PubMed Health⌕ Search

Biomedical subjects

Mark A Talamini

Publications and source records attributed to Mark A Talamini.

At least 19 recordsLinked to original sources
PubMed2006

CO2 abdominal insufflation pretreatment increases survival after a lipopolysaccharide-contaminated laparotomy.

Carbon dioxide (CO(2))-pneumoperitoneum is known to favorably modify the systemic immune response during laparoscopic surgery. The presented studies were designed to determine whether treating animals with CO(2) abdominal insufflation before undergoing a lipopolysaccharide (LPS)-contaminated laparotomy would serve as "shock prophylaxis" and thus improve survival and attenuate cytokine production. Rats were randomized into five groups: CO(2)-pneumoperitoneum, helium-pneumoperitoneum, anesthesia control, laparotomy/LPS control, and LPS only control. Animals in the first four groups all received a laparotomy and a lethal dose of LPS. Immediately preceding their laparotomy, animals in the pneumoperitoneum groups received a 30-minute pretreatment of abdominal insufflation with either CO(2) or helium. The anesthesia control group received a 30-minute pretreatment of isoflurane. Animal mortality was then recorded during the ensuing 72 hours. Subsequently, a similar protocol was repeated for measurements of cytokines. CO(2)-pneumoperitoneum increased survival at 48 hours compared with LPS control (P <.05), and decreased interleukin-6 plasma levels at 2 hours (P <.05). Abdominal insufflation with CO(2) before the performance of a laparotomy contaminated with endotoxin increases survival and attenuates interleukin-6. The beneficial immune-modulating effects of CO(2)-pneumoperitoneum endure after abdominal insufflation. CO(2)-pneumoperitoneum pretreatment may improve outcomes among patients undergoing gastrointestinal surgery who are at high risk for abdominal fecal contamination.

Anesthesia, Inhalation↗
PubMed2006

Mentoring console improves collaboration and teaching in surgical robotics.

BACKGROUND: One of the most significant limitations of surgical robots has been their inability to allow multiple surgeons and surgeons-in-training to engage in collaborative control of robotic surgical instruments. We report the initial experience with a novel two-headed da Vinci surgical robot that has two collaborative modes: the "swap" mode allows two surgeons to simultaneously operate and actively swap control of the robot's four arms, and the "nudge" mode allows them to share control of two of the robot's arms. MATERIALS AND METHODS: The utility of the mentoring console operating in its two collaborative modes was evaluated through a combination of dry laboratory exercises and animal laboratory surgery. The results from surgeon-resident collaborative performance of complex three-handed surgical tasks were compared to results from single-surgeon and single-resident performance. Statistical significance was determined using Student's t-test. RESULTS: Collaborative surgeon-resident swap control reduced the time to completion of complex three-handed surgical tasks by 25% compared to single-surgeon operation of a four-armed da Vinci (P < 0.01) and by 34% compared to single-resident operation (P < 0.001). While swap mode was found to be most helpful during parts of surgical procedures that require multiple hands (such as isolation and division of vessels), nudge mode was particularly useful for guiding a resident's hands during crucially precise steps of an operation (such as proper placement of stitches). CONCLUSION: The da Vinci mentoring console greatly facilitates surgeon collaboration during robotic surgery and improves the performance of complex surgical tasks. The mentoring console has the potential to improve resident participation in surgical robotics cases, enhance resident education in surgical training programs engaged in surgical robotics, and improve patient safety during robotic surgery.

Animals↗
PubMed2006

General anesthesia delays the inflammatory response and increases survival for mice with endotoxic shock.

Anesthesia is an indispensable component of any operative procedure. In this study, we demonstrate that continuous isoflurane anesthesia for 1 h after a lethal dose (20 mg/kg of body weight) of Escherichia coli lipopolysaccharide (LPS) results in a significant increase in survival of C57BL/6J (B6) mice in comparison with survival of nonanesthetized mice. Protection by anesthesia correlates with a delay in plasma LPS circulation, resulting in a delayed inflammatory response, particularly DNA binding activity of NF-kappaB and serum levels of tumor necrosis factor alpha, interleukin-6 (IL-6), and IL-10. Disparate classes of anesthetic agents produce the same effects on the inflammatory response, which is also independent of the inbred mouse strain used. These results suggest that anesthesia has an important impact on the outcome from endotoxemia. Moreover, the immunomodulatory effects of anesthetics should be considered when interpreting data from experimental animal models.

Anesthesia, General↗
PubMed2005

Abdominal insufflation with CO2 causes peritoneal acidosis independent of systemic pH.

We have shown that the inflammation-attenuating effects of CO(2) pneumoperitoneum during laparoscopy are not due to changes in systemic pH. However, acidification of peritoneal macrophages in an in vitro CO(2) environment has been shown to reduce LPS-mediated cytokine release. We tested the hypothesis that the peritoneum is locally acidotic during abdominal insufflation with CO(2)--even when systemic pH is corrected. Rats (n = 20) were anesthetized and randomized into two groups: continued spontaneous ventilation (SV) or intubation and mechanical ventilation (MV). All animals were then subjected to abdominal insufflation with CO(2). Mean arterial pH among SV rats decreased significantly from baseline after 15 and 30 minutes of CO(2) pneumoperitoneum (7.329 --> 7.210 --> 7.191, P < 0.05), while arterial pH among MV rats remained relatively constant (7.388 --> 7.245 --> 7.316, P = NS). In contrast, peritoneal pH dropped significantly from baseline and remained low for both groups during CO(2) abdominal insufflation (SV 6.74 --> 6.41 --> 6.40, P < 0.05; MV 6.94 --> 6.45 --> 6.45, P < 0.05). In a second experiment, rats (n = 10) were randomized to receive abdominal insufflation with either CO(2) or helium. Abdominal insufflation with helium did not significantly affect peritoneal pH (7.10 --> 7.02 --> 6.95, P = NS), and the decrease in pH among CO(2)-insufflated animals was significant compared with helium-insufflated animals (P < 0.05). Peritoneal pH returned to baseline levels in all groups within 15 minutes of desufflation in both experiments. A significant local peritoneal acidosis occurs during laparoscopy which is specifically attributable to the use of CO(2) and which is independent of systemic pH. These data provide additional evidence that localized peritoneal acidosis is central to the mechanism of CO(2)-mediated attenuation of the inflammatory response following laparoscopic surgery.

Acidosis↗
PubMed2005

Carbon dioxide pneumoperitoneum-mediated attenuation of the inflammatory response is independent of systemic acidosis.

BACKGROUND: The purpose of this study was to determine if systemic acidosis induced by peritoneal absorption of carbon dioxide (CO2 ) during laparoscopy plays a role in CO2 pneumoperitoneum-mediated attenuation of the acute phase inflammatory response associated with perioperative sepsis. The influence of hepatic polymorphonuclear (PMN) leukocyte infiltration on this phenomenon was also investigated. METHODS: Forty-five rats were randomized into 5 groups: anesthesia control, open cecal ligation and puncture (OCLP), laparoscopic cecal ligation and puncture using helium for insufflation (He LCLP), LCLP using CO2 with continued spontaneous ventilation (LCLP-SV), and LCLP using CO2 with intubation and positive pressure ventilation (LCLP-PPV). RESULTS: After 30 minutes, arterial blood gas parameters remained normal in control, OCLP rats, and He LCLP rats, while CO2 LCLP-SV rats developed significant hypercarbic acidosis. This acidosis was corrected in CO2 LCLP-PPV rats ( P < .0001 vs CO2 LCLP-SV for both). Expression of the rat acute phase gene alpha 2 -macroglobulin was greater after OCLP and He LCLP than after either CO2 LCLP-SV or CO2 LCLP-PPV ( P < .0001 vs either CO2 OCLP-SV for both). However, levels of alpha 2 -macroglobulin were not significantly different between the acidotic (LCLP-SV) and normocarbic (LCLP-PPV) CO2 groups. Infiltration of the hepatic parenchyma by PMNs did not differ significantly between groups. CONCLUSIONS: CO2 insufflation-induced systemic acidosis is not responsible for the reduction in the acute phase inflammatory response observed in laparoscopic animal models of sepsis. Hepatic PMN infiltration also does not appear to mediate this effect.

Acidosis↗
PubMed2005

Anesthesia-specific protection from endotoxic shock is not mediated through the vagus nerve.

BACKGROUND: We have shown recently that volatile anesthetics significantly decrease inflammatory cytokine production and dramatically increase survival among rodents challenged with lipopolysaccharide (LPS). Because acetylcholine's interaction with nicotine receptors on tissue macrophages during vagus nerve stimulation has been implicated in the modulation of LPS-stimulated tumor necrosis factor alpha (TNF-alpha) production, we hypothesized that the mechanism of anesthetic immunoprotection is mediated through the vagus nerve. METHODS: Male Sprague-Dawley rats underwent bilateral cervical vagotomy (n = 20) or sham operation (n = 6). Twenty-four hours postoperatively, vagotomized rats were randomized into 3 groups: LPS injection (V+LPS, n = 6), LPS injection followed by 60 minutes of isoflurane anesthesia (V+LPS+ISO, n = 7), or saline injection (V+S, n = 7). Sham animals were also given LPS (Sham+LPS). A sublethal dose of LPS (8 mg/kg) was used. Blood samples were collected via cardiac puncture 90 minutes after LPS or saline injection, and plasma was isolated for the measurement of cytokines by enzyme-linked immunosorbent assay. Statistical differences between groups were detected by 1-way analysis of variance. RESULTS: Serum TNF-alpha was reduced significantly and interleukin (IL)-6 was abrogated completely among V+LPS+ISO rats, compared with both V+LPS and Sham+LPS animals (P < or = .05 for all). In contrast, levels of the anti-inflammatory cytokine IL-10 were similar among all LPS groups. CONCLUSIONS: Isoflurane anesthesia administered simultaneously with the injection of LPS decreases serum production of TNF-alpha and IL-6 despite bilateral transection of the vagus nerve. Isoflurane-mediated attenuation of proinflammatory cytokine production occurs via a mechanism other than modulation of vagal output.

Anesthesia↗
PubMed2005

Laparoscopy and malignancy.

BACKGROUND: The advantages of pneumoperitoneum-based surgery are well documented. Laparoscopy is the gold standard of treatment in certain benign conditions such as cholelithiasis and gastroesophageal disease. This success has led to the application of laparoscopy in the management algorithm of malignant conditions. There is currently no universally accepted consensus of the role of pneumoperitoneum-based surgery in the treatment of cancer. This is due to the early reports of port site metastasis, initial lack of randomized controlled trials and the concern of performing oncologically adequate operations. The aim of this section is to review the current literature and attempt to obtain a consensus of the role of laparoscopy in the treatment of cancer. MATERIALS AND METHODS: A literature search was conducted through Pubmed with key words laparoscopy, pneumoperitoneum, carbon dioxide, malignancy, cancer, and port site metastasis. The obtained results were divided into various sections such as non-randomized reports, randomized reports, animal studies, human studies, etc. A comparison was made between laparoscopic and open resections when possible. RESULTS: There are several published reports of studies in animal models and in humans relating to pneumoperitoneum-based surgery in the setting of malignancy. There are also a few randomized controlled trials that compared open versus laparoscopic surgery for malignancies of various organ systems. In addition, the early reports of alarmingly high rate of port site metastasis have been scaled down to rates comparable to wound recurrences after open resections. SUMMARY: Laparoscopy has added another dimension to the management of patients with cancer. Advanced training, superior instrumentation, and a better understanding of the pathophysiology of carbon dioxide pneumoperitoneum has led to the successful application of laparoscopy. The improved results are obtained in centers with high volume of patients and with experience in both fields of oncology and minimally invasive surgery. Laparoscopy is now an integral tool in the management algorithm of malignancies of some organ systems and its role will be further expanded in the future.

Animals↗
PubMed2005

Surgical management of bile duct injuries sustained during laparoscopic cholecystectomy: perioperative results in 200 patients.

OBJECTIVE: A single institution retrospective analysis of 200 patients with major bile duct injuries was completed. Three patients died without surgery due to uncontrolled sepsis. One hundred seventy-five patients underwent surgical repair, with a 1.7% postoperative mortality and a complication rate of 42.9%. SUMMARY BACKGROUND DATA: The widespread application of laparoscopic cholecystectomy (LC) has led to a rise in the incidence of major bile duct injuries (BDI). Despite the frequency of these injuries and their complex management, the published literature contains few substantial reports regarding the perioperative management of BDI. METHODS: From January 1990 to April 2003, a prospective database of all patients with a BDI following LC was maintained. Patients' charts were retrospectively reviewed to analyze perioperative surgical management. RESULTS: Over 13 years, 200 patients were treated for a major BDI following LC. Patient demographics were notable for 150 women (75%) with a mean age of 45.5 years (median 44 years). One hundred eighty-eight sustained their BDI at an outside hospital. The mean interval from the time of BDI to referral was 29.1 weeks (median 3 weeks). One hundred nine patients (58%) were referred within 1 month of their injury for acute complications including bile leak, biloma, or jaundice. Twenty-five patients did not undergo a surgical repair at our institution. Three patients (1.5%) died after delayed referral before an attempt at repair due to uncontrolled sepsis. Twenty-two patients, having intact biliary-enteric continuity, underwent successful balloon dilatation of an anastomotic stricture. A total of 175 patients underwent definitive biliary reconstruction, including 172 hepaticojejunostomies (98%) and 3 end-to-end repairs. There were 3 deaths in the postoperative period (1.7%). Seventy-five patients (42.9%) sustained at least 1 postoperative complication. The most common complications were wound infection (8%), cholangitis (5.7%), and intraabdominal abscess/biloma (2.9%). Minor biliary stent complications occurred in 5.7% of patients. Early postoperative cholangiography revealed an anastomotic leak in 4.6% of patients and extravasation at the liver dome-stent exit site in 10.3% of patients. Postoperative interventions included percutaneous abscess drainage in 9 patients (5.1%) and new percutaneous transhepatic cholangiography and stent placement in 4 patients (2.3%). No patient required reoperation in the postoperative period. The mean postoperative length of stay was 9.5 days (median 9 days). The timing of operation (early, intermediate, delayed), presenting symptoms, and history of prior repair did not affect the incidence of the most common perioperative complications or length of postoperative hospital stay. CONCLUSIONS: This series represents the largest single institution experience reporting the perioperative management of BDI following LC. Although perioperative complications are frequent, nearly all can be managed nonoperatively. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

Adult↗
PubMed2004

Multiservice laparoscopic surgical training using the daVinci surgical system.

BACKGROUND: The daVinci surgical system affords surgeons a magnified three-dimensional videoscopic view of the operative field and precise articulating laparoscopic instruments. The learning curve for this advanced surgical robotics system is poorly characterized. METHODS: Twenty-three surgeons representing seven surgical subspecialties participated in a surgical robotics training program consisting of standardized daVinci system training (phase 1) followed by self-guided learning in a porcine model (phase 2). RESULTS: The average number of recorded procedures performed per surgeon during phase 2 was 5.5. The mean daVinci system set-up time was 45 minutes and decreased by an average of 56.1% by the third successive set-up (r = -0.702, P <0.005). Operative times decreased 39.0% by the third successive practice operation (r = -0.860, P <0.0005). CONCLUSIONS: New use of the daVinci robot is associated with a rapid learning curve and preclinical animal model training is effective in developing surgical robotics skills.

Animals↗
PubMed2004

Robotic abdominal surgery.

As a whole, abdominal surgeons possess excellent videoendoscopic surgical skills. However, the limitations of laparoscopy-such as reduced range of motion and instrument dexterity and 2-dimensional view of the operative field-have inspired even the most accomplished laparoscopists to investigate the potential of surgical robotics to broaden their application of the minimally invasive surgery paradigm. This review discusses data obtained from articles indexed in the MEDLINE database written in English and mapped to the following key words: "surgical robotics," "robotic surgery," "robotics," "computer-assisted surgery," "da Vinci," "Zeus," "fundoplication," "morbid obesity," "hepatectomy," "pancreatectomy," "small intestine," "splenectomy," "colectomy," "adrenalectomy," and "pediatric surgery." A limited subset of 387 publications was reviewed to determine article relevance to abdominal robotic surgery. Particular emphasis was placed on reports that limited their discussion to human applications and surgical outcomes. Included are comments about the initial 202 robotic abdominal surgery cases performed at Johns Hopkins University Hospital (Baltimore, MD) from August 2000 to January 2004. Surgical robotic systems are being used to apply laparoscopy to the surgical treatment of diseases in virtually every abdominal organ. Procedures demanding superior visualization or requiring complex reconstruction necessitating extensive suturing obtain the greatest benefit from robotics over conventional laparoscopy. Whereas advanced surgical robotic systems offer the promise of a unique combination of advantages over open and conventional laparoscopic approaches, clinical data demonstrating improved outcomes are lacking for robotic surgical applications within the abdomen. Outcomes data for surgical robotics are essential given the exorbitant costs associated with the use of these tools.

Digestive System Surgical Procedures↗
PubMed2004

Videoendoscopic endotracheal intubation in the rat: a comprehensive rodent model of laparoscopic surgery.

BACKGROUND: Peritoneal absorption of CO(2) during abdominal insufflation in laparoscopy may disrupt the acid-base equilibrium and alter the physiological response to stress. Current nonventilated rodent models of laparoscopy do not manage the CO(2) load of pneumoperitoneum, but ventilated surgical rodent models are invasive (tracheotomy) and may independently induce the inflammatory response. MATERIALS AND METHODS: A comprehensive rodent model of laparoscopy was developed. Rats were randomized to receive anesthesia alone, anesthesia plus CO(2) pneumoperitoneum, or anesthesia plus CO(2) pneumoperitoneum with videoendoscopic intubation and mechanical ventilation. Arterial blood-gas analysis was performed at baseline and after 30 min of intervention. RESULTS: Baseline pH, pCO(2), and HCO(3)(-) arterial blood gas parameters were normal for all rats. After 30 min, pCO(2) and pH changed slightly but remained normal among rats receiving anesthesia alone (pCO(2) = 46.5 +/- 1.9; pH = 7.365 +/- 0.009) whereas animals receiving anesthesia plus CO(2) pneumoperitoneum that were dependent on spontaneous respiration for ventilation developed significant hypercarbic acidosis (pCO(2) = 53.2 +/- 1.9, P < 0.05; pH = 7.299 +/- 0.011, P < 0.001). This acidosis was completely corrected with increased minute ventilation in intubated rats receiving mechanical ventilation (pCO(2) = 36.8 +/- 1.5, P < 0.001; pH = 7.398 +/- 0.011, P < 0.001). CONCLUSIONS: CO(2) pneumoperitoneum induces significant hypercarbic acidosis in nonventilated rats. Noninvasive endotracheal intubation is feasible in the rat with videoendoscopic assistance. Our noninvasive rodent model of laparoscopic surgery controls for anesthesia- and capnoperitoneum-related acid-base changes and provides an environment in which the biological response to pneumoperitoneum can be studied precisely.

Acid-Base Equilibrium↗
PubMed2004

New tools for laparoscopic division of the pancreas: a comparative animal study.

We tested the hypothesis that the pancreas can be safely divided laparoscopically using non-suture devices. Twelve pigs were randomized into 4 groups: 1) laparoscopic distal pancreatectomy (LDP) using an ultrasonic scalpel; 2) LDP using an ultrasonic scalpel with pancreatic stump suture reinforcement; 3) LDP using a 35-mm laparoscopic linear vascular stapler; 4) LDP using a prototype 35-mm radio-frequency laparoscopic linear vascular stapler. There were no serious complications related to distal pancreatectomy. All groups gained weight by postoperative day (POD) 14. Serum amylase, glucose, electrolytes and total bilirubin levels were measured preoperatively and on POD 1, 3, 7, and 14, and peripancreatic peritoneal fluid amylase levels were measured on POD 7 and 14; all remained normal in all groups. Fewer adhesions to the pancreatic stump were found in the ultrasonic scalpel groups as compared with the stapler groups. Ultrasonic dissection may be the superior means oflaparoscopic transection of the pancreas.

Animals↗
PubMed2003

Decreased cardiac output in humans during laparoscopic antireflux surgery: direct measurements.

OBJECTIVE: In a porcine model, we demonstrated that laparoscopic Nissen fundoplication causes a significant drop in cardiac output (30%) because it exposes both the peritoneal cavity and the mediastinum to CO(2) under pressure. To determine if this occurs in humans, we examined cardiovascular physiology during laparoscopic Nissen fundoplication. Because of invasiveness required in this pilot trial, only six patients were studied. METHODS: The arterial blood pressure (via radial arterial catheter) and the pulmonary artery diastolic pressure and cardiac index (via pulmonary artery thermodilution catheter) were measured at seven points in time during each laparoscopic Nissen fundoplication. RESULTS: The systolic blood pressure decreased in all patients, and the cardiac index decreased in all but one patient. The exception was a patient with Huntington disease, in whom the cardiac output did not decrease. In four of the five patients, the cardiac output was lowest during hiatal dissection, and in the fifth, it was lowest after reverse Trendelenburg positioning. No significant change in the pulmonary artery diastolic pressure was noted. All patients received adequate intravenous fluid replacement (average, 58 +/- 16 mL/kg) to support blood pressure. In one patient, with a particularly large paraesophageal hernia, profound hypotension (40/25 mm Hg) developed during the mediastinal phase of the procedure, and this patient required alpha-adrenergic support followed by laparotomy to eliminate a surgical cause (none found). CONCLUSIONS: Although it is a tremendous advance for patients, laparoscopic Nissen fundoplication can be associated with a significant reduction in cardiac output and blood pressure. Surgeons and anesthesiologists must be alert to changes reflecting these decreases during procedures, which violate both the peritoneal cavity and the mediastinum. We propose careful hemodynamic monitoring during these procedures, especially in patients with coronary artery disease or significant left ventricular dysfunction.

Aged↗
PubMed2003

CO2 Pneumoperitoneum modifies the inflammatory response to sepsis.

OBJECTIVE: To analyze the effect of CO2 pneumoperitoneum on the inflammatory response induced by sepsis during laparoscopy. SUMMARY BACKGROUND DATA: A growing body of evidence challenges the once generally accepted notion that smaller incisions alone account for the observed benefits of the laparoscopic approach. Furthermore, laparoscopic surgery is now being applied to a broad spectrum of patients, including those in whom the inflammatory response is ignited. Delineation of the effects of CO2 pneumoperitoneum on the inflammatory response induced by sepsis is needed. METHODS: Sepsis was induced in rats by cecal ligation and puncture (CLP) performed either open or laparoscopically using CO2 or helium as insufflation gases. Animals were killed 24 hours postoperatively, at which time whole blood was collected for complete blood cell counts and livers were harvested for analysis of hepatic expression of the rat acute phase genes alpha2-macroglobulin and beta-fibrinogen. RESULTS: Laparoscopic CLP using CO2 resulted in significantly reduced hepatic expression of the rat acute phase gene alpha2-macroglobulin compared to both laparoscopic CLP using helium and open CLP. Hepatic expression of another rat acute phase gene, beta-fibrinogen, paralleled that of alpha2-macroglobulin and was significantly reduced following laparoscopic CLP using CO2 compared to laparoscopic CLP using helium. Total white blood cell and neutrophil counts following CLP were both significantly higher when CLP was performed laparoscopically using CO2 than when CLP was performed open or laparoscopically using helium. CONCLUSIONS: Intra-abdominal CO2 present during laparoscopy attenuates the acute phase inflammatory response associated with perioperative sepsis.

Acute-Phase Proteins↗
PubMed2003

Laparoscopy for benign disease: robotics.

Currently available robotic surgical systems appear to be particularly suited for use in benign diseases of the gastrointestinal system. Minimally invasive operations for foregut conditions, such as gastroesophageal reflux disease and achalasia, require excellent visibility and precise tissue dissection. Benign lower gastrointestinal diseases, including inflammatory bowel disease and diverticulitis, also can be approached using robotic assistance. Disadvantages include expense and the loss of tactile feedback. Early clinical results are promising.

Gastrointestinal Diseases↗
PubMed2003

Risk of colonization of central venous catheters: catheters for total parenteral nutrition vs other catheters.

BACKGROUND: Infected central venous catheters cause morbidity and mortality. OBJECTIVE: To compare the risk for colonization of central venous catheters used for total parenteral nutrition with that of catheters used for other purposes. METHODS: Retrospective review of prospectively acquired data on 260 patients with a stay in a surgical intensive care unit longer than 3 days. Single-lumen catheters used solely for total parenteral nutrition were inserted into the subclavian vein and cared for by a dedicated team. Catheters for other purposes were placed and cared for by other staff. Catheters were cultured if clinical findings suggested infection. RESULTS: Of 854 central venous catheters, 61 (7%) were used for total parenteral nutrition. During 4712 catheter days of observation, 89 catheters of all types were colonized. Risk factors for colonization included duration of catheterization (P < .001), having 3 or more lumens (hazard ratio, 1.7; 95% CI, 1.1-2.6), pulmonary artery catheterization (hazard ratio, 1.7; 95% CI, 1.1-2.7), and placement in the internal jugular vein (hazard ratio, 1.6; 95% CI, 1.1-2.5). Catheters used for total parenteral nutrition (hazard ratio, 0.14; 95% CI, 0.04-0.57) and those in the subclavian vein (hazard ratio, 0.51; 95% CI, 0.3-0.8) were at lower risk of colonization. In a multivariate Cox model, the only significant factor was a 5-fold lower risk of infection for catheters used for total parenteral nutrition (hazard ratio, 0.19; 95% CI, 0.04-0.83). CONCLUSION: Rates of colonization were lowest for catheters used solely for total parenteral nutrition, suggesting that a team approach improves patients' care.

Aged↗