Stanislaw Stawicki - Academia.edu (original) (raw)
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Papers by Stanislaw Stawicki
Journal of Surgical Research, 2013
The American surgeon, 2005
Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Mul... more Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73%). All patients initially underwent VAFC and re-exploration 12-48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, D...
Aeromedical transportation industry has grown significantly over the past two decades, with a cor... more Aeromedical transportation industry has grown significantly over the past two decades, with a corresponding increase in air ambulance crashes. The purpose of this report is to provide the reader with a concise update on aeromedical incidents that occurred between January 1, 2013 and December 31, 2014. In addition, two pre-2013 incidents that were not listed in last year's report were included in the current issue. This evidence table, in conjunction with other sources of data regarding aeromedical incidents, provides an excellent foundation for further research in this important area of public health, transportation and patient safety.
![Research paper thumbnail of Housley et al - CPS Readmissions - Accepted JSR Manuscript Draft [May 2015]](https://attachments.academia-assets.com/40268775/thumbnails/1.jpg)
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7 Nasoenteric tubes are associated with a wide variety of complications. These complications can ... more 7 Nasoenteric tubes are associated with a wide variety of complications. These complications can be 8 broadly divided into two groups: those occurring at the time of insertion and those occurring in a 9 delayed fashion, often after a prolonged indwelling time. Many of the complications, including 10 gastrointestinal perforation, intrapleural or intracranial placement, and gastrointestinal ulceration, 11 have potentially disastrous consequences, but with proper caution can be prevented or discovered 12 early. Awareness of the potential complications of placement and long-term tube maintenance is 13 necessary for appropriate precautions to be consistently taken by providers using these seemingly 14 innocuous devices. Should complications occur, early recognition and prompt therapeutic interven-15 tions are key to avoiding further sequelae and poor patient outcomes.
International journal of critical illness and injury science
Measurement of intravascular volume status is an ongoing challenge for physicians in the surgical... more Measurement of intravascular volume status is an ongoing challenge for physicians in the surgical intensive care unit (SICU). Most surrogates for volume status, including central venous pressure (CVP) and pulmonary artery wedge pressure, require invasive lines associated with a number of potential complications. Sonographic assessment of the collapsibility of the inferior vena cava (IVC) has been described as a noninvasive method for determining volume status. The purpose of this study was to analyze the dynamic response in IVC collapsibility index (IVC-CI) to changes in CVP in SICU patients receiving fluid boluses for volume resuscitation. A prospective pilot study was conducted on a sample of SICU patients who met clinical indications for intravenous (IV) fluid bolus and who had preexisting central venous access. Boluses were standardized to crystalloid administration of either 500 mL over 30 min or 1,000 mL over 60 min, as clinically indicated. Concurrent measurements of venous C...
Journal of Surgical Research, 2015
European journal of trauma and emergency surgery : official publication of the European Trauma Society, Jan 11, 2015
Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessm... more Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessment of life-threatening trauma or hemodynamic conditions, to elective procedures such as image-guided peripheral nerve blocks. Sonographers have utilized ultrasound techniques in the pre-hospital setting, emergency departments, operating rooms, intensive care units, outpatient clinics, as well as during mass casualty and disaster management. Currently available ultrasound devices are more affordable, portable, and feature user-friendly interfaces, making them well suited for use in the demanding situation of a mass casualty incident (MCI) or disaster triage. We have reviewed the existing literature regarding the application of sonology in MCI and disaster scenarios, focusing on the most promising and practical ultrasound-based paradigms applicable in these settings.
World journal of gastrointestinal endoscopy, Jan 16, 2015
The intentional ingestion of foreign objects (IIFO) is described more commonly in prison populati... more The intentional ingestion of foreign objects (IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects (e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrence as subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to mon...
Introduction: Open abdomen (OA) spans an entire spectrum of traumatic and non-traumatic indicatio... more Introduction: Open abdomen (OA) spans an entire spectrum of traumatic and non-traumatic indications. We hypothesize that uniformly managed OA patients have favorable outcomes regardless of the initial traumatic or non-traumatic etiology. Methods: This is a retrospective review of OA patients from 2001 to 2006. A comparison was carried out between NTP and trauma OA patients, examining patient demographics, physiologic parameters, resource utilization, and outcome measures. Results: There were 60 OA patients [35 non-trauma (NTP), 25 trauma (TP)]. NTP were significantly older than TP (60.9 vs 38.3 years). The initial mean pH, SAPS II score, predicted and observed 28-day mortality were similar for both groups. The initial base deficit was 5.53 in NTP and 10.4 in TP (P = 0.0191). Lactic acid levels were 3.54 in NTP and 5.57 in TP (P = 0.0326). Time to abdominal closure was 18.2 days for TP and 20.7 days for NTP. NTP had longer mean ICU stays (11.6 vs 8.5 days, P = 0.0438). NTP had more a...
The American surgeon
The esophageal Doppler monitoring (EDM) technology is well described in the literature. As it evo... more The esophageal Doppler monitoring (EDM) technology is well described in the literature. As it evolved over the last several years, the use of EDM has found expanded indications in various clinical settings. One of the areas where EDM has not been studied extensively is its use during optimization of organ donors before organ procurement. Close hemodynamic monitoring has become essential in the era of increasing use of extended organ donors. We present six cases of successful EDM use during preorgan procurement resuscitation of organ donors. Despite labile hemodynamics in the majority of these cases, EDM-guided optimization of resuscitative endpoints allowed successful organ procurements and transplants, including 12 kidneys, 6 livers, 3 hearts, 2 pancreases, and 2 lungs. The EDM technology is noninvasive, technically easy, and less expensive than the traditional pulmonary artery catheter. Other potential benefits of the EDM include its portability and possibility of deployment in an...
Journal of emergencies, trauma, and shock, 2014
Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains... more Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury,"…
Journal of Intensive Care Medicine, 2009
Journal of Surgical Research, 2013
The American surgeon, 2005
Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Mul... more Delayed abdominal closure has gained acceptance in managing a variety of surgical conditions. Multiple techniques were devised to promote safe, uncomplicated, expeditious fascial closure. We retrospectively reviewed patient records between September 22, 2001 and June 30, 2004. Of the 20 patients with open abdomen, two patients died within 24 hours and one was transferred. The remaining 17 were managed using an algorithm including a combination of delayed primary closure (DPC), vacuum-assisted fascial closure (VAFC), Wittmann Patch (WP) (Star Surgical, Inc., Burlington, WI), and planned ventral hernia via absorbable mesh with split thickness skin grafting (PVH). The mean Simplified Acute Physiology Scores (SAPS II) was 31 (predicted mortality 73%). All patients initially underwent VAFC and re-exploration 12-48 hours later. Indications for continued VAFC included 1) gross contamination, 2) massive bowel edema, 3) continued bleeding at re-exploration. If these conditions were absent, D...
Aeromedical transportation industry has grown significantly over the past two decades, with a cor... more Aeromedical transportation industry has grown significantly over the past two decades, with a corresponding increase in air ambulance crashes. The purpose of this report is to provide the reader with a concise update on aeromedical incidents that occurred between January 1, 2013 and December 31, 2014. In addition, two pre-2013 incidents that were not listed in last year's report were included in the current issue. This evidence table, in conjunction with other sources of data regarding aeromedical incidents, provides an excellent foundation for further research in this important area of public health, transportation and patient safety.
7 Nasoenteric tubes are associated with a wide variety of complications. These complications can ... more 7 Nasoenteric tubes are associated with a wide variety of complications. These complications can be 8 broadly divided into two groups: those occurring at the time of insertion and those occurring in a 9 delayed fashion, often after a prolonged indwelling time. Many of the complications, including 10 gastrointestinal perforation, intrapleural or intracranial placement, and gastrointestinal ulceration, 11 have potentially disastrous consequences, but with proper caution can be prevented or discovered 12 early. Awareness of the potential complications of placement and long-term tube maintenance is 13 necessary for appropriate precautions to be consistently taken by providers using these seemingly 14 innocuous devices. Should complications occur, early recognition and prompt therapeutic interven-15 tions are key to avoiding further sequelae and poor patient outcomes.
International journal of critical illness and injury science
Measurement of intravascular volume status is an ongoing challenge for physicians in the surgical... more Measurement of intravascular volume status is an ongoing challenge for physicians in the surgical intensive care unit (SICU). Most surrogates for volume status, including central venous pressure (CVP) and pulmonary artery wedge pressure, require invasive lines associated with a number of potential complications. Sonographic assessment of the collapsibility of the inferior vena cava (IVC) has been described as a noninvasive method for determining volume status. The purpose of this study was to analyze the dynamic response in IVC collapsibility index (IVC-CI) to changes in CVP in SICU patients receiving fluid boluses for volume resuscitation. A prospective pilot study was conducted on a sample of SICU patients who met clinical indications for intravenous (IV) fluid bolus and who had preexisting central venous access. Boluses were standardized to crystalloid administration of either 500 mL over 30 min or 1,000 mL over 60 min, as clinically indicated. Concurrent measurements of venous C...
Journal of Surgical Research, 2015
European journal of trauma and emergency surgery : official publication of the European Trauma Society, Jan 11, 2015
Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessm... more Ultrasound technology has become ubiquitous in modern medicine. Its applications span the assessment of life-threatening trauma or hemodynamic conditions, to elective procedures such as image-guided peripheral nerve blocks. Sonographers have utilized ultrasound techniques in the pre-hospital setting, emergency departments, operating rooms, intensive care units, outpatient clinics, as well as during mass casualty and disaster management. Currently available ultrasound devices are more affordable, portable, and feature user-friendly interfaces, making them well suited for use in the demanding situation of a mass casualty incident (MCI) or disaster triage. We have reviewed the existing literature regarding the application of sonology in MCI and disaster scenarios, focusing on the most promising and practical ultrasound-based paradigms applicable in these settings.
World journal of gastrointestinal endoscopy, Jan 16, 2015
The intentional ingestion of foreign objects (IIFO) is described more commonly in prison populati... more The intentional ingestion of foreign objects (IIFO) is described more commonly in prison populations than in the general population, with an estimated annual incidence of 1 in 1900 inmates in our state correctional facilities. Incidents often involve ingestion of small metal objects (e.g., paperclips, razor blades) or other commonly available items like pens or eating utensils. Despite ingestion of relatively sharp objects, most episodes can be clinically managed with either observation or endoscopy. Surgery should be reserved for those with signs or symptoms of gastrointestinal perforation or obstruction. For those with a history of IIFO, efforts should focus on prevention of recurrence as subsequent episodes are associated with higher morbidity, significant healthcare and security costs. The pattern of IIFO is often repetitive, with escalation both in frequency of ingestions and in number of items ingested. Little is known about successful prevention strategies, but efforts to mon...
Introduction: Open abdomen (OA) spans an entire spectrum of traumatic and non-traumatic indicatio... more Introduction: Open abdomen (OA) spans an entire spectrum of traumatic and non-traumatic indications. We hypothesize that uniformly managed OA patients have favorable outcomes regardless of the initial traumatic or non-traumatic etiology. Methods: This is a retrospective review of OA patients from 2001 to 2006. A comparison was carried out between NTP and trauma OA patients, examining patient demographics, physiologic parameters, resource utilization, and outcome measures. Results: There were 60 OA patients [35 non-trauma (NTP), 25 trauma (TP)]. NTP were significantly older than TP (60.9 vs 38.3 years). The initial mean pH, SAPS II score, predicted and observed 28-day mortality were similar for both groups. The initial base deficit was 5.53 in NTP and 10.4 in TP (P = 0.0191). Lactic acid levels were 3.54 in NTP and 5.57 in TP (P = 0.0326). Time to abdominal closure was 18.2 days for TP and 20.7 days for NTP. NTP had longer mean ICU stays (11.6 vs 8.5 days, P = 0.0438). NTP had more a...
The American surgeon
The esophageal Doppler monitoring (EDM) technology is well described in the literature. As it evo... more The esophageal Doppler monitoring (EDM) technology is well described in the literature. As it evolved over the last several years, the use of EDM has found expanded indications in various clinical settings. One of the areas where EDM has not been studied extensively is its use during optimization of organ donors before organ procurement. Close hemodynamic monitoring has become essential in the era of increasing use of extended organ donors. We present six cases of successful EDM use during preorgan procurement resuscitation of organ donors. Despite labile hemodynamics in the majority of these cases, EDM-guided optimization of resuscitative endpoints allowed successful organ procurements and transplants, including 12 kidneys, 6 livers, 3 hearts, 2 pancreases, and 2 lungs. The EDM technology is noninvasive, technically easy, and less expensive than the traditional pulmonary artery catheter. Other potential benefits of the EDM include its portability and possibility of deployment in an...
Journal of emergencies, trauma, and shock, 2014
Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains... more Clearance of cervical spine injury (CSI) in the obtunded or comatose blunt trauma patient remains controversial. In patients with unreliable physical examination and no evidence of CSI on computed tomography (CT), magnetic resonance imaging of the cervical spine (CS-MRI) is the typical follow-up study. There is a growing body of evidence suggesting that CS-MRI is unnecessary with negative findings on a multi-detector CT (MDCT) scan. This review article systematically analyzes current literature to address the controversies surrounding clearance of CSI in obtunded blunt trauma patients. A literature search through MEDLINE database was conducted using all databases on the National Center for Biotechnology Information (NCBI) website (www.ncbi.nlm.nih.gov) for keywords: "cervical spine injury,"…
Journal of Intensive Care Medicine, 2009