Need For Rates Research Articles

Prognostic Value of Dysnatremia in COVID-19 Disease

Objective: The infection of Corona 2019 (COVID-19) had first diagnosed in December 2019 and evolved into a worldwide pandemic in March 2020. In Turkey first diagnose was announced in March 2020. Low costed and easily accessible laboratory parameters needed for predicting the prognosis of this disease as its outcome pattern vary greatly from patient to patient. There is promising data on predicting the outcomes with disnatremic results. Methods: In this study we retrospectively investigated all adults with the diagnosis of COVID-19 who attended to Turkan Ozilhan Hospital over a 3 months period. We evaluated the relation of dysnatremia (hyponatremia as <135 mmol/L or hypernatremia as >145 mmol/L) for need of intensive care unit (ICU) treatment, need of intubation for mechanic ventilatory support and inpatient mortality. Results: one thousand seventy tree patients with COVID-19 [53..9% males (793 patients) and 46.1% females (680 patients), were investigated for this study. Their median age was 53.9 years ranging betweent 19-94. The dysnatremic groups had significantly higher rates of need for ICU and intubation The need for ICU was 89 (21.5%) patients in normonatremic group but 38 (76%) patients in hypernatremic and 71 (64%) in hyponatremic patients (p<0.01 for each of them). The mortality rate was 5% in normonatremic patients but 50% in hypernatremic and 28% in hyponatremic patients (p<0.01 for each of them). Conclusion: In this study we aimed to draw attention to the importance of abnormal sodium levels as a predictive marker in COVID-19. In small town hospitals the physicians should be aware of the risks of disnatremic patients with COVID-19 and take precautions while treating them.

Reoperation, Readmission, and Discharge Disposition for Patients With Degenerative Lumbar Pathology Treated With Either Open or Minimally Invasive Techniques: A Single-Center Retrospective Review of 1435 Cases.

Spine surgery has been transformed by the growth of minimally invasive surgery (MIS) procedures. Previous studies agree that MIS has shorter hospitalization and faster recovery time when compared to conventional open surgery. However, the reoperation and readmission rates between the 2 techniques have yet to be well characterized. To evaluate the rate of subsequent revision between MIS and open techniques for degenerative lumbar pathology. A total of 1435 adult patients who underwent lumbar spine surgery between 2013 and 2016 were included in this retrospective analysis. The rates of need for subsequent reoperation, 30- and 90-d readmission, and discharge to rehabilitation were recorded for both MIS and traditional open techniques. Groups were divided into decompression alone and decompression with fusion. The rates of subsequent reoperation following MIS and open surgery were 10.4% and 12.2%, respectively (P=.32), which were maintained when subdivided into decompression and decompression with fusion. MIS and open 30-d readmission rates were 7.9% and 7.2% (P=.67), while 90-d readmission rates were 4.3% and 3.6% (P=.57), respectively. Discharge to rehabilitation was significantly lower for patients under 60 yr of age undergoing MIS (1.64% vs 5.63%, P=.04). The use of minimally invasive techniques for the treatment of lumbar spine pathology does not result in increased reoperation or 30- and 90-d readmission rates when compared to open approaches. Patients under the age of 60 yr undergoing MIS procedures were less likely to be discharged to rehab.

Audit of blood product utilization in the care of injured children.

Blood product utilization in injured children is poorly characterized; the decision to prepare products or transfuse patients can be difficult due to a lack of reliable evidence of transfusion needs across pediatric age-groups and injury types. We conducted an audit of transfusion practices in pediatric trauma based on age, injuries, and mechanism of injury. We reviewed and cross-referenced blood product transfusion practice data from the trauma registry and the anesthesia transfusion record database at a level 1 pediatric trauma center over a 10-year period. Demographic data, injury severity scores, and survival statistics were obtained from the trauma registry. Transfusion rates are reported separately for hospital admission and for intraoperative transfusions for procedures performed during the first two hospital days. Descriptive statistical analysis was used to compare specific groups based on age, injury type, and mechanism of injury. We report 14569 trauma admissions of 14606 patients. The transfusion rate during the admission was 1.56% (227/14569). 4591 (30.9%) admissions had surgical interventions in first two days of hospitalization with an intraoperative transfusion rate of 2.98%. Patients younger than one year had the highest transfusion rate during admission (2.8%), and the highest transfusion rate during surgical procedures performed in the first two days of the admission (18.87%). Admissions due to vascular injuries had the highest transfusion rates in infancy followed by hollow visceral injuries in adolescents (71.4% and 25%, respectively). Vascular injuries in most age-groups also had high transfusion rates ranging from 11% in 5- to 9-year age-group to 71% in infants. Mechanisms with the highest transfusion rates were firearm wounds in patients older than one year and vehicular accidents for patients younger than one year. The overall blood product needs in the pediatric trauma population are low (1.56%). Selected populations requiring higher rates of need include infants younger than one year, and children with thoracic and vascular injuries. Understanding transfusion patterns is important to optimize resource allocation.

Effect of Intraoperative Low Tidal Volume vs Conventional Tidal Volume on Postoperative Pulmonary Complications in Patients Undergoing Major Surgery

In patients who undergo mechanical ventilation during surgery, the ideal tidal volume is unclear. To determine whether low-tidal-volume ventilation compared with conventional ventilation during major surgery decreases postoperative pulmonary complications. Single-center, assessor-blinded, randomized clinical trial of 1236 patients older than 40 years undergoing major noncardiothoracic, nonintracranial surgery under general anesthesia lasting more than 2 hours in a tertiary hospital in Melbourne, Australia, from February 2015 to February 2019. The last date of follow-up was February 17, 2019. Patients were randomized to receive a tidal volume of 6 mL/kg predicted body weight (n = 614; low tidal volume group) or a tidal volume of 10 mL/kg predicted body weight (n = 592; conventional tidal volume group). All patients received positive end-expiratory pressure (PEEP) at 5 cm H2O. The primary outcome was a composite of postoperative pulmonary complications within the first 7 postoperative days, including pneumonia, bronchospasm, atelectasis, pulmonary congestion, respiratory failure, pleural effusion, pneumothorax, or unplanned requirement for postoperative invasive or noninvasive ventilation. Secondary outcomes were postoperative pulmonary complications including development of pulmonary embolism, acute respiratory distress syndrome, systemic inflammatory response syndrome, sepsis, acute kidney injury, wound infection (superficial and deep), rate of intraoperative need for vasopressor, incidence of unplanned intensive care unit admission, rate of need for rapid response team call, intensive care unit length of stay, hospital length of stay, and in-hospital mortality. Among 1236 patients who were randomized, 1206 (98.9%) completed the trial (mean age, 63.5 years; 494 [40.9%] women; 681 [56.4%] undergoing abdominal surgery). The primary outcome occurred in 231 of 608 patients (38%) in the low tidal volume group compared with 232 of 590 patients (39%) in the conventional tidal volume group (difference, -1.3% [95% CI, -6.8% to 4.2%]; risk ratio, 0.97 [95% CI, 0.84-1.11]; P = .64). There were no significant differences in any of the secondary outcomes. Among adult patients undergoing major surgery, intraoperative ventilation with low tidal volume compared with conventional tidal volume, with PEEP applied equally between groups, did not significantly reduce pulmonary complications within the first 7 postoperative days. ANZCTR Identifier: ACTRN12614000790640.

Systematic review and meta-analysis of outcomes of anatomic repair in congenitally corrected transposition of great arteries.

BACKGROUNDTreatment of congenitally corrected transposition of great arteries (cc-TGA) with anatomic repair strategy has been considered superior due to restoration of the morphologic left ventricle in the systemic circulation. However, data on long term outcomes are limited to single center reports and include small sample sizes.AIMTo perform a systematic review and meta-analysis for observational studies reporting outcomes on anatomic repair for cc-TGA.METHODSMEDLINE and Scopus databases were queried using predefined criteria for reports published till December 31, 2017. Studies reporting anatomic repair of minimum 5 cc-TGA patients with at least a 2 year follow up were included. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software.RESULTSEight hundred and ninety-five patients underwent anatomic repair with a pooled follow-up of 5457.2 patient-years (PY). Pooled estimate for operative mortality was 8.3% [95% confidence interval (CI): 6.0%-11.4%]. 0.2% (CI: 0.1%-0.4%) patients required mechanical circulatory support postoperatively and 1.7% (CI: 1.1%-2.4%) developed post-operative atrioventricular block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5% (CI: 89.5%-95.4%) per 100 PY and a low rate of need for pacemaker (0.3/100 PY; CI: 0.1-0.4). 84.7% patients (CI: 79.6%-89.9%) were found to be in New York Heart Association (NYHA) functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3 per 100 PY (CI: 3.8-6.8).CONCLUSIONOperative mortality with anatomic repair strategy for cc-TGA is high. Despite that, transplant free survival after anatomic repair for cc-TGA patients is highly favorable. Majority of patients maintain NYHA I/II functional class. However, monitoring for burden of re-interventions specific for operation type is very essential.

Patterns of Youth Mental Health Service Use and Discontinuation: Population Data From Australia's Headspace Model of Care.

Young people (ages 12-25) experience the highest risk of developing mental disorders; however, their uptake of and engagement with treatment is low. The study explored sociodemographic predictors of attendance and discontinuation of mental health services in a large, population-based sample. Data were from the minimum data set collected from young people (ages 12-25) who attended headspace, Australia's National Youth Mental Health Foundation, from 2013 to 2017 (N=80,502). Data on key demographic and clinical variables and practitioner ratings of need for ongoing care were analyzed. Cox regression was used to examine the association between sociodemographic factors and rates of discontinuation based on practitioner-rated need for ongoing treatment. The mean±SD number of sessions attended during the first episode of care was 4.6±4.4 sessions (median=3). Session-by-session discontinuation rates ranged from 14% to 19% across 10 sessions. The proportion discontinuing treatment before session 11 was 71.2%. Analysis of a subgroup (N=40,039) showed that 24% of those who discontinued treatment later returned to the same headspace center for a second episode of care. Those who were most at risk of discontinuation were older (ages 18-25), male, heterosexual, Aboriginal or Torres Strait Islander, and living in a rural location. Sociodemographic factors were found to be associated with treatment discontinuation, and some young people followed a pathway in and out of mental health treatment. Further exploration is needed to determine the appropriate length and type of care for specific sociodemographic groups and how best to tailor treatment accordingly.

The issue of permanent pacemaker implantation following cardiac surgery

The issue of postoperative arrhythmias requiring pacemaker therapy is widely studied in the field of cardiac surgery and it is a complex perioperative problem. The aim of this paper is to summarize the relevant international guidelines and recommendations and to present our hospital's experience. We present the current, decisive recommendations and important studies, and present patients who underwent pacemaker implantation within one month after cardiac surgery between 01. 01. 2014 and 31. 12. 2018 in our hospital and compare them with the international findings. According to the international literature, the rate of permanent pacemaker implantation after cardiac surgery ranges from about 1.5% to 5%, and this rate seems to increase later. We have detailed information and many identified predictors about the development of conduction disturbances, but the current guidelines provide only weak recommendations. In the early perioperative period (1 month), pacemaker implantation was required in 15 cases (0.55%); in the course of long-term follow-up, 6 patients were still pacemaker-dependent. Perioperative arrhythmias are frequent and serious complications after cardiac surgery, prolong patient recovery time and put financial burden on the hospitals. The rate of need for a permanent pacemaker is low in our hospital, and in the late follow-up we can find only a small part of patients with pacemaker dependency. It would be necessary to start a prospective study and to develop a standardized protocol based on the information currently available. This would be a useful and authoritative help for the postoperative care in cardiac surgery. Orv Hetil. 2020; 161(31): 1271-1280.

Training Needs Among Family Caregivers Assisting During Home Health, as Identified by Home Health Clinicians

ObjectivesTo estimate the proportion of family caregivers assisting older adults during Medicare home health who have an identified need for activity-specific training and identify characteristics associated with caregiver training needs. DesignNationally representative retrospective cohort study. Setting and Participants1758 (weighted n = 8,477,990) Medicare beneficiaries who participated in the National Health and Aging Trends Study (NHATS) and received Medicare-funded home health care between 2011 and 2016. MeasuresOlder adult and caregiving network characteristics before home health (sociodemographic factors, caregiver assistance, older adult health and function) were drawn from NHATS; characteristics during home health (family caregiver training needs, older adult health and function) were drawn from home health patient assessments. Weighted proportions of family caregivers with an identified need for activity-specific training were estimated. Weighted, multivariable logistic regressions modeled associations between older adult/caregiving network characteristics and family caregivers’ identified activity-specific training needs during home health. ResultsMore than 1 in 3 (35.7%) family caregivers assisting older adults during Medicare home health had an identified training need with at least 1 caregiving activity. Rates of need for training varied widely, from 8.6% among caregivers helping with advocacy to 48.2% among caregivers helping with medical procedures. In weighted analyses that adjusted for older adults’ health and function, family caregivers were less likely to have identified training needs when assisting older adults with ongoing disability or who received caregiver assistance before home health admission. Conclusions and ImplicationsFindings highlight the pervasiveness of family caregivers' training needs, particularly with medically oriented activities, and indicate that escalations in older adults’ care needs are linked to caregiver training needs. Therefore, transitions of care may present critical opportunities to connect family caregivers with training resources.

Plasma N-terminal pro-brain natriuretic peptide level as a marker of adverse outcome in patients with co-existing diabetes, chronic kidney disease and heart failure

Introduction: N-terminal pro–B-type natriuretic peptide (NT-proBNP) is a novel marker of cardiac disease and heart failure; both are in patients with diabetes and chronic kidney disease. Objectives: This study aimed to investigate the NT-proBNP and adverse outcome in patients with diabetes complicated by chronic kidney disease (CKD). Patients and Methods: We measured the serum levels of NT-proBNP. The association of this novel marker with re-hospitalization and mortality rate were prospectively compared among the studied groups. Results: Among 120 patients, baseline NT-proBNP at the time of admission was significantly elevated in patients with CKD (P= 0.001). Levels of NT-proBNP were significantly elevated in patients with diabetes and CKD than those with CKD alone (P= 0.04) at the end of follow-up. Higher proBNP levels significantly correlated with decreased glomerular filtration rate (GFR) and higher serum creatinine levels (P= 0.03, P< 0.001, respectively). In addition, increased mortality was noticed in those patients. Conclusion: NT-proBNP levels have prognostic implication in the setting of CKD, diabetes mellitus and heart failure. Adverse outcomes are; a higher rate of need for dialysis, re-hospitalization and increased mortality which are correlated with levels of NT-proBNP.

The Effectiveness of Bupivacaine in Decrease Post-Operative Pain After Lumbar Decompression Surgery

Aim: There are many reports about the efficacy of analgesics in reducing postoperative pain after lumbar decompressive surgery. This study aimed to investigate the effect of subdermal and intramuscular injection of bupivacaine on the severity of postoperative pain after lumbar decompression surgery. Material and Methods: in this randomized double-blind trial, 50 patients who candidate for lumbar decompressive surgery elective for this them. Bupivacaine (0.25%) in the intervention group and normal saline (40 ml) in the control group were injected subcutaneously and intramuscularly. Factors of age, size of surgical cutting, number of operating space, duration of operation, the rate of need to analgesia, and the severity of pain at times of 3,12 and 24 hours after surgery were assessed. Results: The severity of pain in Bupivacaine group, in hours 3, 12 and 24 after postoperative surgery was less than control group (P value<0.05). Also There was no significant difference between the two groups in terms of mean pain intensity using repeated measure design (P value<0.05). But within Bupivacaine group, pain severity significantly decreased during the 24 hours after surgery. (p<0.05) Conclusion: Although bupivacaine (0.25%) results in reducing pain after surgery, more studies are recommended to investigate the effect of bupivacaine in combination with other drugs in cases of lumbar decompressive surgery. Also, it reduces pain during the 24 hours after surgery is very important.

Outcomes of Ahmed glaucoma valve FP8 versus FP7 in adult secondary glaucoma.

To compare the outcomes of Ahmed glaucoma valve (AGV) pediatric FP8 versus the large-sized adult FP7 implants in an adult secondary glaucoma. Patients who underwent AGV implantation from January 2011 to December 2016 for adult secondary glaucoma (due to causes other than post-vitreoretinal/buckle surgery glaucoma) with a follow-up of 6months were included for this retrospective study. Success was defined as IOP > 6mm Hg and < 21mm Hg without any loss of vision, with or without the need of anti-glaucoma medications or additional procedures for control of IOP. Hypertensive phase was defined as IOP > 21mmHg at any visit in the first 6months of postoperative follow-up period, while failure was defined as IOP > 21mm Hg even after medications or additional procedures, need of removal of implant or loss of light perception. Cumulative survival rates and intraoperative or postoperative complications along with IOP profiles were compared between the implants. Of 43 patients, 19 patients underwent FP7 and 24 patients underwent FP8 Ahmed Glaucoma valve implantation. The IOP significantly reduced in both groups from baseline (31 ± 8.2mm Hg in FP7 eyes and 37 ± 13.1mm Hg in FP8 eyes) by a mean of 64 ± 23.5% in FP8 and 64 ± 21.5% in FP7 group, respectively, p = 0.8 with comparable final IOP of 16.5mm Hg and 16.9mm Hg, respectively, p = 0.9. Both groups had 75% qualified success rates at 20months after surgery with similar rates of need for postoperative medications or incidence of hypertensive phase. The FP8 eyes had more frequent conjunctiva-related complications in eyes with prior surgeries and preoperative conjunctival scarring while the other complications were similar in the two groups. Surgical outcomes of adult FP7 and pediatric FP8 AGV in adult secondary glaucoma seem to achieve similar IOP control and success rates. This suggests that smaller-sized FP8 can be used in adult glaucoma with good surgical outcomes albeit with careful case selection in eyes with extensive preoperative scarring to avoid conjunctival thinning-related complications postoperatively.

Youth Matters: Philly (YMP): Development, usability, usefulness, & accessibility of a mobile web-based app for homeless and unstably housed youth

BackgroundYoung people experiencing homelessness accounted for about 7% of the total homeless population in the United States in 2018. These young people are among the most marginalized youth populations and face numerous hardships. Accessing and connecting with provider organizations is challenging for these young people for myriad reasons related to their marginalization and vulnerability. As a result, homeless and unstably housed youth exhibit low rates of health and social service utilization, despite high rates of need. Objectives(1) To document the development of a mobile web-based app called Youth Matters: Philly (YMP) for young people experiencing homelessness or unstable housing that is designed to help them search, identify, locate, and utilize Philadelphia-based social and health services; and, (2) To explore youth’s perceptions of the usability, usefulness, and accessibility of YMP. MethodsWe used the Mobile App Rating Scale (MARS) to assess young people’s perceptions of YMP’s usability, usefulness, and accessibility. Ten young people who either were currently experiencing homelessness/unstable housing or recently had experienced such hardship participated in the study. During a two-week window, participants logged onto YMP at least three times and searched for resources. They then completed the MARS. Participants were between the ages of 18 and 25 years old (M = 21.5 years; SD = 2.3 years), mostly female (67%), and mostly black/African American (67%). Thirty percent identified as Hispanic/Latinx. All had spent time in foster care and aged out, with an average length of 8.1 years in care (SD = 4.0 years). We used Qualtrics to collect all data and descriptive statistics to analyze all data in SPSS. ResultsThe mean scores on the subscales of the MARS (Engagement, Functionality, Aesthetics, and Information) ranged from 3.60 (Aesthetics) to 3.98 (Functionality; Information) out of 5. The mean score for overall Quality was 3.47 (out of 5). We also asked a set of questions specific to YMP to assess perceived impact of the app on the respondents’ awareness, knowledge, attitudes, help seeking, and behavior change related to experiencing homelessness and unstable housing. For all questions, at minimum, all participants “somewhat agreed.” ConclusionsYMP is a promising way to increase engagement and overcome barriers to accessing services for youth experiencing homelessness or unstable housing. Findings offer insights into ways to improve future versions of YMP. YMP also offers a model for other localities committed to improving access to services for young people experiencing homelessness or unstable housing. Future research directions for YMP and similar technology are discussed.

319. Minimally invasive surgery for neuromuscular scoliosis: a case control study of 140 consecutive patients

BACKGROUND CONTEXT Minimally invasive surgery (MIS) has been shown to have benefits in adolescent idiopathic scoliosis (AIS) and adult scoliosis with regards to estimated blood loss (EBL), transfusion rate, pain, narcotic usage and hospital stay. These benefits are ideal for neuromuscular scoliosis (NMS) patients, who generally have larger and stiffer curves which are at risk of progression, even with bracing. PURPOSE The purpose of this study was to report a consecutive case series of NMS patients undergoing MIS or standard PSF. STUDY DESIGN/SETTING Retrospective chart review. PATIENT SAMPLE A total of 37 NMS patients treated with MIS and 103 NMS patients treated with PSF. OUTCOME MEASURES Pre- and postoperative Cobb angle, pre- and postoperative kyphosis, pre- and postoperative pelvic obliquity, perioperative complications, surgery time, EBL, transfusion rates, ICU length of stay, hospital length of stay. METHODS We retrospectively collected data of 37 consecutive patients with neuromuscular scoliosis treated with MIS using 1 incision and a muscle-splitting approach by 2 senior surgeons from 2013-2018. 103 NMS patients treated with standard PSF and pedicle screw constructs were retrospectively reviewed in comparison. RESULTS In the MIS group, respectively the control group, the mean Cobb angle was corrected from 69.9° vs 67.7° to 29.4° vs 25.4° with a mean correction of 59% vs 63%, (p CONCLUSIONS The use of MIS for patients with neuromuscular scoliosis results in a significant correction of spinal deformity, with a low EBL, a significantly lower rate of need for allogenic blood transfusion, and a shorter LOS. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Long-term outcomes after low power, slower movement versus high power, faster movement irrigated-tip catheter ablation for atrial fibrillation

High power, shorter duration (HPSD) ablation strategies have been advocated to increase efficacy and minimize posterior wall deep tissue thermal injury during atrial fibrillation (AF) ablation. The purpose of this study was to determine the long-term outcomes of arrhythmia-free survival from AF and atrial flutter (AFL) between HPSD and low power, longer duration (LPLD) ablation strategies. Of a total of 1333 first time AF ablation procedures with 3 years of follow-up, propensity-matched populations for baseline risk factors were created, comprising 402 patients treated with LPLD ablation (30 W for 5 seconds: posterior wall; 30 W for 10-20 seconds: anterior wall) and 402 patients treated with HPSD ablation (50 W for 2-3 seconds: posterior wall; 50 W for 5-15 seconds: anterior wall). AF/AFL outcomes after a 90-day blanking period were assessed. HPSD ablation was associated with shorter procedure and fluoroscopy times (P < .0001 for both). The recurrence of AF at 1 year (12.9% vs 16.2%; P = .19) and 3 years (26.5% vs 30.7%; P= .23) was similar between LPLD and HPSD groups. AFL was higher at 1 year (7.2% vs 11.2%; P = .03) and 3 years (16.1% vs 21.8%; P= .06; P = .04 after multivariate adjustment) with HPSD ablation. Patients who underwent an LPLD approach had lower rates of need for repeat ablation (21% vs 30%; P = .002). Long-term freedom from AF rates were not significantly different between both approaches. An HPSD ablation strategy compared with an LPLD approach was associated with an increased risk of AFL and need for repeat ablation but with lowered procedure times.

Behavioral Health Service Utilization and Unmet Need After Traumatic Brain Injury in Childhood.

The need for behavioral health services, service utilization, and predictors of utilization was examined in children with moderate-to-severe traumatic brain injury (TBI) relative to a comparison group of children with orthopedic injury (OI) 6.8 years after injury. A total of 130 children hospitalized for moderate-to-severe TBI (16 severe and 42 moderate) or OI (72) between the ages of 3 and 7 years, who were enrolled at the time of injury at 3 tertiary care children's hospital and one general hospital in Ohio, and completed a long-term follow-up 6.8 years after injury were included in analyses. Adolescents with TBI (moderate [38%] and severe [69%]) had significantly greater rates of need than those with OI (17%). Behavioral health services were utilized by 10% of the sample with no injury group differences (OI: 6%; moderate: 17%; severe: 13%). Early treatment and white race were associated with less service utilization; 77% had an unmet need, with no injury group differences (OI: 75%; moderate: 75%; severe: 82%). Rate of unmet need was greater among white than non-white children. Children who sustain a TBI in early childhood experience persistent and clinically significant impairments even years after injury. Rates of unmet need were high for all injury groups. Findings underscore the importance of long-term monitoring to identify developing needs and prevent significant complications/deficits.

Ten years of severe respiratory syncytial virus infections in a tertiary paediatric intensive care unit.

To describe the epidemiology and treatment of respiratory syncytial virus (RSV) infection in a tertiary paediatric intensive care unit (PICU), including the clinical presentations, comorbidities, respiratory support required, costs and outcomes. This study was an analysis of a database for all children with RSV infections admitted to the PICU in Melbourne between 2005 and 2015. A total of 604 episodes of community-acquired RSV infections were analysed, and the median age of children was 4 months (interquartile range 2-14 months); 94% of cases had lower respiratory tract infection, principally bronchiolitis, and 8.9% presented with extrapulmonary features. Respiratory support included humidified high-flow nasal cannula oxygen therapy (76% of patients since its introduction in 2011), non-invasive ventilation (41%) and intubation and mechanical ventilation (32%). Almost half (n = 270; 45%) had one or more pre-existing comorbid condition. Risk factors for intubation and mechanical ventilation were presence of comorbidities (odds ratio 1.97; confidence interval 1.39-2.79, P < 0.001) and transfer from an external hospital (odds ratio 1.82; confidence interval 1.58-2.57, P < 0.001). Of the children without pre-existing comorbidities, 25% required intubation and mechanical ventilation. Following the introduction of humidified high-flow nasal cannula oxygen therapy, the number of annual PICU admissions for RSV infection doubled; however, the number of children requiring intubation remained unchanged. The median length of intensive care unit stay was 3.7 days and further hospital stay was 3.6 days, and the average cost per case was approximately AU$20000. RSV infection carries a high burden in PICU, in bed-days and cost. Chronic comorbidities and transfer from a peripheral hospital were associated with a higher rate of need for mechanical ventilation.

Retrograde nailing versus locked plating for distal femur fractures

Purpose Two major therapeutic principles can be employed for the treatment of distal femoral fractures: Retrograde Intramedullary Nail (RIN) or locked plating (LP). Both operative stabilizing systems follow the principle of biological osteosynthesis. Intramedullary nailing protects the soft tissue envelope owing to its minimally invasive approach and closed reduction techniques better than distal femoral LP. The purpose of this study was to evaluate and compare outcome of distal femur fracture stabilization using RIN or LP techniques. Patients and methods In a prospective study from 2014 to 2015, we analyzed 30 patients with distal femur fracture who had been treated by RIN (15 patients) or LP (15 patients). The patients had a mean age of 49 years (20–85 years). Mechanism of injury was high-energy impact in 66.7% and low-energy injury in 33.3%. Fractures were classified according to Association for Osteosynthesis (AO) classification: there were 17 type A fractures and 13 type C1 fractures. Functional and radiological outcomes were assessed. Results Clinical and radiographic evaluation according to the functional score of Sanders and colleagues demonstrated that, in RIN group, one (6.6%) case was excellent, nine (60%) cases were good, and four (26.8%) cases were fair, whereas in locked compression plates (LCP) group; eight (53.2%) cases were good, four (26.8%) cases were fair, and three (20%) cases were poor. In RIN group, the average time of fracture union was 19.5 weeks, with a range of 12–28 weeks. Of 15 cases, 14 (93.4%) cases progressed to union, and one (6.6%) case had delayed union and need dynamization. In LCP group, average time was 27.65 weeks, with a range of 12–32 weeks. Of 15 cases, 12 (80%) cases progressed to union, one (6.6%) case had nonunion, and two (13.4%) cases had delayed union. Conclusion Both femoral retrograde interlocking nail and LCP of distal femur appear to have statistically insignificant differences regarding knee motion, pain, resuming function, and rate of need of second surgery. However, retrograde nail is preferable to LP in terms of operative time, blood loss, image intensifier exposure time, early appearance of callus, weight bearing, and shorter time required for full union.

Procedural findings and clinical outcome of second-generation cryoballoon ablation in patients with variant pulmonary vein anatomy.

The procedural findings and clinical outcome of second-generation cryoballoon (CB2) ablation in patients with variant pulmonary vein (PV) anatomy have not been fully investigated. A total of 424 consecutive patients who underwent PV isolation with CB2 were included. Computed tomographic (CT) scan was performed in all patients before the procedure. The study population was divided into common PV, accessory PV, and nonvariant PV groups according to the CT scan. Procedural findings and clinical outcome between the three groups were compared. Variant PV anatomy was observed in 118 of 424 (27.8%) patients. PV isolation was successfully achieved in all patients in three groups with low rates of need for touch-up ablation (P = 0.974). Total procedure time was longer in the accessory PV group compared with nonvariant PV group (53.7 ± 12.9 vs 49.5 ± 8.8 minutes; P < 0.001). More number of applications per patient were required in accessory PV group compared with the nonvariant PV and common PV groups (7.5 ± 2.1 vs 6.5 ± 1.6, P < 0.001; 7.5 ± 2.1 vs 6.8 ± 1.4, P = 0.027, respectively). No significant difference in phrenic nerve (PN) injury was observed between the three groups (P = 0.693). During mean follow-up duration of 16.1 ± 3.3 months, there was no significant difference in rates of atrial fibrillation (AF) recurrences in the three groups (13 of 43 common PV group, 21 of 75 accessory PV group, and 80 of 306 nonvariant PV group, P = 0.178). Variant PV patterns are common in patients undergoing ablation for drug-resistant AF. CB2 ablation appears to be a reasonable strategy in the setting of the variant PV anatomy with a small increase in procedure time and the number of cryoapplications.

Outcomes of Anatomic Repair in Patients with Congenitally Corrected Transposition of Great Arteries: Systematic Review and Meta-analysis

Introduction Anatomic repair of congenitally corrected transposition of great arteries (cc-TGA) has long held the promise of prevention of congestive heart failure by restoring the systemic ventricle function to the morphologic left ventricle. However data are limited and variable. We intended to perform a pooled analysis to try and delineate the outcomes after anatomic repair. Methods A comprehensive search of Medline and Scopus databases from inception through Dec 31, 2017 was conducted using predefined criteria. We included studies reporting anatomic repair of minimum 5 cc-TGA patients with a follow-up duration of 2 years or more. Meta-analysis was performed using Comprehensive meta-analysis v3.0 software. Random effects modelling was used because of observational nature of pooled data. Results In 21 eligible studies, 895 patients underwent anatomic repair with a pooled follow-up of 5457.2 person-years (PY). There was an even split between patients treated with the double switch operation and the atrial switch / ventricular re-routing operation. Pooled estimate for operative mortality was 8.3% (95% CI: 6.0-11.4%). 0.2% (CI: 0.1-0.4%) patients required ECMO/LVAD postoperatively and 1.7% (CI: 1.1-2.4%) developed post-operative AV block requiring a pacemaker. Patients surviving initial surgery had a transplant free survival of 92.5%(CI: 89.5-95.4%) per 100 PY and a low rate of need for pacemaker (0.5% / year; CI: 0.2-0.8%). 84.7% patients (CI: 79.6-89.9%) were found to be in NYHA functional class I or II after 100 PY follow up. Total re-intervention rate was 5.3% per year (CI: 3.8-6.8%). Incidence of baffle stenosis, AV valve dysfunction, neo-aortic insufficiency and LVOT obstruction were estimated at 1.1% (CI: 0.8-1.5%); 0.3% (CI: 0.2-0.5%); 0.5% (CI: 0.2-0.9%) and 0.4% (CI: 0.1-0.6%) per year. Rate of development of LV dysfunction was 1.7%/ year (CI: 1.0-2.4%). Conclusions Despite a relatively high operative mortality, our study provides favorable updated estimates for follow-up outcomes after anatomic repair for cc-TGA patients. The pooled data suggests need for active monitoring over the long term for important complications including heart block and worsening ventricular dysfunction despite majority of patients being in NYHA class I/II.

THE EARLY USE OF NON-INVASIVE VENTILATION FOR ACUTE RESPIRATORY FAILURE IN ICU

Background: The noninvasive ventilation (NIV) can prevent the need for intubation and the mortality associated with episodes of chronic obstructive pulmonary disease (COPD), pneumonia, asthma... The aim of this study was to find whether the introduction of NPPV early after the admission was effective at reducing the need for intubation and the mortality rate. Methods: Patients were recruited from 9/2017 to 5/2018. CPAP mode delivered through a face mask may be used. Blood gas was tested after 3 hrs. Results: 31 patients were recruited, The use of NIV significantly reduced the need for intubation. The failure rate must set an local management in the research group is 19,8%. Conclusions: The early use of NIV in ICU improved arterial blood gas, decreases the rate of need for intubation and reduces the mortality in patients with moderate respiratory failure. Key words: noninvasive ventilation (NIV), failure in ICU