ABSTRACT
BACKGROUND: Hyperlactatemia is associated with increased mortality. Possible differences between patients directly admitted via the emergency department to the intensive care unit (ICU) and inpatient transfers to the ICU have not yet been investigated. MATERIALS AND METHODS: In this retrospective analysis, characteristics and outcomes between critically ill medical inpatient transfers and direct admissions with hyperlactatemia on ICU admission, defined as a blood lactate >2â¯mmol/l, were compared. RESULTS: A total of 1042 patients were included, with 424 inpatient transfers and 618 direct admissions. The median age of inpatient transfers and direct admissions was 67.0 and 70.5 years, respectively (Pâ¯= 0.03). The median APACHE II score was 25 for inpatient transfers and 23 for direct admissions (Pâ¯= 0.01). The median blood lactate on ICU admission for inpatient transfers and direct admissions was similar (3.6 vs. 3.5â¯mmol/l). Sepsis was more common among inpatient transfers than direct admissions (53.5 vs. 31.6%, Pâ¯= 0.001). The ICU (39.6 vs. 28.8%, Pâ¯< 0.001), hospital (56.8 vs. 38.3%, Pâ¯< 0.001) and 28-day mortality (46.5 vs. 35.4%, Pâ¯< 0.001) was significantly higher for inpatient transfers than direct admissions. Among the sepsis cohort, inpatient transfer, APACHE II score and elevated blood lactate were independent predictors of ICU mortality. CONCLUSION: Among medical ICU patients with admission hyperlactatemia, the median blood lactate was not significantly different between direct admissions and inpatient referrals. Inpatients with sepsis may have been referred to the ICU late.
Subject(s)
Hospital Mortality , Hyperlactatemia , Inpatients/statistics & numerical data , Patient Transfer/statistics & numerical data , Aged , Critical Illness , Female , Humans , Hyperlactatemia/diagnosis , Hyperlactatemia/epidemiology , Intensive Care Units , Male , Retrospective StudiesABSTRACT
BACKGROUND: Microsurgical preparation is limited by geometric and mechanical constraints. In preparation for clinical use, this study investigates performance, ease of handling and precision of a novel manipulator concept for microsurgery. MATERIAL AND METHODS: A group of 15 ENT experienced doctors, as well as a group of 17 medical students with low/non surgical experience participated in the study. Each of the subjects carried out 4 trials of simulated surgeries on a phantom with built-in force sensors. The task was to apply a defined force between 1.5 and 2 N using a Fisch micro perforator, 16 cm length, 0.4 mm (Storz) targeting holes with a diameter of 0.5 mm. For comparison, the Fisch micro perforator was moved manually or with the manipulator. RESULTS: Assessing the total number of errors proved a significantly lower error number (p<0.0001) and an improvement of the accuracy of 76% with the manipulator. The time requirement for the procedure with the micro manipulator is on average 2-3 times higher than with manual control (p<0.0001). But it is notable that this time requirement significantly decreases with training (p<0.0001). CONCLUSION: The study shows a significant reduction in the number of errors by using a new manipulator concept compared to the non-augmented human hand in an experimental setup. We observed a significant learning effect when subjects applied the micro manipulator, resulting in reduction of the time requirement while maintaining a constant number of errors.
