Anastomotic leak management after a low anterior resection leading to recurrent abdominal compartment syndrome: a case report and review of the literature

<p>Abstract</p> <p>Introduction</p> <p>Low anterior resection is usually the procedure of choice for rectal cancer, but a series of complications often accompany this procedure. This case report describes successful management of an intricate anastomotic leak after a low anterior resection.</p> <p>Case presentation</p> <p>A 66-year-old Caucasian man was admitted to our hospital and diagnosed with a low rectal adenocarcinoma. He underwent a low anterior resection but subsequently developed fecal peritonitis due to an anastomotic leak. He was operated on again but developed abdominal compartment syndrome, multi-organ failure and sepsis. He was aggressively treated in the intensive care unit and in the operating room. Overall, the patient underwent four laparotomies and stayed in the intensive care unit for 75 days. He was discharged after 3 months of hospitalization.</p> <p>Conclusion</p> <p>Abdominal compartment syndrome may present as a devastating complication of damage control laparotomy. Prompt recognition and goal-directed management are the cornerstones of treatment.</p

Hyperoxemia and excess oxygen use in early acute respiratory distress syndrome : Insights from the LUNG SAFE study

Publisher Copyright: © 2020 The Author(s). Copyright: Copyright 2020 Elsevier B.V., All rights reserved.Background: Concerns exist regarding the prevalence and impact of unnecessary oxygen use in patients with acute respiratory distress syndrome (ARDS). We examined this issue in patients with ARDS enrolled in the Large observational study to UNderstand the Global impact of Severe Acute respiratory FailurE (LUNG SAFE) study. Methods: In this secondary analysis of the LUNG SAFE study, we wished to determine the prevalence and the outcomes associated with hyperoxemia on day 1, sustained hyperoxemia, and excessive oxygen use in patients with early ARDS. Patients who fulfilled criteria of ARDS on day 1 and day 2 of acute hypoxemic respiratory failure were categorized based on the presence of hyperoxemia (PaO2 > 100 mmHg) on day 1, sustained (i.e., present on day 1 and day 2) hyperoxemia, or excessive oxygen use (FIO2 ≥ 0.60 during hyperoxemia). Results: Of 2005 patients that met the inclusion criteria, 131 (6.5%) were hypoxemic (PaO2 < 55 mmHg), 607 (30%) had hyperoxemia on day 1, and 250 (12%) had sustained hyperoxemia. Excess FIO2 use occurred in 400 (66%) out of 607 patients with hyperoxemia. Excess FIO2 use decreased from day 1 to day 2 of ARDS, with most hyperoxemic patients on day 2 receiving relatively low FIO2. Multivariate analyses found no independent relationship between day 1 hyperoxemia, sustained hyperoxemia, or excess FIO2 use and adverse clinical outcomes. Mortality was 42% in patients with excess FIO2 use, compared to 39% in a propensity-matched sample of normoxemic (PaO2 55-100 mmHg) patients (P = 0.47). Conclusions: Hyperoxemia and excess oxygen use are both prevalent in early ARDS but are most often non-sustained. No relationship was found between hyperoxemia or excessive oxygen use and patient outcome in this cohort. Trial registration: LUNG-SAFE is registered with ClinicalTrials.gov, NCT02010073publishersversionPeer reviewe

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P &lt; 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Correction to: Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

The original version of this article unfortunately contained a mistake

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Η σχέση της αντιλαμβανόμενης επάρκειας με την εκδήλωση επιθετικής συμπεριφοράς στο μάθημα της φυσικής αγωγής στο δημοτικό σχολείο

ΕΙΣΑΓΩΓΗ: Σκοπός της εργασίας ήταν να εξεταστεί κατά πόσο η αντιλαμβανόμενη επάρκεια (αυτοαντίληψη, αυτοεκτίμηση) του παιδιού σχετίζεται με τη συμπεριφορά του στο μάθημα της Φυσικής Αγωγής στο Δημοτικό Σχολείο. Η συμπεριφορά στο μάθημα της Φυσικής Αγωγής, εξετάστηκε μέσω της επιθετικότητας και του τίμιου παιχνιδιού. ΜΕΘΟΔΟΣ: Δείγμα της έρευνας αποτέλεσαν 388 μαθητές Ε΄ και ΣΤ΄ τάξεων, Δημόσιων Δημοτικών Σχολείων του Νομού Αττικής. Η επιλογή των σχολείων έγινε κατόπιν τυχαίας στρωσιγενούς δειγματοληψίας με ανάλογη εκπροσώπηση όλων των περιφερειών. Προηγήθηκε ενημέρωση των διευθυντών, υποδεικνύοντας την άδεια διεξαγωγής της έρευνας από το Υπουργείο Εθνικής Παιδείας και Θρησκευμάτων. Επίσης, ζητήθηκε ενυπόγραφη δήλωση συγκατάθεσης. Για την αξιολόγηση της αντιλαμβανόμενης επάρκειας χρησιμοποιήθηκε το ερωτηματολόγιο Πώς αντιλαμβάνομαι τον εαυτό μου-ΠΑΤΕΜ ΙΙ, ενώ για την αξιολόγηση της επιθετικής συμπεριφοράς χρησιμοποιήθηκε το Ερωτηματολόγιο επιθετικής συμπεριφοράς. Για την αξιολόγηση της συμπεριφοράς στις διαγωνιστικές δραστηριότητες της Φυσικής Αγωγής χρησιμοποιήθηκε το Ερωτηματολόγιο Τίμιου Παιχνιδιού. Τέλος, χορηγήθηκε το Ερωτηματολόγιο Κοινωνικής Επιθυμητότητας για να ελεγχθεί η διάθεση των παιδιών να δώσουν κοινωνικά επιθυμητές απαντήσεις. ΑΠΟΤΕΛΕΣΜΑΤΑ: Η ανάλυση των αποτελεσμάτων έδειξε ότι όλοι οι παράγοντες της αυτοαντίληψης εμφανίζουν αρνητική συσχέτιση με την επιθετικότητα, εκτός από την αθλητική ικανότητα. Στην προβλεπτική διαδικασία οι παράγοντες που έδειξαν να προβλέπουν τη γενική επιθετικότητα ήταν το φύλο και η διαγωγή-συμπεριφορά. Οι επιμέρους μεταβλητές της αντιλαμβανόμενης επάρκειας μπορούν να ερμηνευτούν ως μέρη της εκδήλωσης επιθετικής συμπεριφοράς, δεδομένου ότι οι συσχετίσεις τους θεωρούνται μέτριες έως υψηλές. ΣΥΖΗΤΗΣΗ: Η υψηλή αυτοεκτίμηση σχετίζεται με τη μειωμένη εμφάνιση επιθετικής συμπεριφοράς, ενώ οι παράγοντες που προβλέπουν την γενική επιθετικότητα είναι το φύλο και η διαγωγή-συμπεριφορά. Τα παιδιά που έχουν ισχυρή αντίληψη για τη διαγωγή τους, σέβονται τις τυπικότητες στον αθλητισμό, ενώ τα παιδιά που δεν έχουν καλή αντίληψη για τη σχολική τους ικανότητα ή υστερούν στη διαγωγή, είναι τα παιδιά που κάνουν τα πάντα για τη νίκη. Προτείνονται μελλοντικές έρευνες με συνδυασμό παρατήρησης και αναφορές γονέων