Evidence-based clinical practice guidelines on some important aspects of the care of critically ill surgical patients Part II: Surgical intensive care units, implementation of guidelines

The first part of the critical care guidelines of the Philippine College of Surgeons (PCS) and supported by Glaxo Wellcome Philippines, Inc. dealt with resuscitation fluids, blood transfusion, assessment of volume resuscitation, nutritional support and cardiovascular support. The second part deals with the last 2 aspects identified by the Technical Working Group (TWG) namely: surgical intensive care units and implementation of guidelines. The literature search, limited to english publications. Used both electronic and manual methods. Three electronic databases were used: 1) The Cochrane Library, Issue 4, 2000; 2) National Library of Medicine - Medline (PubMed, no time limit): and HERDIN (Health Research and Development Information Network) Version 1, 1997 of DOST-PCHRD. Manual searching of the reference lists of review articles and some important meta-analyses and randomized controlled trials (RCTs) was also done. The search terms used were: 1) Cochrane library: surgical intensive care, guidelines implementation, 2) Medline: surgical intensive care, 3) HERDIN: intensive care. Titles of all articles were printed and all members of the TWG went over the list and checked the titles of articles whose abstracts they felt should be read. The abstracts of all checked articles were printed. The printed abstracts were given to the members, who then decided which articles were to be included for full text retrieval. The full texts were obtained from the University of the Philippines Manila Library, and were appraised using standard forms. (Author)

Application of the TRISS method to evaluate trauma care

The TRISS (Revised Trauma Score and Injury Severity Score) method of trauma care evaluation was applied to 476 consecutive trauma patients admitted to our medical center over a 6-month period. Male to female ratio was 8:1, with a mean age of 24.7 years. Penetrating injury was the most common mechanism of injury (62%), with the chest as the most common region injured (36%). Mean probability of survival of 476 patients was 0.9802 and a predicted mortality of 9.4 patients. The overall mortality was 5.4 per cent with 26 actual deaths. As 93 per cent of patients had injuries to isolated anatomic regions, using the TRISS method, assigning numerical values to noninjured anatomic regions mathematically increased their probability of survival, even though the isolated injury was life-threatening. Consideration should be taken before adapting the TRISS method as the gold standard in evaluating trauma care in the local setting

A multicenter randomized clinical trial comparing the clinical efficacy of Imipenem/Cilastin and Ceftazidime plus Metronidazole in surgically treated serious intra-abdominal infections

An open, prostective, randomized multicenter clinical trial randomly allocated successive patient who were scheduled for a surgical procedure for serious intra-abdominal infections to receive either treatment CM (ceftazidine plus metronidazole) or monotherapy with treatment IC (imipenem/cilastatin). Out of 90 eligible patients, 87 were clinically evaluable of which 71 were clinically and bacteriologically evaluable (CBE). Cases allocated to each treatment group were comparable as to age, sex, diagnostic group distribution, mean APACHE II scores, and bacteriologic evaluability. Among the 87 clinically evaluable patients, there were 4 (9.1%) and 2 (4.7%) treatment failures among those who received treatments CM and IC respectively (p=0.486). For all eligible patients, the mean fever days was 2.07, mean treatment days was 6.01, and mean hospital days was 11.57, and was not significantly different between the two treatment groups. Among clinically evaluable cases, the mean APACHE II scores of patients with succesful outcomes (5.8) was very significantly lower (p=0.000) than that of patients whose treatment failed (13.8). This was also true for CBE cases. Logistic regression analysis showed that among six variables (diagnostic group, APACHE II score, antibiotic used, fever days, hospital days and treatment days) only the APACHE II score signficantly contributed to treatment failure (p=0.001).

Scrimp technique in the rapid cytologic diagnosis of surgical specimens - A local experience

A rapid tissue preparation to establish the diagnosis of surgical specimens was reported. The specific reason to request such a preparation usually relates to a suspicion of a neoplastic lesion. This study was conducted to evaluate the role of scrimp technique, a modification of imprint cytology, in the rapid intraoperative diagnosis of tumors as compared with frozen section. Scrape and imprints of tumors were made from 86 unfixed specimens at the time of frozen section. Rapid and permanent staining methods were employed and the accuracy of diagnosis was compared with frozen and paraffin preparations. The results showed that the sensitivity and specificity of scrimp preparation were 95% each as compared with frozen section which has 98% and 100% respectively which manifested a negligible inferiority over frozen section. This technique was simple, fast, easy, and reliable and does not require special instruments or time consuming set-up. While not meant to replace frozen section, it can be an excellent adjunct or alternative especially in remote and secondary hospitals unequipped with sophisticated apparatus. (Author)