heart surgery. We carried out a preoperative structured interview in which the patient completed the Hospital Anxiety and Depression Scale, and sociodemographic (age, sex, marital status, and income) and surgical variables (surgical risk, type of surgery, length of preoperative hospital stay, and surgical history) were also recorded. Pain, analgesic use, and postoperative morbidity were evaluated in the intensive care unit. Results Thirty-two percent of the patients developed preoperative anxiety and 19%, depression. Age <65 years (odds ratio = 3.05; 95% confidence interval, 1.27-7.3) was the only significant risk factor for developing preoperative anxiety. A length of preoperative hospital stay ≥3 days was the main risk factor for preoperative depression (odds ratio = 4.59; 95% confidence interval, 1.6-13.17). Preoperative anxiety significantly increased the postoperative pain and analgesic consumption. Neither anxiety nor depression significantly modified the rest of the postoperative variables associated with morbidity in the intesive care unit. Conclusions Anxiety and depression are mood disorders that are detected in patients awaiting heart surgery, with age <65 years and a prolonged preoperative hospital stay being decisive factors in the development of these conditions. Although preoperative anxiety increased the postoperative pain in these patients, their state of mind did not modify their postoperative course. Full English text available from: www.revespcardiol.org

A protocol of no sedation for critically ill patients receiving mechanical ventilation: a randomised trial

Standard treatment of critically ill patients undergoing mechanical ventilation is continuous sedation. Daily interruption of sedation has a beneficial effect, and in the general intesive care unit of Odense University Hospital, Denmark, standard practice is a protocol of no sedation. We aimed to establish whether duration of mechanical ventilation could be reduced with a protocol of no sedation versus daily interruption of sedation. Of 428 patients assessed for eligibility, we enrolled 140 critically ill adult patients who were undergoing mechanical ventilation and were expected to need ventilation for more than 24 h. Patients were randomly assigned in a 1:1 ratio (unblinded) to receive: no sedation (n=70 patients); or sedation (20 mg/mL propofol for 48 h, 1 mg/mL midazolam thereafter) with daily interruption until awake (n=70, control group). Both groups were treated with bolus doses of morphine (2.5 or 5 mg). The primary outcome was the number of days without mechanical ventilation in a 28-day period, and we also recorded the length of stay in the intensive care unit (from admission to 28 days) and in hospital (from admission to 90 days). Analysis was by intention to treat. This study is registered with ClinicalTrials.gov, number NCT00466492. 27 patients died or were successfully extubated within 48 h, and, as per our study design, were excluded from the study and statistical analysis. Patients receiving no sedation had significantly more days without ventilation (n=55; mean 13.8 days, SD 11.0) than did those receiving interrupted sedation (n=58; mean 9.6 days, SD 10.0; mean difference 4.2 days, 95% CI 0.3-8.1; p=0.0191). No sedation was also associated with a shorter stay in the intensive care unit (HR 1.86, 95% CI 1.05-3.23; p=0.0316), and, for the first 30 days studied, in hospital (3.57, 1.52-9.09; p=0.0039), than was interrupted sedation. No difference was recorded in the occurrences of accidental extubations, the need for CT or MRI brain scans, or ventilator-associated pneumonia. Agitated delirium was more frequent in the intervention group than in the control group (n=11, 20%vs n=4, 7%; p=0.0400). No sedation of critically ill patients receiving mechanical ventilation is associated with an increase in days without ventilation. A multicentre study is needed to establish whether this effect can be reproduced in other facilities. Danish Society of Anesthesiology and Intensive Care Medicine, the Fund of Danielsen, the Fund of Kirsten Jensa la Cour, and the Fund of Holger og Ruth Hess.

Sensory Development in the Fetus, Neonate, and Infant: Introduction and Overview

The knowledge and understanding of the development of the sensory systems in the fetus, neonate, and infant have progressed and grown extensively in the past twenty to thirty years. This has been a result of the advances in technology for study of brain development and the sensory systems specifically. While the basic physcial structure of the sensory receptors (i.e. eyes, ears etc.) develops early in gestation, most of the neurosensory development occurs in the last sixteen to twenty weeks. The neurological processes are not accelerated by preterm birth. Preterm birth accelerates the maturation of the kidney, gastrointestinal, lung and cardiovascular function but does not alter the sequence or timing of neurodevelopment. The stresses and the environment of the Newborn Intesive Care Unit (NICU) play a major role in the altered neurodevelopment observed in preterm infants. The brain development in the fetus, neonate, and infant includes not just sensory systems but motor systems, social/emotional systems, and the cognitive systems. These systems are connected and integrated during development. The development of the brain, both structure and function, is shaped by the influence of four major factors or processes. These inlude (1) the genetic endowment and the epigenetic effects from the environment, (2) the endogenous or internal brain activity and sleep, (3) external experiences and stimulation of the sensory organs, and (4) the physical, chemical, sensory, and social/emotional environments. These factors operate on and influence the development of each of the brain systems. These effects depend on age and developmental level of the particular system. Many of the processes and stimulations needed to facilitate brain development can result in adverse effects if exposure is at the wrong time in development or the level of intensity is not appropriate. The NICU inviroment can have very adverse consequences for healthy nuerodevelopment. It is essential that the invironment of the fetus, neonate, infant be adapted and managed to provide for the healthy early brain development. This requires both a developmentally, supportive environment and developmentally appropriate care practices.

Acute liver failure. Current aspects of diagnosis and therapy

Disturbances of some partial liver functions, such as synthesis, excretion, or biotransformation of xenobiotics, are important for prognosis and ultimate survival in patients presenting with multiple organ dysfunction on the intesive care unit (ICU). The incidence of liver dysfunction is underestimated when traditional "static" measures such as serum-transaminases or bilirubin as opposed to "dynamic" tests, such as clearance tests, are used to diagnose liver dysfunction. Similar to the central role of the failing liver in MODS, extrahepatic complications, such as hepatorenal syndrome and brain edema develop in acute or fulminant hepatic failure and determine the prognosis of the patient. This is reflected in the required presence of hepatic encephalopathy in addition to hyperbilirubinemia and coagulopathy for the diagnosis of acute liver failure. In addition to these clinical signs, dynamic tests, such as indocyanine green clearance, which is available at the bed-side, are useful for the monitoring of perfusion and global liver function. In addition to specific and causal therapeutic interventions, e.g. N-acetylcysteine for paracetamol poisoning or termination of pregnancy for the HELLP-syndrome, new therapeutic measures, e.g. terlipressin/albumin or albumin dialysis are likely to improve the poor prognosis of acute-on-chronic liver failure. Nevertheless, liver transplantation remains the treatment of choice for fulminant hepatic failure when the expected survival is <20%.

Outcome of right hepatectomies in patients older than 70 years.

The increasing number of elderly patients undergoing liver resections mandates updating of clinical outcomes on this specific population. Case series. A tertiary care teaching hospital. Twenty-three patients older than 70 years who underwent right hepatectomies (including 7 extended right hepatectomies) between January 1, 1995, and October 31, 2001 (group 1) and 99 patients younger than 70 years who underwent 64 right hepatectomies and 35 extended right hepatectomies during the same period (group 2) were included for a total sample population of 122. Preoperative clinicopathological features, intraoperative factors, in-hospital mortality, postoperative complications, intensive care unit requirement, hospital stay, and course of main biochemical liver function test results of groups 1 and 2 were analyzed and compared. The 2 groups were similar for indications for surgery and the presence of underlying liver disease. Group 1 had a higher incidence of associated pulmonary diseases (21.7% vs 5%, P =.02) and patients with an American Society of Anesthesiologists score of III (ie, a patient with severe systemic disease limiting activity, but not incapacitating) (56.5% vs 26.3% of cases, P =.01). There were no differences in intraoperative requirement of packed red blood cells and in operation time. There were no in-hospital deaths in group 1; there were 2 deaths (2%) in group 2. Nine patients (39.1%) in group 1 and 32 patients (32.3%) in group 2 experienced postoperative complications (P =.53), of whom, respectively, 5 (21.7%) and 17 (17.2%) developed transient liver dysfunction (P =.56), and 4 (17.4%) and 5 (5.1%) required a supplementary intesive care unit stay (P =.06). The postoperative stay (mean [SD], 16 [14] days vs 13 [9] days, P =.88) and peak values of the aminotransferase level, total serum bilirubin level, and prothrombin time were similar in the 2 groups. The timing of the peak value of the total serum bilirubin level (mean [SD], 4.1 [4.8] days vs 2.5 [2.5] days, P =.28) and its period of normalization (mean [SD], 9.4 [10.8] days vs 6.7 [5.1] days, P =.67) were also similar for both groups. For patients with malignancies, the 3-year survival rate was 64.2% in group 1 and 53.9% in group 2 (P =.53). Being older than 70 years should not be a contraindication for major hepatectomies, provided that liver cirrhosis and severe associated medical conditions are ruled out during the preoperative evaluation.

250 Elevated troponin T is not associated with mortallity in the medical intesive care unit

250 Elevated troponin T is not associated with mortallity in the medical intesive care unit