Browsing by Author "Keegan, Mark T."
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Item Intensive care unit utilization and outcome after esophagectomy(Elsevier, 2010-06) Brown, Daniel R.; Cassivi, Stephen D.; Keegan, Mark T.; İşçimen, Remzi; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji ve Reanimasyon Anabilim Dalı.; 0000-0001-8111-5958; AAI-8104-2021; 16645821200Objective: To establish the frequency of intensive care unit (ICU) admission after esophagectomy and to determine the associated outcomes. Design: Retrospective cohort study. Setting: Tertiary referral center. Participants: Four hundred thirty-two patients who underwent esophagectomy between January 2000 and June 2004. Interventions: None Measurements and Main Results: Data relating to demographics, patient co-morbidities, perioperative management, complications, and Acute Physiology and Chronic Health Evaluation (APACHE) III variables were abstracted. Statistical analyses were performed to compare survivors with non-survivors and ICU patients with non-ICU patients. Of 432 patients included in the study, 123 (28.5%) were admitted to the ICU. Arrhythmias, new infiltrates on chest radiograph, and documented aspiration were common reasons for ICU admission. Patients admitted to ICU were of high acuity (mean APACHE III score 54.5, mean prediction of ICU death 6.4%). Of 352 patients originally not sent to the ICU, 43 (12.2%) were subsequently admitted to the ICU, often for aspiration. Overall in-hospital mortality was 3.7% (16 of 432 patients). Fifteen of the 123 ICU patients (12.2%) did not survive to hospital discharge. Conclusions: A significant minority of patients will require ICU admission after esophagectomy, often for aspiration pneumonitis and arrhythmias. Despite high severity of illness scores, the perioperative mortality rate for patients after esophagectomy at a high-volume center is low.Item Six-month survival of patients with acute lung injury: Prospective cohort study(Lippincott Williams & Wilkins, 2007-10) Yılmaz, Murat; Keegan, Mark T.; Vlahakis, Nicholas E.; Afessa, Bekele; Hubmayr, Rolf D.; Gajic, Ognjen; İşçimen, Remzi; Uludağ Üniversitesi/Tıp Fakültesi/Anesteziyoloji & Reanimasyon Anabilim Dalı.; 0000-0001-8111-5958; AAI-8104-2021; 16645821200Objective: Both short- and long-term outcome studies in acute lung injury (ALI) performed thus far were conducted before the implementation of recent advances in mechanical ventilation and supportive care and/or in the context of clinical trials with restricted inclusion criteria. We sought to determine the outcome of consecutive acute lung injury patients after the implementation of these interventions. Design: Prospective cohort study. Setting: Three intensive care units of two tertiary care hospitals. Patients: Patients with acute lung injury treated from October 2005 to May 2006, excluding those with no research authorization or do-not-resuscitate order. Interventions: None. Measurements and Main Results: The investigators collected detailed information about comorbidities, severity of pulmonary and nonpulmonary organ failures, complications, respiratory support, and other interventions. The main outcome measure was mortality 6 months after the onset of acute lung injury. From 142 patents enrolled over a 6-month period, 24 (17%) died in the intensive care unit, 38 (27%) in the hospital, and 55 (39%) by the end of the 6-month follow-up. Median (interquartile range) intensive care unit length of stay, duration of mechanical ventilation, and number of day 28 ventilator-free days were 7.1 (3.6-11.3), 5.7 (2.6-10.3), and, 19.0 (0-24.2) days. Multiple logistic regression analysis identified underlying Charlson comorbidity score (odds ratio 3.11, 95% confidence interval 2.01-5.05) for each point increase, transfer admission from the floor or outside hospital (odds ratio 3.75, 95% confidence interval 1.41-10.99), day 3 cardiovascular failure (odds ratio 3.30, 95% confidence interval 1.19-9.92), and day 3 Pao2/Fio2 (odds ratio 0.94,95% confidence interval 0.88-0.99) as significant predictors of 6-month mortality. Conclusions: With the implementation of recent advances in mechanical ventilation and supportive care, premorbid condition is the most important determinant of acute lung injury survival