Management algorithm for septic arthritis after anterior cruciate ligament reconstruction / 北京大学学报(医学版)

OBJECTIVE@#To summarize the experience in the diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction.@*METHODS@#A retrospective review was conducted of all the arthroscopic anterior cruciate ligament reconstructions performed at Department of Sports Medicine, Peking University Third Hospital between January 2001 and December 2020. In the study, 65 of 27 867 patients experienced postoperative septic arthritis. The incidence, presentation, laboratory results, treatment, and outcome of all the infected patients were analyzed. The experiences of diagnosis and management of septic arthritis after anterior cruciate ligament reconstruction were summarized.@*RESULTS@#A total of 27 867 anterior cruciate ligament reconstructions were performed at our department between January 2001 and December 2020. In the study, 65 (0.23%) patients were identified with postoperative septic arthritis. The most common symptoms of the infected patients were fever (38.7±0.5) ℃, knee swelling, pain, and restricted motion. The mean peripheral white blood cell count (WBC) was (9.2±2.6)×109/L (range 4.2×109/L-19.4×109/L), with (72.5±6.3) % (range 54.9%-85.1%) polymorphonuclear neutrophils (N). The mean erythrocyte sedimentation rate (ESR) was (59.9±24.1) mm/h (range 9-108 mm/h), C-reactive protein (CRP) was (10.9±5.7) mg/dL (range 1.2-30.8 mg/dL), and fibrinogen (FIB) level was (7.0±1.6) g/L (range 3.7-10.8 g/L). All of the laboratory results were statistically higher in the infection group compared with the normal postoperative group (P＜0.001). The synovial white blood cell count (SWBC) of aspirated knee joint fluid was (45.0±29.8)×109/L (range 7.1×109-76.5×109/L). Polymorphonuclear cell percentage (PMNC) was (90.27±7.86) % (range 60%-97%). In the study, 45 patients (69.2%) had positive aspirate cultures. Microbiology showed coagulase-negative Staphylococcus (CNS) and Staphylococcus aureus (SA) were the most common bacterium (34 cases and 7 cases, individually). There were 26 methicillin-resistant Staphylococcus. Both conservative (16 patients) and operative (49 patients) treatments were effective, but conservative group had a longer recovery time (5.6 d vs. 1.6 d, P=0.042).@*CONCLUSION@#Septic arthritis after arthroscopic anterior cruciate ligament reconstruction is a rare but potentially devastating complication. The correct diagnosis relies on synovial fluid analysis and bacterial culture. Our proposed treatment protocol is arthroscopic debridement and antibiotic therapy as quickly as possible.

Soluções para a fadiga de alarmes em unidades de terapia intensiva: algoritmo de gestão de alarmes / Solutions for alarm fatigue in intensive care units: alarm management algorithm

Objetivo: Propor um Algoritmo de Gestão de alarmes de monitores multiparametricos em UTIs, usando Logica Fuzzy e o programa MATLAB, que objetiva a redução da Fadiga de Alarmes em UTI, pela seleção inteligente das prioridades no atendimento aos alarmes. A gestão inteligente dos alarmes visa evitar o problema da Fadiga de Alarmes, que leva a ignorar, silenciar ou retardar o atendimento aos pacientes em UTI. Método: quanti-qualitativa, com pesquisa observacional descritiva. Resultados: O estudo mostra que a modelagem pela Logica Fuzzy consegue emular o raciocínio humano dos profissionais de saúde da UTI na tomada de decisões de atendimento a pacientes alarmados. Conclusão: a Logica Fuzzy poderá ser eficiente na gestão de parâmetros fisiológicos alarmados em UTI, pelo uso de Algoritmos "Smart Alarms" ponderando sobre a prioridade de atendimento ao paciente

Purpose: To propose a management algorithm multiparameter monitors alarms in ICUs, using Fuzzy Logic and MATLAB program, which aims to reduce the Alarm Fatigue in ICU, the intelligent selection of priorities in meeting the alarms.. The intelligent alarm management aims to avoid the problem of Fatigue Alarm, which leads to ignore, mute or delay patient care in the ICU. Method: quantitative and qualitative, with descriptive observational research Results: The study shows that modeling by Fuzzy Logic can emulate the human reasoning of health professionals in the ICU decision-making services to patients alarmed. Conclusion: Fuzzy Logic can be efficient in managing alarmed physiological parameters in the ICU, by the use of algorithms "Smart Alarms" pondering the priority of patient care

Objetivo: Proponer un multiparamétrico algoritmo de gestión monitorea las alarmas en las UCI, utilizando el programa MATLAB, que tiene como objetivo reducir la fatiga de alarma en la UCI, pela selección inteligente de las prioridades en el cumplimiento de las alarmas y Lógica Fuzzy. La gestión de alarmas inteligentes pretende evitar el problema de la fatiga de alarma, lo que lleva a ignorar, silenciar o retrasar la atención al paciente en la UCI. Método: cuantitativa y cualitativa, con la investigación observacional descriptivo Resultados: El estudio muestra que el modelado por la Lógica Fuzzy puede emular el razonamiento humano de profesionales de la salud en los servicios de toma de decisión de la UCI de pacientes alarmados. Conclusión: Lógica Fuzzy puede ser eficiente en la gestión de los parámetros fisiológicos alarmados en la UCI, utilizando algoritmos de gestión inteligentes ponderando la prioridad de la atención al paciente