Abstract:
OBJECTIVE:Arterial base deficit (BD) is a commonly used marker of injury severity and endpoint of resuscitation but requires an arterial puncture and blood gas analysis. Serum bicarbonate (HCO3) is routinely obtained as part of the chemistry panel on most admissions. We hypothesized that serum HCO3 strongly correlates with arterial BD and provides equivalent predictive information. METHODS:All trauma ICU admissions from 1996 to 2004 with simultaneously obtained serum chemistry panels and arterial blood gases were identified. Correlation between BD and HCO3 was analyzed by using linear regression, and predictive abilities for acidoses and mortality were compared using the area under the respective receiver operating characteristic curve (AUC). Separate analyses were done for the entire dataset and the subset of ICU admission laboratory values. RESULTS:We identified 3,102 patients with 50,311 matched pairs of laboratory data. Serum HCO3 showed a significant linear correlation with BD for all laboratory sets (r = 0.85, P < .01) and admission laboratory values only (r = 0.80, P < .01). Serum HCO3 reliably predicted the presence of significant metabolic acidoses (BD >5), with an AUC of 0.96 (P < .01), which clearly outperformed pH (AUC = 0.83), anion gap (AUC = 0.7), and lactate (AUC = 0.73). The mean admission BD among survivors was 2.5 versus 5.2 for nonsurvivors (P < .01), and the mean HCO3 was 17.7 versus 19.8 (P < .01). The admission HCO3 identified nonsurvivors as accurately as BD (AUCs of 0.66 and 0.68) and more accurately than either pH (AUC = 0.53) or anion gap (AUC = 0.6). CONCLUSION:Serum HCO3 measurement shows a strong linear correlation and similar predictive ability compared with the arterial BD. Serum HCO3 may be safely and accurately substituted for arterial BD measurement in critically injured patients.
journal_name
Am J Surgjournal_title
American journal of surgeryauthors
FitzSullivan E,Salim A,Demetriades D,Asensio J,Martin MJdoi
10.1016/j.amjsurg.2005.08.024subject
Has Abstractpub_date
2005-12-01 00:00:00pages
941-6issue
6eissn
0002-9610issn
1879-1883pii
S0002-9610(05)00723-3journal_volume
190pub_type
杂志文章abstract:INTRODUCTION:The need for diverting loop ileostomies to protect high-risk anastomoses has been questioned recently by several authors. This study was designed to evaluate the potential benefits and complications of diverting loop ileostomies in a high-risk anastomosis population. METHODS:Ninety-four consecutive patien...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.01.005
更新日期:2007-05-01 00:00:00
abstract:BACKGROUND:Mesenteric vein thrombosis (MVT) is an uncommon type of intestinal ischemia associated with significant mortality and morbidity because of its delay in diagnosis. METHODS:A retrospective analysis of 9 patients treated surgically for MVT during 1982 to 1997 was performed. RESULTS:Nine patients underwent sur...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(00)00532-8
更新日期:2001-01-01 00:00:00
abstract::Thrombosis and its major sequela, embolism, continue to contribute significantly to morbidity and mortality, both as primary disorders and as complications of other systemic systems. The understanding of the etiology of thromboembolism and the role of platelets, endothelium, and the plasma proteins in the development ...
journal_title:American journal of surgery
pub_type: 杂志文章,评审
doi:10.1016/s0002-9610(05)80743-3
更新日期:1990-12-01 00:00:00
abstract::Miliary tuberculosis is the most lethal form of tubercular disease. If dissemination of tubercle bacilli occurs without therapy, death is almost certain. The importance of establishing an etiologic diagnosis as promptly as possible in patients receiving immunosuppressive therapy is self-explanatory. The presence of a ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(75)90402-x
更新日期:1975-09-01 00:00:00
abstract::A total of ninety three patients with biliary tract disease were studied to determine the concentration of the pancreatic enzymes, amylase and lipase, in bile obtained from the gallbladder and/or common bile duct. Of seventy gallbladder bile samples, amylase levels were higher than actual or predicted serum levels in ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(79)90055-2
更新日期:1979-03-01 00:00:00
abstract:BACKGROUND:Metabolic syndrome (MetS) is defined by numerous comorbidities. We sought to assess MetS's effect on the 7 main emergency general surgery (EGS) procedures that constitute 80% of EGS procedures, mortalities, complications, and costs. METHODS:Data were acquired from the ACS-NSQIP database from 2005 to 2017. C...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2019.12.021
更新日期:2020-08-01 00:00:00
abstract:BACKGROUND:Trovafloxacin, a broad-spectrum fourth-generation quinolone with gram-positive and gram-negative aerobic and anaerobic bacterial activity, is available in oral and intravenous formulations. The objective of this prospective, multicenter, double-blind, randomized study was to compare the efficacy of trovaflox...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/s0002-9610(98)00223-2
更新日期:1998-12-01 00:00:00
abstract:BACKGROUND:The clinical pulmonary infection score (CPIS) and bronchoalveolar lavage (BAL) are 2 tools that have been validated to diagnose pneumonia in critically ill patients. However, the role of the CPIS in diagnosing trauma-associated pneumonia (TAP) remains in question. METHODS:This prospective observational stud...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.10.010
更新日期:2011-07-01 00:00:00
abstract::1. A well defined group of patients have been studied. 2. Composite operation resulted in a 56 per cent five year disease-free survival rate. 3. Treatment of recurrent disease with irradiation increased the five year survival to 61 per cent. 4. Preoperative irradiation for squamous cell carcinoma of the intraoral cavi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(75)90490-0
更新日期:1975-10-01 00:00:00
abstract:BACKGROUND:Extended left hepatectomy including the middle hepatic vein (MHV) may potentially induce right paramedian sector congestion of the remnant liver. METHODS:To prevent venous congestion in the right paramedian sector, we performed extended left hepatectomy including the left hemiliver and anterior segment, whi...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.10.027
更新日期:2010-07-01 00:00:00
abstract:BACKGROUND:Hypercapnia and local pressure effects unique to CO(2) base minimally invasive surgery alter renal blood flow. We have demonstrated laparoscopic antireflux surgery to have an additional impact upon hemodynamics (decreased cardiac output), potentially extending known effects upon renal blood flow. METHODS:We...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(02)00824-3
更新日期:2002-04-01 00:00:00
abstract::The survival of 103 patients operated on for advanced carcinoma of the stomach other than the cardia was assessed. The median duration of survival for patients subjected to palliative partial gastrectomy, total gastrectomy, gastrojejunostomy, and biopsy only was 24, 22, 11, and 10 weeks, respectively. All of these pat...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(82)90051-4
更新日期:1982-06-01 00:00:00
abstract:BACKGROUND:The aim of the current study was to identify predictors of pathologic complete response (pCR) following neoadjuvant therapy. METHODS:From 2000 to 2007, 518 breast cancer patients received neoadjuvant therapy. Data were compared using chi(2) and Fisher's exact tests and multivariate analysis of variance, as ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2009.06.004
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:Some previous studies suggested that transplantation performed in Department of Veterans Affairs (VA) patients was associated with a higher rate of complications and poorer outcomes. We examined more than a decade of experience with solid organ transplantation at a single center and compared VA patients with...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2003.07.024
更新日期:2003-11-01 00:00:00
abstract::Our experience with 184 previously untreated patients who had adenoid cystic carcinoma of salivary gland origin is reviewed. Retrospective staging was possible in all but nine patients who had minor salivary gland primary tumors. Sixty-three percent of patients were diagnosed as having stage I or stage II disease (sta...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(05)80721-4
更新日期:1992-12-01 00:00:00
abstract:BACKGROUND:The Trauma Evaluation and Management (TEAM) module orients medical students to the initial assessment of an injured patient. At the Medical College of Wisconsin, a course based on expanded TEAM (eTEAM) was developed for junior medical students. This study determined whether eTEAM improved the ability to perf...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2005.08.033
更新日期:2006-02-01 00:00:00
abstract::We present a patient with pseudo-Meigs syndrome (PMS) secondary to sigmoid colon cancer metastasis to the ovary with elevated serum levels of carcinoembryonic antigen, CA19-9, and CA-125 who showed a marked change in pleural effusion before and after surgery. We have to consider PMS associated with colon cancer in pat...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.09.007
更新日期:2012-01-01 00:00:00
abstract:BACKGROUND:The AAMC developed 13 Core Entrustable Professional Activities (EPAs) for graduating medical students. EPA 5 is: Document a clinical encounter in the patient record. Our goal was to develop an assessment rubric and gather evidence to support its validity in measuring progress towards entrustability. METHODS...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.12.055
更新日期:2020-02-01 00:00:00
abstract:BACKGROUND:We examined and compared APP versus surgical resident perceptions of the role of APPs in surgical subspecialty teams. METHODS:Residents/first year surgical critical care fellows and inpatient service-specific APPs responded to a survey that examined perceptions about the APP-resident/fellow relationship. St...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2018.10.014
更新日期:2019-06-01 00:00:00
abstract::The effects of ischemia on the electrical and contractile activites of the small bowel were studied in dogs. Ischemia due to arterial occlusion abolished the contractile activity and made the regular rhythm of the pacesetter potential (PP) irregular. Revascularization within 3 hours restored the contractile activity a...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(78)90237-4
更新日期:1978-08-01 00:00:00
abstract:BACKGROUND:Patients often have an incomplete understanding of the levels of training and roles of the various surgical providers in teaching hospitals, leading to patient confusion and dissatisfaction. METHODS:Pre-intervention discharge surveys were administered to gastrointestinal surgery inpatients (10/2016-02/2017)...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/j.amjsurg.2018.07.056
更新日期:2018-10-01 00:00:00
abstract::A plan is advocated for the management of the dominant breast mass with use of local anesthesia in the outpatient setting as the primary diagnostic tool, but with selection of certain patients for immediate general anesthesia biopsy in the "conventional" manner. Experience with this plan in 2,492 patients during a per...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(76)90030-1
更新日期:1976-05-01 00:00:00
abstract:BACKGROUND:Hemorrhage during hepatectomy remains the major cause of morbidity and mortality associated with this surgery. Traditionally, a Pringle technique is employed to reduce vascular inflow during parenchymal transection. METHODS:This paper describes a simple method to achieve unilateral vascular control during h...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/s0002-9610(01)00697-3
更新日期:2001-09-01 00:00:00
abstract:BACKGROUND:Administrative databases oversimplify the relationship of factors such as volume or training on surgical outcomes. METHODS:A prospective statewide surgeon-initiated database was queried to obtain incident cases of rectal cancer in Vermont from April 1999 to June 2001. Demographics, procedure performed, meth...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2007.01.029
更新日期:2007-10-01 00:00:00
abstract:BACKGROUND:Fournier's gangrene is a fulminant and destructive inflammation of the scrotum, penis, and perineum. The objective of this study was to compare 2 different approaches to wound management after aggressive surgical debridement. METHODS:Data from 35 patients with Fournier's gangrene were prospectively collecte...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2008.07.053
更新日期:2009-02-01 00:00:00
abstract:BACKGROUND:The availability and utility of public statements and policies on gender equity from professional surgical societies has not been studied. METHODS:Professional surgical society websites were searched for publicly available statements and policies related to gender equity. These were compiled and assessed fo...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2020.06.041
更新日期:2020-11-01 00:00:00
abstract::The clinical efficacy and safety of cefotetan was assessed in two multicenter clinical trials involving 335 evaluable patients hospitalized with obstetric and gynecologic infections. In Study I, cefotetan was compared with moxalactam and in Study II, cefotetan was compared with cefoxitin. The clinical response rate in...
journal_title:American journal of surgery
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-9610(88)80214-9
更新日期:1988-05-31 00:00:00
abstract:BACKGROUND:Acute lung injury (ALI) and acute respiratory distress syndrome (ARDS) are sequelae of severe trauma. It is unknown if certain races are at greater risk of developing ALI/ARDS, and once established, if there are racial differences in the severity of lung injury or mortality. METHODS:Retrospective cohort stu...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2010.02.003
更新日期:2011-04-01 00:00:00
abstract:BACKGROUND:Elderly patients are at an increased risk of protein-energy malnutrition (PEM) which increases the risk of morbidity/mortality. We evaluated the association between hypoalbuminemia at the time of emergency department (ED) admission and in-hospital complications among geriatric trauma patients. METHODS:This ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/j.amjsurg.2015.06.013
更新日期:2016-07-01 00:00:00
abstract::An improved technique is presented for placement of the upper arm graft fistula for hemodialysis. This approach brings the graft anteriorly across the front of the biceps muscle, thereby allowing easier puncture and greater comfort for the patient during dialysis treatment. ...
journal_title:American journal of surgery
pub_type: 杂志文章
doi:10.1016/0002-9610(86)90478-2
更新日期:1986-03-01 00:00:00