34 research outputs found
Functional mobility recovery predicts readmission to the surgical intensive care unit
No full textPremature ICU discharge without optimal recovery of functional mobility increases the risk of ICU readmission
Association between propofol dose and 1-year mortality in patients with or without a diagnosis of solid cancer
No full textPreclinical data suggest suppression of cancer proliferation by propofol, and retrospective studies suggest improved survival after cancer surgery with propofol-based anaesthesia
Proper selection of sedative drugs improves outcomes: volatile anesthetics are surgeons’ best friends
No full textRecommended from our members
Prevention of respiratory complications of the surgical patient: actionable plan for continued process improvement
No full textPurpose of review Postoperative respiratory complications (PRCs) increase hospitalization time, 30-day mortality and costs by up to $35 000. These outcomes measures have gained prominence as bundled payments have become more common. Recent findings Results of recent quantitative effectiveness studies and clinical trials provide a framework that helps develop center-specific treatment guidelines, tailored to minimize the risk of PRCs. The implementation of those protocols should be guided by a local, respected, and visible facilitator who leads proper implementation while inviting center-specific input from surgeons, anesthesiologists, and other perioperative stakeholders. Summary Preoperatively, patients should be risk-stratified for PRCs to individualize intraoperative choices and postoperative pathways. Laparoscopic compared with open surgery improves respiratory outcomes. High-risk patients should be treated by experienced providers based on locally developed bundle-interventions to optimize intraoperative treatment and ICU bed utilization. Intraoperatively, lung-protective ventilation (procedure-specific positive end-expiratory pressure utilization, and low driving pressure) and moderately restrictive fluid therapy should be used. To achieve surgical relaxation, high-dose neuromuscular blocking agents (and reversal agents) as well as high-dose opioids should be avoided; inhaled anesthetics improve surgical conditions while protecting the lungs. Patients should be extubated in reverse Trendelenburg position. Postoperatively, continuous positive airway pressure helps prevent airway collapse and protocolized, early mobilization improves cognitive and respiratory function.Version of Recor
Market building, polity building, and community in the European Union. IHS Political Science Series 60, February 1999
No full textThe central argument detailed in the paper is that European integration will only become sustainable in the long run when the problem of developing a political community of European citizens is directly addressed. Contrasting the historical development of the West-European nation states with the conditions in the EC/EU the conclusion is drawn that a community of European citizens cannot and need not be based on a programme of state and nation building. Instead, a political community of European citizens could be founded on more recent political achievements and the integrative mechanisms of modern federally organized political systems in general: common citizenship, a democratic and participatory structure of governance, a more balanced distribution of labour between the national and the European level in substantial policy areas, combined with a pro-active strategy of protecting multinational diversity and tolerance
Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial
No full textPrevalence of Herpesvirus DNA in Corneal Transplant Recipients
No full textPurpose: Graft failure after penetrating keratoplasty (PK) is a serious complication, especially in eyes with herpetic keratitis (HK). This study evaluated the prevalence and graft survival of herpes simplex virus type 1 (HSV-1) and varicella zoster virus (VZV) DNA in recipient corneas during PK. Methods: The retrospective study was performed at the Department of Ophthalmology at University Hospital in Mainz, Germany. We analyzed data from every patient who underwent PK between January 2020 and June 2021. According to our clinical routine, we performed HSV-1 and VZV polymerase chain reaction (PCR) on all excised corneal buttons regardless of the primary clinical diagnosis. Results: We included 112 eyes of 112 consecutive patients who underwent PK. At the time of PK, 91 (81.25%) patients had no history of HK and 21 (18.75%) patients did. The recipient corneas of 91 patients without a history of HK tested positive for HSV-1 DNA in 12 (13.2%) eyes, for VZV DNA in 3 (3.3%) eyes, and for HSV-1 and VZV DNA simultaneously in 2 (2.2%) eyes. The recipient corneas of 21 patients with a preoperative history of HK tested positive for HSV-1 DNA in 13 (61.9%) eyes and VZV DNA in 1 (4.8%) eye. All patients with positive herpes DNA and no history of HK prior to PK received antiherpetic treatment and had a 100% graft survival rate after 1 year. Conclusions: We found herpesvirus DNA in 18.7% of recipient corneas without clinical suspicion or history of herpes keratitis. This suggests the need of routine HSV-1 and VZV PCR testing in all explanted corneas regardless of clinical suspicion, to detect, treat and prevent possible recurrence of herpes infection in corneal grafts and support graft survival
Impact of the Different Corneal Storage Flasks on Endothelial Cell Loss During Cultivation—A Retrospective Analysis
No full textObjectives: To evaluate the impact of different corneal storage containers—with and without corneal holders—on endothelial cell density (ECD) and endothelial cell loss (ECL) during organ culture, following a temporary shortage of Böhnke Donor Corneal Holders at a German eye bank. Methods: A retrospective analysis was conducted on 383 human donor corneas cultured in six types of containers between January and September 2024 at the Eye Bank of Rhineland-Palatinate. ECD was measured at 6.0 ± 1.2 days (ECD1) and again at 14.9 ± 4.4 days (ECD2) after retrieval using standardized organ culture protocols with an inverted light microscope. Group 1 (G1) used the standard 50 mL Corning® flask with the Böhnke corneal holder. Groups 2–6 used alternative containers, with or without corneal holders. ECL was defined as the difference between ECD2 and ECD1. Results: Mean overall ECD1 was 2478.3 ± 843.4 cells/mm2. G1 showed ECD1 < 2000 cells/mm2 in 29% of corneas and low ECL (−1%). The 60 mL Ratiolab® flask with Cornea-Claw® was the best alternative, showing the lowest incidence of ECD1 < 2000 cells/mm2 (7%) and no ECL. Containers without corneal holders, particularly the 100 mL Sterilin™ and 15 mL Cryogenic Tube®, had significantly higher rates of ECD1 < 2000 (40% and 75%) and greater ECL (9% and 14%). Conclusions: Container design, especially volume and the presence of corneal holders, significantly influences endothelial preservation. Especially a lack of corneal holders led to unacceptable endothelial cell loss. Eye banks should prioritize appropriate flask configurations to minimize tissue deterioration, particularly during supply shortages
Prevalence of herpesvirus DNA in corneal transplant recipients
No full textPurpose: Graft failure after penetrating keratoplasty (PK) is a serious complication, especially in eyes with herpetic keratitis (HK). This study evaluated the prevalence and graft survival of herpes simplex virus type 1 (HSV-1) and varicella zoster virus (VZV) DNA in recipient corneas during PK. Methods: The retrospective study was performed at the Department of Ophthalmology at University Hospital in Mainz, Germany. We analyzed data from every patient who underwent PK between January 2020 and June 2021. According to our clinical routine, we performed HSV-1 and VZV polymerase chain reaction (PCR) on all excised corneal buttons regardless of the primary clinical diagnosis. Results: We included 112 eyes of 112 consecutive patients who underwent PK. At the time of PK, 91 (81.25%) patients had no history of HK and 21 (18.75%) patients did. The recipient corneas of 91 patients without a history of HK tested positive for HSV-1 DNA in 12 (13.2%) eyes, for VZV DNA in 3 (3.3%) eyes, and for HSV-1 and VZV DNA simultaneously in 2 (2.2%) eyes. The recipient corneas of 21 patients with a preoperative history of HK tested positive for HSV-1 DNA in 13 (61.9%) eyes and VZV DNA in 1 (4.8%) eye. All patients with positive herpes DNA and no history of HK prior to PK received antiherpetic treatment and had a 100% graft survival rate after 1 year. Conclusions: We found herpesvirus DNA in 18.7% of recipient corneas without clinical suspicion or history of herpes keratitis. This suggests the need of routine HSV-1 and VZV PCR testing in all explanted corneas regardless of clinical suspicion, to detect, treat and prevent possible recurrence of herpes infection in corneal grafts and support graft survival
