ABSTRACT
We retrospectively studied 50 surgical patients who required more than 14 days of care in the intensive care unit (ICU) in terms of the admission diagnosis, reason for extended stay, complications, cost, therapeutic intervention scores, mortality, and quality of life after discharge. The morbidity, mortality, and cost were extraordinary. Survival varied inversely with the therapeutic intervention scores. The ICU and one-year mortalities were 46.0% and 74.5%, respectively. The quality of life following discharge was generally poor. Increased mortality was associated with the following criteria: multiple-organ failure, age, sepsis, cancer, the combination of infection and failure of a major organ system, the requirement for a tracheostomy for prolonged respiratory support, and the requirement for hemodialysis for renal failure. In light of the escalating demand and cost of ICU care, it is advisable to identify those factors that determine whether these patients will benefit from intensive care, to develop strategies that are cognizant of the prognosis and the cost at the outset of care.
Subject(s)
Hospitalization/economics , Intensive Care Units , Length of Stay , Mortality , Surgical Procedures, Operative/mortality , Adult , Aged , Economics, Medical , Female , Humans , Intensive Care Units/economics , Length of Stay/economics , Long-Term Care , Male , Middle Aged , Postoperative Complications , Quality of Life , Respiration, ArtificialABSTRACT
A small series of patients with blunt injury to eigher a carotid or vertebral artery is presented. In three patients the injury was recognized relatively promptly. Two underwent surgery and one was observed with reasonably good results. In two patients the injury was unrecognized, resulting in death in one patient and in a severe, fixed, long-term neurologic deficit in the other. It appears likely that reconstruction may be the treatment of choice in any patient with angiographically proven injury unless coma or severe dense hemiplegia is present.
Subject(s)
Carotid Artery Injuries , Vertebral Artery/injuries , Wounds, Nonpenetrating/diagnostic imaging , Accidents, Home , Accidents, Traffic , Adolescent , Adult , Aortic Dissection/diagnostic imaging , Aortic Dissection/surgery , Carotid Arteries/surgery , Carotid Artery Diseases/diagnostic imaging , Carotid Artery, Internal/diagnostic imaging , Cerebral Angiography , Female , Humans , Male , Middle Aged , Vertebral Artery/surgery , Wounds, Nonpenetrating/surgeryABSTRACT
The construction of various types of access fistulas for hemodialysis has been known to be followed by ischemic symptoms distal to the anastomosis. The occurrence of a steal phenomenon as a complication of a PTFE (Gortex) fistula is often serious enough to necessitate taking down the fistula. A typical patient with this steal phenomenon is presented illustrating the value of banding the graft to reverse steal without significant threat of thrombosis.
