Rescue bedside laparotomy in the intensive care unit in patients too unstable for transport to the operating room

INTRODUCTION: The prognoses of critically ill patients with a requirement for emergency laparotomy and severe respiratory and/or hemodynamic instability precluding transport to the operating room (OR) are often fatal without surgery. Attempting emergency surgery at the bedside might equally result in an adverse outcome. However, risk factors and predictors that could support clinical decision making have not been identified so far. This study describes the clinical characteristics, indicative pathophysiology and outcomes in patients undergoing resuscitative laparotomy in the intensive care unit (ICU). METHODS: This was a retrospective observational study of all critically ill adult patients undergoing resuscitative laparotomy in the ICUs of a German university hospital from January 2005 to July 2013. Clinical characteristics, risk factors, and treatments were compared between survivors and non-survivors. The primary endpoint was 28-day survival. RESULTS: A total of 41 patients with a median age of 64 (21 to 83) were included. The most frequent reasons for ICU admission were sepsis, pneumonia, and pancreatic surgery. All patients were mechanically ventilated, receiving vasopressors, and were in multiple organ failure. Twenty-nine patients (70.7%) were on renal replacement therapy and two patients (4.9%) on extracorporeal membrane oxygenation. The main reasons for surgery were suspected intra-abdominal bleeding (39.0%), suspected intestinal ischemia (24.4%) or abdominal compartment syndrome (24.4%). Twenty-eight-day, ICU and hospital mortalities were 75.6%, 80.5%, and 82.9%, respectively. In six out of ten patients (60%) who survived surgery for more than 28 days, bedside laparotomy was rated as a life-saving procedure by an interdisciplinary group of the investigators. CONCLUSIONS: These findings suggest that in selected critically ill patients with a vital indication for emergency laparotomy and severe cardiopulmonary instability precluding transport to the OR, a bedside resuscitative laparotomy in the ICU can be considered as a rescue procedure, even though very high mortality is to be expected

Advanced electron cyclotron heating and current drive experiments on the stellarator Wendelstein 7-X

During the first operational phase (OP 1.1) of Wendelstein 7-X (W7-X) electron cyclotron resonance heating (ECRH) was the exclusive heating method and provided plasma start-up, wall conditioning, heating and current drive. Six gyrotrons were commissioned for OP1.1 and used in parallel for plasma operation with a power of up to 4.3 MW. During standard X2-heating the spatially localized power deposition with high power density allowed controlling the radial profiles of the electron temperature and the rotational transform. Even though W7-X was not fully equipped with first wall tiles and operated with a graphite limiter instead of a divertor, electron densities of n e > 3·1019 m-3 could be achieved at electron temperatures of several keV and ion temperatures above 2 keV. These plasma parameters allowed the first demonstration of a multipath O2-heating scenario, which is envisaged for safe operation near the X-cutoff-density of 1.2·1020 m-3 after full commissioning of the ECRH system in the next operation phase OP1.2

Soft X-ray multiphoton excitation of small iodine methane derivatives

The fragmentation pattern of the iodine-containing molecules CH2I2CH2Is and CH3ICH3I following a strong multiphoton excitation in the vicinity of the iodine 4d giant resonance regime is studied using soft X-ray free electron laser radiation. A strong difference of the charge distribution and the kinetic energy release (KER) for the two molecules is found. The effects can be attributed to charge rearrangement processes induced by the photoexcitation. The difference in the observed distribution for higher charge states of iodine and carbon fragments is consistent with an over-the-barrier model for the charge rearrangement in the dissociating molecules. The KER for singly ionised carbon fragments indicates an ultrafast charge rearrangement before the dissociation starts

A Service-oriented Architecture for Emergency Management Systems

Abstract: The complexity and openness of today’s modern societies result in the threat of serious cascading effects when natural disasters or terrorist attacks strike. Thus, there is ahigh demand for state of the art IT support in the field of emergency management systems. In this paper, weidentify the core requirements of future emergency management systems and present anew generation of modular,service-oriented and semantic-webbased architecture for emergency management systems. Our emergency management system offers innovative functionality in the context of distributed information sources, collaborative work environments, and consistent situation pictures.