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Biomedical subjects

Michael Jacka

Publications and source records attributed to Michael Jacka.

4 recordsLinked to original sources
PubMed2004

Incidence of and risk factors for pulmonary complications after nonthoracic surgery.

The prediction of postoperative pulmonary complications is an underinvestigated field. We conducted a prospective cohort study (with postoperative pulmonary complications ascertained by an investigator blinded to perioperative variables) to determine the risk factors for pulmonary complications after elective nonthoracic surgery. Of 1,055 consecutive patients attending the Pre-Admission Clinic of a university hospital (mean age 55 years, 50% men, 15% with history of obstructive airways disease), 28 (2.7%) suffered a postoperative pulmonary complication within 7 days of surgery: 13 patients developed respiratory failure requiring ventilatory support, 9 pneumonia, 5 atelectasis requiring bronchoscopic intervention, and 1 pneumothorax requiring intervention. Mean lengths of stay were substantially prolonged for those patients who developed pulmonary complications within 7 days of surgery: 27.9 days versus 4.5 days, p = 0.006. Eight variables were statistically significantly associated with pulmonary complications on bivariate analyses. Multivariate analyses revealed that four were independently associated with increased risk of pulmonary complications: age (odds ratio [OR] 5.9 for age >/= 65 years, p < 0.001), positive cough test (OR 3.8, P = 0.01), perioperative nasogastric tube (OR 7.7, p < 0.001), and duration of anesthesia (OR 3.3 for operations lasting at least 2.5 hours, p = 0.008). Thus, several perioperative factors predict an increased risk for pulmonary complications after elective nonthoracic surgery.

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PubMed2004

Evidence-based clinical practice guideline for the prevention of ventilator-associated pneumonia.

BACKGROUND: Ventilator-associated pneumonia (VAP) is an important patient safety issue in critically ill patients. PURPOSE: To develop an evidence-based guideline for the prevention of VAP. DATA SOURCES: MEDLINE, EMBASE, and the Cochrane Database of Systematic Reviews. STUDY SELECTION: The authors systematically searched for relevant randomized, controlled trials and systematic reviews that involved mechanically ventilated adults and were published before 1 April 2003. DATA EXTRACTION: Physical, positional, and pharmacologic interventions that may influence the development of VAP were considered. Independently and in duplicate, the authors scored the validity of trials; the effect size and confidence intervals; the homogeneity of results; and safety, feasibility, and economic issues. DATA SYNTHESIS: Recommended: The orotracheal route of intubation, changes of ventilator circuits only for each new patient and if the circuits are soiled, use of closed endotracheal suction systems that are changed for each new patient and as clinically indicated, heat and moisture exchangers in the absence of contraindications, weekly changes of heat and moisture exchangers, and semi-recumbent positioning in the absence of contraindications. Consider subglottic secretion drainage and kinetic beds. Not recommended: Sucralfate to prevent VAP in patients at high risk for gastrointestinal bleeding and topical antibiotics to prevent VAP. Because of insufficient or conflicting evidence, no recommendations were made about systematically searching for maxillary sinusitis, chest physiotherapy, the timing of tracheostomy, prone positioning, prophylactic intravenous antibiotics, or intravenous plus topical antibiotics. LIMITATIONS: No formal economic analysis was performed, and patient perspectives were not considered. CONCLUSION: If effectively implemented, this guideline may decrease the morbidity, mortality, and costs of VAP in mechanically ventilated patients.

Antibiotic Prophylaxis↗
PubMed2003

A randomized, controlled trial of the use of pulmonary-artery catheters in high-risk surgical patients.

BACKGROUND: Some observational studies suggest that the use of pulmonary-artery catheters to guide therapy is associated with increased mortality. METHODS: We performed a randomized trial comparing goal-directed therapy guided by a pulmonary-artery catheter with standard care without the use of a pulmonary-artery catheter. The subjects were high-risk patients 60 years of age or older, with American Society of Anesthesiologists (ASA) class III or IV risk, who were scheduled for urgent or elective major surgery, followed by a stay in an intensive care unit. Outcomes were adjudicated by observers who were unaware of the treatment-group assignments. The primary outcome was in-hospital mortality from any cause. RESULTS: Of 3803 eligible patients, 1994 (52.4 percent) underwent randomization. The base-line characteristics of the two treatment groups were similar. A total of 77 of 997 patients who underwent surgery without the use of a pulmonary-artery catheter (7.7 percent) died in the hospital, as compared with 78 of 997 patients in whom a pulmonary-artery catheter was used (7.8 percent)--a difference of 0.1 percentage point (95 percent confidence interval, -2.3 to 2.5). There was a higher rate of pulmonary embolism in the catheter group than in the standard-care group (8 events vs. 0 events, P=0.004). The survival rates at 6 months among patients in the standard-care and catheter groups were 88.1 and 87.4 percent, respectively (difference, -0.7 percentage point [95 percent confidence interval, -3.6 to 2.2]; negative survival differences favor standard care); at 12 months, the rates were 83.9 and 83.0 percent, respectively (difference, -0.9 percentage point [95 percent confidence interval, -4.3 to 2.4]). The median hospital stay was 10 days in each group. CONCLUSIONS: We found no benefit to therapy directed by pulmonary-artery catheter over standard care in elderly, high-risk surgical patients requiring intensive care.

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