10 results on '"Walz, J. Matthias"'
Search Results
2. Lumbar drain complications in patients undergoing fenestrated or branched endovascular aortic aneurysm repair: Development of an institutional protocol for lumbar drain management.
- Author
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Alqaim M, Cosar E, Crawford AS, Robichaud DI, Walz JM, Schanzer A, and Simons JP
- Subjects
- Aged, Aged, 80 and over, Cerebral Intraventricular Hemorrhage epidemiology, Cerebral Intraventricular Hemorrhage etiology, Cerebrospinal Fluid Leak epidemiology, Cerebrospinal Fluid Leak etiology, Drainage methods, Endovascular Procedures instrumentation, Female, Humans, Male, Middle Aged, Post-Dural Puncture Headache epidemiology, Post-Dural Puncture Headache etiology, Postoperative Complications etiology, Retrospective Studies, Spinal Cord Ischemia etiology, Stents, Subarachnoid Hemorrhage epidemiology, Subarachnoid Hemorrhage etiology, Treatment Outcome, Aortic Aneurysm surgery, Drainage adverse effects, Endovascular Procedures adverse effects, Postoperative Complications epidemiology, Spinal Cord Ischemia prevention & control
- Abstract
Objective: Lumbar drain placement with cerebrospinal fluid (CSF) drainage is an effective adjunct for reducing the risk of spinal cord ischemia in patients undergoing complex aortic aneurysm repair. However, lumbar drain placement is a challenging procedure with potential for significant complications. We sought to characterize complications of lumbar drain placement in a large, single-center experience of patients who underwent fenestrated or branched endovascular aneurysm repair (F/BEVAR)., Methods: All patients who underwent F/BEVAR and attempted lumbar drain placement from 2010 to 2019 were retrospectively reviewed. All lumbar drains were placed by four cardiovascular anesthesiologists who compose the complex aortic anesthesia team. Lumbar drain placement was guided by a set protocol and used whenever the aortic stent graft coverage was planned to extend more proximal than 40 mm above the celiac artery. Details relating to lumbar drain placement, management, and frequency and type of associated complications were characterized., Results: During the study period, 256 patients underwent F/BEVAR, of whom 100 (39%) were planned for lumbar drain placement. Successful placement occurred in 98 (98%) of the cases. All lumbar drains were placed before induction of general anesthesia, using fluoroscopy guidance in 28 cases (28%). The most common level of placement was L4-5 (n = 42 [42%]). The majority (n = 82 [82%]) were left in place ≤48 hours; 21% were removed during the first 24 hours, and 61% were removed between 24 and 48 hours. Nonfunctionality was the most common complication, occurring in 16 (16%) patients. Catheter dislodgment or fracture, CSF leak, and postdural puncture headache were observed in 4 (4%), 7 (7%), and 4 (4%) patients, respectively. The most common bleeding complication was the presence of asymptomatic blood in the CSF (n = 11 [11%]), whereas subarachnoid hemorrhage combined with intraventricular hemorrhage occurred in three patients (3%); none of these patients required surgical drainage or intervention. No infectious complications were observed., Conclusions: Lumbar drain placement for CSF drainage is a commonly employed adjunct to prevent spinal cord ischemia in F/BEVAR. Our experience demonstrates that lumbar drain placement can be performed successfully but is associated with a significant rate of nonfunctionality and a diverse range of complications that, fortunately, do not commonly have significant long-term sequelae., (Copyright © 2020 Society for Vascular Surgery. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
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3. Response.
- Author
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Scott JA, Heard SO, Zayaruzny M, and Walz JM
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- Humans, Airway Management, Critical Illness
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- 2020
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4. Airway Management in Critical Illness: An Update.
- Author
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Scott JA, Heard SO, Zayaruzny M, and Walz JM
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- Humans, Intubation, Intratracheal methods, Laryngoscopy methods, Airway Management methods, Airway Management trends, Critical Illness therapy, Emergency Medical Services
- Abstract
Expertise in airway management is a vital skill for any provider caring for critically ill patients. A growing body of literature has identified the stark difference in periprocedural outcomes of elective intubation in the operating room when compared with emergency intubation in the ICU. A number of strategies to reduce the morbidity and mortality associated with airway management in the critically ill have been described. In this review, we provide an updated framework for airway assessment before direct laryngoscopy and video laryngoscopy, and use of newer pharmacologic agents; comment on current concepts in tracheal intubation in the ICU; and address human factors around critical decision-making during ICU airway management., (Copyright © 2019 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2020
- Full Text
- View/download PDF
5. Should the Ramped Position Be "Sniffed at" in the ICU?
- Author
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Scott JA, Walz JM, and Heard SO
- Subjects
- Adult, Humans, Intensive Care Units, Posture, Critical Illness, Intubation, Intratracheal
- Published
- 2017
- Full Text
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6. A 10-Year Review of Total Hospital-Onset ICU Bloodstream Infections at an Academic Medical Center.
- Author
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Civitarese AM, Ruggieri E, Walz JM, Mack DA, Heard SO, Mitchell M, Lilly CM, Landry KE, and Ellison RT 3rd
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- APACHE, Academic Medical Centers, Bacteremia etiology, Blood Culture, Candidemia etiology, Gastrointestinal Diseases complications, Gram-Negative Bacterial Infections complications, Gram-Positive Bacterial Infections complications, Humans, Intensive Care Units, Linear Models, Logistic Models, Mortality, Pseudomonas Infections complications, Respiratory Tract Infections complications, Retrospective Studies, Soft Tissue Infections complications, Staphylococcal Infections complications, Surgical Wound Infection complications, United States epidemiology, Urinary Tract Infections complications, Bacteremia epidemiology, Candidemia epidemiology, Gram-Negative Bacterial Infections epidemiology, Gram-Positive Bacterial Infections epidemiology, Pseudomonas Infections epidemiology, Staphylococcal Infections epidemiology
- Abstract
Background: The rates of central line-associated bloodstream infections (CLABSIs) in U.S. ICUs have decreased significantly, and a parallel reduction in the rates of total hospital-onset bacteremias in these units should also be expected. We report 10-year trends for total hospital-onset ICU-associated bacteremias at a tertiary-care academic medical center., Methods: This was a retrospective analysis of all positive-result blood cultures among patients admitted to seven adult ICUs for fiscal year 2005 (FY2005) through FY2014 according to Centers for Disease Control and Prevention National Healthcare Safety Network definitions. The rate of change for primary and secondary hospital-onset BSIs was determined, as was the distribution of organisms responsible for these BSIs. Data from three medical, two general surgical, one combined neurosurgical/trauma, and one cardiac/cardiac surgery adult ICU were analyzed., Results: Across all ICUs, the rates of primary BSIs progressively fell from 2.11/1,000 patient days in FY2005 to 0.32/1,000 patient days in FY2014; an 85.0% decrease (P < .0001). Secondary BSIs also progressively decreased from 3.56/1,000 to 0.66/1,000 patient days; an 81.4% decrease (P < .0001). The decrease in BSI rates remained significant after controlling for the number of blood cultures obtained and patient acuity., Conclusions: An increased focus on reducing hospital-onset infections at the academic medical center since 2005, including multimodal multidisciplinary efforts to prevent central line-associated BSIs, pneumonia, Clostridium difficile disease, surgical site infections, and urinary tract infections, was associated with progressive and sustained decreases for both primary and secondary hospital-onset BSIs., (Copyright © 2017 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.)
- Published
- 2017
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7. Early, goal-directed mobilisation in the surgical intensive care unit: a randomised controlled trial.
- Author
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Schaller SJ, Anstey M, Blobner M, Edrich T, Grabitz SD, Gradwohl-Matis I, Heim M, Houle T, Kurth T, Latronico N, Lee J, Meyer MJ, Peponis T, Talmor D, Velmahos GC, Waak K, Walz JM, Zafonte R, and Eikermann M
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- Aged, Algorithms, Austria, Confounding Factors, Epidemiologic, Critical Care standards, Critical Care trends, Female, Germany, Humans, Intensive Care Units, Male, Middle Aged, Reproducibility of Results, Research Design, Single-Blind Method, Surgical Procedures, Operative adverse effects, Treatment Outcome, United States, Critical Care methods, Early Ambulation methods, Early Ambulation standards, Early Ambulation trends, Patient Care Planning trends, Physical Therapy Modalities, Surgical Procedures, Operative rehabilitation
- Abstract
Background: Immobilisation predicts adverse outcomes in patients in the surgical intensive care unit (SICU). Attempts to mobilise critically ill patients early after surgery are frequently restricted, but we tested whether early mobilisation leads to improved mobility, decreased SICU length of stay, and increased functional independence of patients at hospital discharge., Methods: We did a multicentre, international, parallel-group, assessor-blinded, randomised controlled trial in SICUs of five university hospitals in Austria (n=1), Germany (n=1), and the USA (n=3). Eligible patients (aged 18 years or older, who had been mechanically ventilated for <48 h, and were expected to require mechanical ventilation for ≥24 h) were randomly assigned (1:1) by use of a stratified block randomisation via restricted web platform to standard of care (control) or early, goal-directed mobilisation using an inter-professional approach of closed-loop communication and the SICU optimal mobilisation score (SOMS) algorithm (intervention), which describes patients' mobilisation capacity on a numerical rating scale ranging from 0 (no mobilisation) to 4 (ambulation). We had three main outcomes hierarchically tested in a prespecified order: the mean SOMS level patients achieved during their SICU stay (primary outcome), and patient's length of stay on SICU and the mini-modified functional independence measure score (mmFIM) at hospital discharge (both secondary outcomes). This trial is registered with ClinicalTrials.gov (NCT01363102)., Findings: Between July 1, 2011, and Nov 4, 2015, we randomly assigned 200 patients to receive standard treatment (control; n=96) or intervention (n=104). Intention-to-treat analysis showed that the intervention improved the mobilisation level (mean achieved SOMS 2·2 [SD 1·0] in intervention group vs 1·5 [0·8] in control group, p<0·0001), decreased SICU length of stay (mean 7 days [SD 5-12] in intervention group vs 10 days [6-15] in control group, p=0·0054), and improved functional mobility at hospital discharge (mmFIM score 8 [4-8] in intervention group vs 5 [2-8] in control group, p=0·0002). More adverse events were reported in the intervention group (25 cases [2·8%]) than in the control group (ten cases [0·8%]); no serious adverse events were observed. Before hospital discharge 25 patients died (17 [16%] in the intervention group, eight [8%] in the control group). 3 months after hospital discharge 36 patients died (21 [22%] in the intervention group, 15 [17%] in the control group)., Interpretation: Early, goal-directed mobilisation improved patient mobilisation throughout SICU admission, shortened patient length of stay in the SICU, and improved patients' functional mobility at hospital discharge., Funding: Jeffrey and Judy Buzen., (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Published
- 2016
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8. Rebuttal from Dr Walz.
- Author
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Walz JM
- Subjects
- Humans, Airway Management, Anesthesiology, Intensive Care Units, Specialization
- Published
- 2012
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9. Point: Should an anesthesiologist be the specialist of choice in managing the difficult airway in the ICU? Yes.
- Author
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Walz JM
- Subjects
- Humans, Hypotension prevention & control, Hypoxia prevention & control, Intubation, Laryngoscopes, Airway Management adverse effects, Anesthesiology, Intensive Care Units, Specialization
- Published
- 2012
- Full Text
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10. Airway management in critical illness.
- Author
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Walz JM, Zayaruzny M, and Heard SO
- Subjects
- Cervical Vertebrae injuries, Humans, Hypnotics and Sedatives therapeutic use, Immobilization, Neuromuscular Agents therapeutic use, Obesity, Morbid, Critical Care, Intubation, Intratracheal methods
- Abstract
Airway management in the ICU can be complicated due to many factors including the limited physiologic reserve of the patient. As a consequence, the likelihood of difficult mask ventilation and intubation increases. The incidence of failed airways and of cardiac arrest related to airway instrumentation in the ICU is much higher than that of elective intubations performed in the operating room. A thorough working knowledge of the devices available for the management of the difficult airway and recommended rescue strategies is paramount in avoiding bad patient outcomes. In this review, we will provide a conceptual framework for airway assessment, with an emphasis on assessment of the patient with limited cervical spine movement or injury and of morbidly obese patients. Furthermore, we will review the devices that are available for airway management in the ICU, and discuss controversies surrounding interventions like cricoid pressure and the use of muscle relaxants in the critically ill patient. Finally, strategies for the safe extubation of patients with known difficult airways will be provided.
- Published
- 2007
- Full Text
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