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Elizabeth D. Krebs Robert B. Hawkins J. Hunter Mehaffey Clifford E. Fonner Alan M. Speir Mohammed A. Quader Jeffrey B. Rich Leora T. Yarboro Nicholas R. Teman Gorav Ailawadi 《The Journal of thoracic and cardiovascular surgery》2019,157(4):1533-1542.e2
Objectives
Expedient extubation after cardiac surgery has been associated with improved outcomes, leading to postoperative extubation frequently during overnight hours. However, recent evidence in a mixed medical-surgical intensive care unit population demonstrated worse outcomes with overnight extubation. This study investigated the impact of overnight extubation in a statewide, multicenter Society of Thoracic Surgeons database.Methods
Records from 39,812 patients undergoing coronary artery bypass grafting or valve operations (2008-2016) and extubated within 24 hours were stratified according to extubation time between 06:00 and 18:00 (day) or between 18:00 and 6:00 (overnight). Outcomes including reintubation, mortality, and composite morbidity-mortality were evaluated using hierarchical regression models adjusted for Society of Thoracic Surgeons predictive risk scores. To further analyze extubation during the night, a subanalysis stratified patients into 3 groups: 06:00 to 18:00, 18:00 to 24:00, and 24:00 to 06:00.Results
A total of 20,758 patients were extubated overnight (52.1%) and were slightly older (median age 66 vs 65 years, P < .001) with a longer duration of ventilation (4 vs 7 hours, P < .001). Day and overnight extubation were associated with equivalent operative mortality (1.7% vs 1.7%, P = .880), reintubation (3.7% vs 3.4%, P = .141), and composite morbidity-mortality (8.2% vs 8.0%, P = .314). After risk adjustment, overnight extubation was not associated with any difference in reintubation, mortality, or composite morbidity-mortality. On subanalysis, those extubated between 24:00 and 06:00 exhibited increased composite morbidity-mortality (odds ratio, 1.18; P = .001) but no difference in reintubation or mortality.Conclusions
Extubation overnight was not associated with increased mortality or reintubation. These results suggest that in the appropriate clinical setting, it is safe to routinely extubate cardiac surgery patients overnight. 相似文献15.
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目的 分析肝内胆管癌(ICC)病人肝切除术后“教科书式结局”(TO)的影响因素,构建预测TO评分模型。方法 回顾性分析2011年1月至2017年1月东南大学附属中大医院和中国人民解放军东部战区总医院八一医院收治的261例行肝切除术的ICC病人临床病理资料,分析影响TO的独立危险因素,根据危险因素的权重构建预测TO的评分模型。结果 261例ICC病人中,67例(25.7%)术后发生TO。年龄、肝硬化、手术时间和T分期[第8版美国癌症联合委员会(AJCC)癌症分期]为术后TO的独立预测因素。依此4项因素构建的评分模型显示了较好的预测准确性,最佳截断值为-1.9分,其敏感度为67.2%,特异度为62.9%。一致性检验显示其预测概率和实际发生概率有着较好的一致性(χ2=1.350,P=0.853)。结论 基于年龄、肝硬化、手术时间、T分期4个因素建立的评分模型可较准确地预测ICC病人术后TO的可能性,即手术时间短、无肝硬化、肿瘤直径<5 cm的年轻ICC病人肝切除后获得TO的可能性更大。 相似文献
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《Australian critical care》2019,32(6):540-559
ObjectivesThe objective of this review was to describe cardiovascular risk (CVR) assessment methods and to identify evidence-based practice recommendations when dealing with population at risk of developing cardiovascular diseases.Review methods and data sourcesA literature review following the Arksey and O'Malley scoping review methodology was conducted. By using appropriate key terms, literature searches were conducted in PubMed, SciELO, Cochrane Library, Dialnet, ENFISPO, Medigraphic, ScienceDirect, Cuiden, and Lilacs databases. A complementary search on websites related to the area of interest was conducted. Articles published in English or Spanish in peer-review journals between 2010 and 2017. Critical appraisal for methodological quality was conducted. Data was extracted using ad-hoc tables and qualitatively synthesized.ResultsAfter eliminating duplicates, 55 325 records remained, and 1432 records were selected for screening. Out of these, 88 full-text articles were selected for eligibility criteria, and finally, 67 studies were selected for this review, and 25 studies were selected for evidence synthesis. In total, 23 CVR assessment tools have been identified, pioneered by the Framingham study. Qualitative findings were grouped into four thematic areas: assessment tools and scores, CVR indicators, comparative models, and evidence-based recommendations.ConclusionsIt is necessary to adapt the instruments to the epidemiological reality of the population. The most appropriate way to estimate CVR is to choose the assessment tool that best suits individual conditions, accompanied by a comprehensive assessment of the patient. More research is required to determine a single, adequate, and reliable tool. 相似文献
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Jae Yun Ahn Jung Bae Park Sungbae Moon Jae Wan Cho Dong Ho Park 《Ophthalmic epidemiology》2020,27(2):105-114
ABSTRACT
Purpose
Work-related eye injuries have been reported with a variety of epidemiologic and clinical characteristics. We aimed to identify epidemiologic characteristics of work-related eye injuries and risk factors associated with severe injury in a large metropolitan city. 相似文献19.
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《Biomedical and environmental sciences : BES》2020,33(2):89-102
Objective The present study aims to investigate the concentrations of Hg and its aspects methyl mercury(Me-Hg) and inorganic mercury(I-Hg) in the biological samples(BSs) of fluorescent lamp industries workers(FLIWs).Methodology Different BSs including red blood cells(RBCs),plasma,urine,hair and nails were collected from the workers exposed to Hg and unexposed persons were selected as control group to measure both the T-Hg concentration as well as its species in different biological samples through quantitative analysis.Health data was collected through questionnaire survey.Results The mean concentrations of T-Hg(31.9 μg/L),Me-Hg(27.7 μg/L),and I-Hg(5.36 μg/L) in RBCs were found significantly(P 0.001) higher among the workers(n = 40) as compared to the control group(n = 40).Similarly the mean Hg concentrations in plasma,urine,hair and nails were also significantly higher among the workers than the control group.The statistical relation between Hg concentration and demographic characteristics observed that workers experience and fish consumption has increased the Hg concentration while age,weight and smoking found no significant effect on Hg concentration in the BSs.Conclusion The study observed that the workers were highly exposed to high concentration of Hg and they are at a high health risk. 相似文献