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Emergency Laparotomy in the Critically Ill: Futility at the Bedside
المؤلفون المشاركون
Martin, Niels D.
Patel, Sagar P.
Chreiman, Kristen
Pascual, Jose L.
Braslow, Benjamin
Reilly, Patrick M.
Kaplan, Lewis J.
المصدر
Critical Care Research and Practice
العدد
المجلد 2018، العدد 2018 (31 ديسمبر/كانون الأول 2018)، ص ص. 1-6، 6ص.
الناشر
Hindawi Publishing Corporation
تاريخ النشر
2018-08-26
دولة النشر
مصر
عدد الصفحات
6
التخصصات الرئيسية
الملخص EN
Background.
Critically ill patients are often evaluated for an intra-abdominal catastrophe.
In the absence of a preoperative diagnosis, abdominal exploration may be offered despite desperate circumstances.
We hypothesize that (1) abdominal exploration for such patients is associated with a high mortality and (2) commonly obtained physiologic measures at laparotomy anticipate mortality.
Methods.
All acute care surgery (ACS) patients undergoing emergency laparotomy at a quaternary referral center during a 3-year period were reviewed.
Inclusion was defined by emergency laparotomy in the operating room (OR) in a patient with an American Society of Anesthesiologists (ASA) score ≥4 or bedside laparotomy in the ICU (BSL).
Mortality was the primary endpoint and was stratified by demographics, admitting service, surgical findings, and physiology.
Comparisons between OR and BSL were by Fisher’s exact and Mann–Whitney tests.
Results.
144 patients underwent emergency laparotomy (45 BSL vs.
99 OR).
Overall mortality was 55.6% (77.8% BSL vs.
45.5% OR; p<0.001).
Mortality by admitting service was cardiac 71.4% (n=42), medical 70% (n=30), ACS 42% (n=50), and other 36.4% (n=22) services.
Preoperative lactate levels were higher in nonsurvivors (2.7 vs.
8.5 mmol/L, p<0.001), as was vasopressor use (62.5% vs.
97.5%, p<0.001), acute kidney injury (51.6% vs.
72.5%, p<0.01), leukocytosis (53.1% vs.
71.3%, p<0.04), and anemia (45.3% vs.
71.3%, p<0.01).
The presence of any identifiable abdominal pathology established a 90% mortality rate.
Conclusions.
The need for BSL portends an extremely high mortality rate and is likely useful in preintervention counselling.
Emergency OR laparotomy leads to mortality in nearly half of such patients and is anticipatable based on concurrent abnormal physiology.
نمط استشهاد جمعية علماء النفس الأمريكية (APA)
Martin, Niels D.& Patel, Sagar P.& Chreiman, Kristen& Pascual, Jose L.& Braslow, Benjamin& Reilly, Patrick M.…[et al.]. 2018. Emergency Laparotomy in the Critically Ill: Futility at the Bedside. Critical Care Research and Practice،Vol. 2018, no. 2018, pp.1-6.
https://search.emarefa.net/detail/BIM-1130449
نمط استشهاد الجمعية الأمريكية للغات الحديثة (MLA)
Martin, Niels D.…[et al.]. Emergency Laparotomy in the Critically Ill: Futility at the Bedside. Critical Care Research and Practice No. 2018 (2018), pp.1-6.
https://search.emarefa.net/detail/BIM-1130449
نمط استشهاد الجمعية الطبية الأمريكية (AMA)
Martin, Niels D.& Patel, Sagar P.& Chreiman, Kristen& Pascual, Jose L.& Braslow, Benjamin& Reilly, Patrick M.…[et al.]. Emergency Laparotomy in the Critically Ill: Futility at the Bedside. Critical Care Research and Practice. 2018. Vol. 2018, no. 2018, pp.1-6.
https://search.emarefa.net/detail/BIM-1130449
نوع البيانات
مقالات
لغة النص
الإنجليزية
الملاحظات
Includes bibliographical references
رقم السجل
BIM-1130449
قاعدة معامل التأثير والاستشهادات المرجعية العربي "ارسيف Arcif"
أضخم قاعدة بيانات عربية للاستشهادات المرجعية للمجلات العلمية المحكمة الصادرة في العالم العربي
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