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Acute acalculous cholecystitis in critically ill patients.

https://arctichealth.org/en/permalink/ahliterature9411
Source
Acta Anaesthesiol Scand. 2004 Sep;48(8):986-91
Publication Type
Article
Date
Sep-2004
Author
J. Laurila
H. Syrjälä
P A Laurila
J. Saarnio
T I Ala-Kokko
Author Affiliation
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Finland. jouko.laurila@pp_fimnet.fi
Source
Acta Anaesthesiol Scand. 2004 Sep;48(8):986-91
Date
Sep-2004
Language
English
Publication Type
Article
Keywords
APACHE
Adult
Aged
Bacterial Infections - complications - microbiology
Cardiac Surgical Procedures
Cholecystectomy
Cholecystitis - diagnosis - etiology - microbiology
Critical Illness
Female
Humans
Intensive Care Units
Male
Middle Aged
Multiple Organ Failure - etiology
Norepinephrine - administration & dosage - therapeutic use
Palpation
Vasoconstrictor Agents - administration & dosage - therapeutic use
Abstract
BACKGROUND: Acute acalculous cholecystitis (AAC) is a serious complication of critical illness. We evaluated the underlying diseases, clinical and diagnostic features, severity of associated organ failures, and outcome of operatively treated AAC in a mixed ICU patient population. METHODS: The data of all ICU patients who had operatively confirmed AAC during their ICU stay between 1 January 2000 and 31 December 2001 were collected from the hospital records and the intensive care unit's data management system for predetermined variables. RESULTS: Thirty-nine (1%) out of 3984 patients underwent open cholecystectomy for AAC during the two-year period. Infection was the most common admission diagnosis, followed by cardiovascular surgery. The mean APACHE II score on admission was 25, and 64% of the patients had three or more failing organs on the day of cholecystectomy. The mean length of ICU stay before cholecystectomy was 8 days, and the mean total length of ICU stay was 19 days. Most patients (85%) received norepinephrine infusion, and 90% suffered respiratory failure before cholecystectomy. Hospital mortality was 44%. The non-survivors had higher Sequential Organ Failure Assessment (SOFA) scores on the day of cholecystectomy compared to the survivors (12.9 vs. 9.5, P = 0.007). CONCLUSION: Acute acalculous cholecystitis was associated with severe illness, infection, long ICU stay, and multiple organ failure. Mortality was related to the degree of organ failure. Prompt diagnosis and active treatment of AAC can be life-saving in these patients.
PubMed ID
15315616 View in PubMed
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Organ system dysfunction following open cholecystectomy for acute acalculous cholecystitis in critically ill patients.

https://arctichealth.org/en/permalink/ahliterature76312
Source
Acta Anaesthesiol Scand. 2006 Feb;50(2):173-9
Publication Type
Article
Date
Feb-2006
Author
J. Laurila
P A Laurila
J. Saarnio
V. Koivukangas
H. Syrjälä
T I Ala-Kokko
Author Affiliation
Division of Intensive Care, Department of Anesthesiology, Oulu University Hospital, Oulu, Finland. jouko.laurila@pp.fimnet.fi
Source
Acta Anaesthesiol Scand. 2006 Feb;50(2):173-9
Date
Feb-2006
Language
English
Publication Type
Article
Keywords
APACHE
Acalculous Cholecystitis - complications - surgery
Acute Disease
Adult
Aged
Aged, 80 and over
Cholecystectomy - adverse effects - methods
Cohort Studies
Critical Illness
Disease Progression
Female
Humans
Male
Middle Aged
Multiple Organ Failure - etiology - surgery
Retrospective Studies
Severity of Illness Index
Time Factors
Abstract
BACKGROUND: Acute acalculous cholecystitis (AAC) refers to cholecystitis without gallstones and is a serious complication of critical illness. We describe the time course of organ system dysfunction associated with cholecystectomy in critically ill patients with AAC. METHODS: The data of all intensive care unit (ICU) patients who had operatively confirmed AAC during their ICU stay between 2003 and 2004 were analyzed. Patients who also had other intra-abdominal pathologies were excluded. The Sequential Organ Failure Assessment (SOFA) scores were recorded 3 days before, on the day of operation and on the first, second, third and seventh post-operative day after cholecystectomy. The impact of open cholecystectomy on organ dysfunction was evaluated on the basis of the change in the total and individual organ SOFA scores. RESULTS: Twenty-four patients underwent open cholecystectomy for AAC with no other intra-abdominal pathology. Sepsis was the most common admission diagnosis, followed by cardiovascular surgery. The mean (standard deviation, SD) Acute Physiology and Chronic Health Evaluation (APACHE II), Simplified Acute Physiology Score (SAPS) II and SOFA scores on admission were 24.7 (5.8), 44.3 (12.3) and 9.4 (3.2), respectively. The median (25th, 75th percentiles) total SOFA score 3 days before cholecystectomy was 7.5 (1.3, 8.0), which increased to 10.5 (8.3, 13.0) (P
PubMed ID
16430538 View in PubMed
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