Malnutrition in Joint Arthroplasty: Prospective Study Indicates Risk of Unplanned ICU Admission.

BACKGROUND: Malnutrition has been linked to poor outcomes after elective joint arthroplasty, but the risk of unplanned postoperative intensive care unit (ICU) admission in malnourished arthroplasty patients is unknown. METHODS: 1098 patients were followed as part of a prospective risk stratification program at a tertiary, high-volume arthroplasty center. Chronic malnutrition was defined as preoperative albumin <3.5 g/dL. RESULTS: The overall incidence of malnutrition was 16.9% (primary and revision arthroplasty patients). Average BMI was highest for patients in albumin category 3.0-3.5 (BMI 35.7). Preoperative albumin <3.0 and <3.5 g/dL translated to 15.4% and 3.8% rates of unplanned ICU admission, respectively, indicating nutritional status to be a factor in postoperative ICU admission. CONCLUSION: Patients with poor nutritional status must be counseled on the risks of adverse medical complications.

Unplanned admission to the intensive care unit after total hip arthroplasty.

Triage to the intensive care unit (ICU) after elective total hip arthroplasty proves a complex medical and resource decision point. A total of 1259 consecutive total hip arthroplasties were reviewed; 89 patients experienced unplanned ICU admissions. Significant risk factors for ICU admission in univariate analysis were age greater than 75 years, revision surgery, obstructive sleep apnea, creatinine clearance less than 60 mL/min, prior myocardial infarction, American Society of Anesthesiologist class 3 or greater, use of vasopressors intraoperatively, and body mass index greater than 35 kg/m(2). With multiple regression, age greater than 75 years (odds ratio [OR], 2.6 [1.2-5.6]), revision surgery (OR, 5.8 [3.0-11.4]), creatinine clearance less than 60 mL/min (OR, 6.5 [2.5-16.3]), prior myocardial infarction (OR, 7.2 [2.0-25.4]), and body mass index greater than 35 kg/m(2) (OR, 2.9 [1.4-6.2]) were predictive of unplanned ICU admission. With 1 risk factor, the risk of ICU admission was 40%, 2 (75%), 3 (93.5%), 4 (98.5%), and 5 (>99%). A prospective study of these risk factors is needed to establish a threshold for planned ICU admission.

Physiological and psychological fatigue in extreme conditions: the military example.

The extreme conditions causing fatigue in military service members in combat and combat training deserve special consideration. The collective effects of severe exertion, limited caloric intake, and sleep deprivation, combined with the inherent stressors of combat, lead to both physiological and psychological fatigue that may significantly impair performance. Studies of combat training have revealed a myriad of endocrine, cognitive, and neurological changes that occur as a result of exposure to extreme conditions. Further contributory effects of multiple military deployments, post-traumatic stress disorder, and traumatic brain injury may also influence both the susceptibility to and expression of fatigue states. Further research is needed to explore these effects to enhance military readiness and performance as well as prevent injuries.

Normalization of horizontal pseudoneglect following right, but not left, upper limb amputation.

OBJECTIVES: Subjects who have suffered limb amputations are known to have physiological alterations of their body's representation, or schema. Such changes of brain function might alter the right-left spatial allocation of attention. The goal of this study was to learn if, compared to normal subjects, limb amputees had alterations of right-left spatial attention. METHODS: The subjects were veterans with amputation of one upper or lower limb. All subjects performed horizontal line bisections in their left, middle and right body-centered space. RESULTS: Following right upper limb amputation, there appears to be a reduction of the normal left-sided bias (pseudoneglect) primarily for lines presented in the right body hemispace. CONCLUSIONS: This amputation-induced alteration of attentional bias might be related to changes in the body schema, a compensatory strategy, or alterations of scanning patterns. Further studies are needed to reproduce these results and to learn the underlying brain mechanism.