Activiteit

At the time of most recent follow-up, all patients survived, 1 continues to require ventilation support, 1 remains admitted without ventilation support, and 8 (80%) were discharged to home. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

Hospitals worldwide have postponed all nonessential surgery during the COVID-19 pandemic, but non-COVID-19 patients are still in urgent need of care. Uncertainty about a patient’s COVID-19 status risks infecting health care workers and non-COVID-19 inpatients. We evaluated the use of quantitative reverse transcription polymerase chain reaction (RT-qPCR) screening for COVID-19 on admission for all patients with fractures.

We conducted a retrospective cohort study of patients older than 18 years admitted with low-energy fractures who were tested by RT-qPCR for SARS-CoV-2 at any time during hospitalization. Two periods based on the applied testing protocol were defined. During the first period, patients were only tested because of epidemiological criteria or clinical suspicion based on fever, respiratory symptoms, or radiological findings. In the second period, all patients admitted for fracture treatment were screened by RT-qPCR.

We identified 15 patients in the first period and 42 in the second. In total, 9 (15.8%) patients without clinical or radiological findings tested positive at any moment. read more Five (33.3%) patients tested positive postoperatively in the first period and 3 (7.1%) in the second period (P = 0.02). For clinically unsuspected patients, postoperative positive detection went from 3 of 15 (20%) during the first period to 2 of 42 (4.8%) in the second (P = 0.11). Clinical symptoms demonstrated high specificity (92.1%) but poor sensitivity (52.6%) for infection detection.

Symptom-based screening for COVID-19 has shown to be specific but not sensitive. Negative clinical symptoms do not rule out infection. Protocols and separated areas are necessary to treat infected patients. RT-qPCR testing on admission helps minimize the risk of nosocomial and occupational infection.

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

To assess which skin suture pattern-simple, vertical mattress, horizontal mattress, Allgöwer-Donati (AD), or running subcuticular-enables the greatest degree of perfusion as measured by indocyanine green laser angiography after ankle fracture surgery.

Prospective, randomized.

Level 1 Academic Trauma Center.

Seventy-five patients undergoing ankle fracture surgery were prospectively randomized to 1 of 5 skin suture patterns (n = 15 per cohort). Patient demographics and operative parameters were similar between groups.

Skin perfusion was assessed intraoperatively after skin closure using indocyanine green laser angiography and quantified in fluorescence units. Two perfusion values were collected (1) mean incision perfusion was the mean of 10 points along the incision and (2) mean perfusion impairment was the perfusion difference between the incision and the skin adjacent to it. We also collected a postoperative patient scar assessment score.

Running subcuticular closure had significantly better mean incision perfusion than all other closure patterns. Mean perfusion impairment also favored running subcuticular closure, which was significantly lower than all other suture patterns except AD. We found no patient perceived cosmetic differences between the 5 suture pattern types.

Running subcuticular suture pattern resulted in the greatest incision perfusion than simple, horizontal mattress, vertical mattress, and AD techniques after ankle fracture fixation.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.

Right heart failure develops in lung transplantation candidates on extracorporeal membrane oxygenation (ECMO) support and increases mortality. The safety and feasibility of the oxy-right ventricular assist device (oxyRVAD) as a bridge to lung transplantation in severe right heart failure caused by terminal lung disease have not been evaluated.

We retrospectively reviewed 14 patients who used oxyRVAD for bridging of right heart failure to lung transplantation.

The major cause of lung transplantation was acute exacerbation of interstitial lung disease (78.6%), and the median venovenous ECMO duration was 7 days. Before oxyRVAD, median mean pulmonary artery pressure (PAP) was 60.5 mmHg (interquartile range (IQR) 54-68), and the median peak tricuspid regurgitation velocity (TRV) was 3.9 m/s (IQR 3.7-4.1). After oxyRVAD conversion, median mean PAP was 60.5 mmHg (IQR 57.3-65), and the median peak TRV was 2.9 (IQR 2.6-3.2). All patients were hemodynamically stable (median arterial blood pressure 83 mmHg, median heart rate 79 bpm). Three patients developed pulmonary congestion (21.4%), and all patients stabilized within 24 h. Active rehabilitation during ECMO was possible in all patients, and the median duration of awake state during ECMO was 14 days. A total of 10 patients were bridged successfully to lung transplantation, and hospital survival rates were 90%.

OxyRVAD stabilized hemodynamic parameters without fatal complications, permitted the discontinuation of sedation, and allowed active rehabilitation in patients with severe right heart failure. OxyRVAD may be a feasible option for bridging of right heart failure to lung transplantation.

OxyRVAD stabilized hemodynamic parameters without fatal complications, permitted the discontinuation of sedation, and allowed active rehabilitation in patients with severe right heart failure. OxyRVAD may be a feasible option for bridging of right heart failure to lung transplantation.

Rates of withdrawal of life-sustaining treatment are higher amongst critically ill pediatric patients compared to adults. Therefore, livers from pediatric donation after circulatory death (pDCD) could improve graft organ shortage and waiting time for listed patients. Since knowledge on the utilization of pDCD is limited, this study used US national registry data (2002-2017) to estimate the prognostic impact of pDCD in both adult and pediatric LT.

In adult liver transplant (LT), the short (1-year) and long-term (overall) graft survival (GS) between pDCD and adult DCD (aDCD) grafts was compared. In pediatric LT, the short and long-term prognostic outcomes of pDCD were compared with other type of grafts (brain dead, split and living donor).

Of 80 843 LTs in the study, 8967 (11.1%) were from pediatric donors. Amongst these, only 443 were pDCD, which were utilized mainly in adult recipients (91.9%). In adult recipients, short and long-term GS did not differ significantly between pDCD and aDCD grafts (HR=0.82 in short-term and 0.