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Papers by konstantinos rellos
Journal of the American Geriatrics Society, 2006
OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of you... more OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of younger patients. DESIGN: Prospective cohort study. SETTING: General intensive care unit (ICU) of a tertiary care hospital in Athens, Greece. PARTICIPANTS: The oldest-old and younger patients. MEASUREMENTS: In-hospital and ICU mortality and stay, demographics, comorbidity, and complications. RESULTS: Of 5,505 consecutive patients admitted to the ICU, 60 (1.1%) were in the oldest-old group (aged 90-98). Their mean length of ICU and hospital stay AE standard deviation was 5.3 AE 6.8 and 23.3 AE 35.7 days, respectively. ICU mortality was 20%. Total in-hospital mortality was 40%, compared with 8.9% (P 5.001) in younger patients. Acute Physiology and Chronic Health Evaluation II score was independently associated with in-hospital mortality (odds ratio 5 1.18, 95% confidence interval 5 1.05-1.33). Of 24 oldest-old patients who died, 22 (91.7%) died in the ICU or in the ward within 30 days after ICU discharge. CONCLUSION: All-cause in-hospital mortality was higher in the oldest-old group than in younger patients, but the mortality of this cohort of patients did not seem to reach a figure that would make physicians, relatives, and healthcare administrators decide against ICU care in this population.
European Journal of Anaesthesiology, Jul 11, 2005
The Journal of Thoracic and Cardiovascular Surgery, Sep 1, 2006
It included all adult patients who underwent coronary artery bypass grafting with no valve surger... more It included all adult patients who underwent coronary artery bypass grafting with no valve surgery and without the use of cardiopulmonary bypass during a period of 3 years. Case patients were those with development of microbiologically documented nosocomial infections. Various variables were examined as possible risk factors for nosocomial infections. Results: Twenty-one of 782 studied patients (2.7%) acquired 26 microbiologically documented nosocomial infections after off-pump coronary artery bypass grafting. Eight of 782 studied patients had pneumonia (1.02%), 7 of 782 (0.90%) had bacteremia, 4 of 782 (0.51%) had superficial wound infection at the sternotomy site, 4 of 782 (0.51%) had urinary tract infection, 2 of 782 (0.26%) had mediastinitis, and 1 of 782 (0.13%) had pressure sore infection. Twenty-one infections were monomicrobial, whereas 5 were polymicrobial. All polymicrobial infections were wound infections. There was a statistically significant difference in mortality between patients with and without nosocomial infection (23.8% vs 1.2%, P Ͻ .001). Clinical response of the infection to the treatment administered was observed in 21 of 26 episodes (80.8%) in 21 patients. A backward stepwise multivariable logistic regression model showed that independent risk factors (P Ͻ .05) associated with development of microbiologically documented nosocomial infection were arterial hypertension, previous vascular surgery, urgent operation, postoperative atrial fibrillation, number of inotropes used during and after operation, transfusion of fresh-frozen plasma during the intensive care unit stay, and intensive care unit stay until development of infection. Conclusion: Nosocomial infection after off-pump coronary artery bypass grafting is an uncommon but potentially life-threatening complication. The identification of independent risk factors, including arterial hypertension, associated with development of postoperative infection may help in the development of clinical strategies for the prevention, early diagnosis, and treatment of these infections. C oronary artery bypass grafting (CABG) on a beating heart (off-pump CABG, or OPCAB) has become common in the last 10 years in an attempt to decrease the complications associated with the use of extracorporeal circulation. OPCAB is associated with a significant reduction in inflammatory response, a fact supported by decreased production of interleukin 8, lower postoperative concentrations of elastase, and lower postoperative white blood cell, neutrophil, and monocyte counts. 1,2 A recent meta-analysis of 37 randomized trials that
Respiratory Medicine, Jun 1, 1998
The role of positive end-expiratory pressure (PEEP) in the postoperative course of cardiac surger... more The role of positive end-expiratory pressure (PEEP) in the postoperative course of cardiac surgery patients remains questionable. In this prospective study, we examined the effect of different levels of PEEP on arterial oxygenation, SO, and fi0, values, and on haemodynamic indices, during the early postoperative period in cardiac surgery patients. Upon transfer to the ICU, 67 adult patients with normal preoperative respiratory status were randomly assigned to receive zero PEEP (Group A), 5 cmH,O (Group B), or 10 cmH,O PEEP (Group C) during mechanical ventilatory support. PaO,/fiO, ratio, mixed venous fi0, and SiiO,, and cardiac index, were measured 30 min, 4 h and 8 h after application of mechanical ventilation in the ICU, just prior to extubation, half an hour after extubation, and 4 h post-extubation. We found no statistically significant differences (P=n.s.) in arterial oxygenation expressed by PaO,/FrO 2 ratio, SO, and fi0, values, and in cardiac index among the three groups at any study interval. We conclude that low levels of PEEP have no advantage over zero PEEP in improving gas exchange in the early postoperative course of patients following open heart surgery.
Intensive Care Medicine, 1996
Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery pati... more Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery patients (pts). Routine use of PEEP (5 to 10 cm H20) has been advocated in these pts, but its utility is largely unknown. On the other hand, the use of PEEP is sometimes avoided in cardiac surgery pts because of circulatory depression. In this
Annals of The Royal College of Surgeons of England, May 1, 2017
The frequency of surgical site infections (SSIs) after clean neck surgery is low and antibiotic p... more The frequency of surgical site infections (SSIs) after clean neck surgery is low and antibiotic prophylaxis is not recommended. This retrospective study investigated the effect of perioperative prophylactic antimicrobial therapy on the development of infections. A total of 807 consecutive patients undergoing clean neck surgery were included in the study. Antimicrobial prophylaxis with intravenous cefuroxime was administered in 518 cases. Although patients who received prophylaxis had a lower rate of SSIs than those who did not receive antibiotics, this was not statistically significant (0.4% vs 1.4% respectively, p=0.19). Older age was the only variable associated with the development of SSIs (p=0.014).
European Journal of Anaesthesiology, 2003
We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after... more We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period
We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after... more We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period June 2004-October 2005 at Henry Dunant Hospital, Athens, Greece. C-reactive protein (CRP) and procalcitonin were assayed from 222 patients preoperatively, and 1-3 days following OPCABG. Variables independently associated with infection were identified by a multivariable logistic regression model. Eighteen of 360 (5%) patients developed postoperative infections; 1.7% developed superficial wound infection, 1.4% pneumonia, 1.1% bacteremia, 0.3% mediastinitis, and 0.3% intra-aortic balloon pump related infection. The mean increase of CRP and procalcitonin levels in the first two or three days, respectively, after surgery was significantly higher (P-0.05) in patients with infection. Independent risk factors of infection (P-0.05) were history of major nervous system disorder, left ventricula...
Interactive Cardiovascular and Thoracic Surgery, 2007
We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after... more We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period
European Journal of Cardio-Thoracic Surgery, 2008
The aim of this study was to prospectively evaluate frequency, characteristics, and predictors of... more The aim of this study was to prospectively evaluate frequency, characteristics, and predictors of nosocomial infections (NI) in a tertiary care centre. Methods: Study population included 925 patients (mean age 62.3 AE 12.5, 32.3% females, 22.9% diabetics, 6.8% with previous cardiac procedures) operated on between June 2005 and December 2006 (CABG 48.72%, valvular procedures 30.05%, thoracic aortic 10.9%, heart transplantations 3.78% and miscellanea 6.55%, procedure status: elective 72.9%, urgent 15.9% and emergent 11.2%). The study population was divided in two groups according to development of NI. Primary endpoints were multiorgan failure (MOF) and hospital mortality in the two groups. Secondary endpoints were length of intubation, intensive care unit (ICU) stay and overall hospitalisation. Univariate and multivariate analysis of NI predictors was conducted between 115 perioperative variables. Results: Eighty-three patients (9%) developed a NI. Infections affected respiratory tract in 51.8%, blood stream in 20.5 and wound infection in 27.7 (13.3% deep wound). Staphylococcal species (60.6%) predominated in blood stream and surgical wound infections while Gram-negative species predominated in respiratory infections. Patients affected by NI experienced significantly higher incidence of MOF (12% vs 0.8%) and hospital mortality (24.1 vs 6.9%). Development of NI significantly lengthened all the steps of postoperative process of care (length of intubation: 49.9
Crit Care, 2005
Globalization in business, politics and other aspects of our everyday life is viewed by many as a... more Globalization in business, politics and other aspects of our everyday life is viewed by many as an inevitable reality. The English language has undoubtedly benefited significantly from the new era, in gradually penetrating into other cultures in many fields such as music, arts, education, and more recently science. Previous reports indicate that such penetration is also evident in the field of biomedical sciences [1,2], primarily supported by the paper and online publication in the English language of the majority of about 6,000 journals indexed in PubMed. The adoption of a universal language in science, namely English, could facilitate communication between individuals from different countries and enhance the timely interchange of ideas among researchers and scientists with potential benefits to scientific advancement and development [3]. Language barriers could also potentially be eliminated and
International Journal of Antimicrobial Agents, 2016
Highlights Significant variability in early colistin concentrations following a loading dose ha... more Highlights Significant variability in early colistin concentrations following a loading dose has been observed. Data from observational studies do not support higher effectiveness of a loading dose. Three ongoing RCTs evaluating the efficacy of a loading dose on mortality. Direct administration of colistin instead of colistimethate sodium could predict patient outcomes more reliably. Higher doses and topical administration when applicable could enhance colistin effectiveness.
Journal of the American Geriatrics Society, 2006
OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of you... more OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of younger patients. DESIGN: Prospective cohort study. SETTING: General intensive care unit (ICU) of a tertiary care hospital in Athens, Greece. PARTICIPANTS: The oldest-old and younger patients. MEASUREMENTS: In-hospital and ICU mortality and stay, demographics, comorbidity, and complications. RESULTS: Of 5,505 consecutive patients admitted to the ICU, 60 (1.1%) were in the oldest-old group (aged 90-98). Their mean length of ICU and hospital stay AE standard deviation was 5.3 AE 6.8 and 23.3 AE 35.7 days, respectively. ICU mortality was 20%. Total in-hospital mortality was 40%, compared with 8.9% (P 5.001) in younger patients. Acute Physiology and Chronic Health Evaluation II score was independently associated with in-hospital mortality (odds ratio 5 1.18, 95% confidence interval 5 1.05-1.33). Of 24 oldest-old patients who died, 22 (91.7%) died in the ICU or in the ward within 30 days after ICU discharge. CONCLUSION: All-cause in-hospital mortality was higher in the oldest-old group than in younger patients, but the mortality of this cohort of patients did not seem to reach a figure that would make physicians, relatives, and healthcare administrators decide against ICU care in this population.
Critical care (London, England), 2005
Journal of the American Geriatrics Society, 2006
OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of you... more OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of younger patients. DESIGN: Prospective cohort study. SETTING: General intensive care unit (ICU) of a tertiary care hospital in Athens, Greece. PARTICIPANTS: The oldest-old and younger patients. MEASUREMENTS: In-hospital and ICU mortality and stay, demographics, comorbidity, and complications. RESULTS: Of 5,505 consecutive patients admitted to the ICU, 60 (1.1%) were in the oldest-old group (aged 90-98). Their mean length of ICU and hospital stay AE standard deviation was 5.3 AE 6.8 and 23.3 AE 35.7 days, respectively. ICU mortality was 20%. Total in-hospital mortality was 40%, compared with 8.9% (P 5.001) in younger patients. Acute Physiology and Chronic Health Evaluation II score was independently associated with in-hospital mortality (odds ratio 5 1.18, 95% confidence interval 5 1.05-1.33). Of 24 oldest-old patients who died, 22 (91.7%) died in the ICU or in the ward within 30 days after ICU discharge. CONCLUSION: All-cause in-hospital mortality was higher in the oldest-old group than in younger patients, but the mortality of this cohort of patients did not seem to reach a figure that would make physicians, relatives, and healthcare administrators decide against ICU care in this population.
European Journal of Anaesthesiology, Jul 11, 2005
The Journal of Thoracic and Cardiovascular Surgery, Sep 1, 2006
It included all adult patients who underwent coronary artery bypass grafting with no valve surger... more It included all adult patients who underwent coronary artery bypass grafting with no valve surgery and without the use of cardiopulmonary bypass during a period of 3 years. Case patients were those with development of microbiologically documented nosocomial infections. Various variables were examined as possible risk factors for nosocomial infections. Results: Twenty-one of 782 studied patients (2.7%) acquired 26 microbiologically documented nosocomial infections after off-pump coronary artery bypass grafting. Eight of 782 studied patients had pneumonia (1.02%), 7 of 782 (0.90%) had bacteremia, 4 of 782 (0.51%) had superficial wound infection at the sternotomy site, 4 of 782 (0.51%) had urinary tract infection, 2 of 782 (0.26%) had mediastinitis, and 1 of 782 (0.13%) had pressure sore infection. Twenty-one infections were monomicrobial, whereas 5 were polymicrobial. All polymicrobial infections were wound infections. There was a statistically significant difference in mortality between patients with and without nosocomial infection (23.8% vs 1.2%, P Ͻ .001). Clinical response of the infection to the treatment administered was observed in 21 of 26 episodes (80.8%) in 21 patients. A backward stepwise multivariable logistic regression model showed that independent risk factors (P Ͻ .05) associated with development of microbiologically documented nosocomial infection were arterial hypertension, previous vascular surgery, urgent operation, postoperative atrial fibrillation, number of inotropes used during and after operation, transfusion of fresh-frozen plasma during the intensive care unit stay, and intensive care unit stay until development of infection. Conclusion: Nosocomial infection after off-pump coronary artery bypass grafting is an uncommon but potentially life-threatening complication. The identification of independent risk factors, including arterial hypertension, associated with development of postoperative infection may help in the development of clinical strategies for the prevention, early diagnosis, and treatment of these infections. C oronary artery bypass grafting (CABG) on a beating heart (off-pump CABG, or OPCAB) has become common in the last 10 years in an attempt to decrease the complications associated with the use of extracorporeal circulation. OPCAB is associated with a significant reduction in inflammatory response, a fact supported by decreased production of interleukin 8, lower postoperative concentrations of elastase, and lower postoperative white blood cell, neutrophil, and monocyte counts. 1,2 A recent meta-analysis of 37 randomized trials that
Respiratory Medicine, Jun 1, 1998
The role of positive end-expiratory pressure (PEEP) in the postoperative course of cardiac surger... more The role of positive end-expiratory pressure (PEEP) in the postoperative course of cardiac surgery patients remains questionable. In this prospective study, we examined the effect of different levels of PEEP on arterial oxygenation, SO, and fi0, values, and on haemodynamic indices, during the early postoperative period in cardiac surgery patients. Upon transfer to the ICU, 67 adult patients with normal preoperative respiratory status were randomly assigned to receive zero PEEP (Group A), 5 cmH,O (Group B), or 10 cmH,O PEEP (Group C) during mechanical ventilatory support. PaO,/fiO, ratio, mixed venous fi0, and SiiO,, and cardiac index, were measured 30 min, 4 h and 8 h after application of mechanical ventilation in the ICU, just prior to extubation, half an hour after extubation, and 4 h post-extubation. We found no statistically significant differences (P=n.s.) in arterial oxygenation expressed by PaO,/FrO 2 ratio, SO, and fi0, values, and in cardiac index among the three groups at any study interval. We conclude that low levels of PEEP have no advantage over zero PEEP in improving gas exchange in the early postoperative course of patients following open heart surgery.
Intensive Care Medicine, 1996
Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery pati... more Respiratory complications, particularly atelectasis, are commonly seen in open heart surgery patients (pts). Routine use of PEEP (5 to 10 cm H20) has been advocated in these pts, but its utility is largely unknown. On the other hand, the use of PEEP is sometimes avoided in cardiac surgery pts because of circulatory depression. In this
Annals of The Royal College of Surgeons of England, May 1, 2017
The frequency of surgical site infections (SSIs) after clean neck surgery is low and antibiotic p... more The frequency of surgical site infections (SSIs) after clean neck surgery is low and antibiotic prophylaxis is not recommended. This retrospective study investigated the effect of perioperative prophylactic antimicrobial therapy on the development of infections. A total of 807 consecutive patients undergoing clean neck surgery were included in the study. Antimicrobial prophylaxis with intravenous cefuroxime was administered in 518 cases. Although patients who received prophylaxis had a lower rate of SSIs than those who did not receive antibiotics, this was not statistically significant (0.4% vs 1.4% respectively, p=0.19). Older age was the only variable associated with the development of SSIs (p=0.014).
European Journal of Anaesthesiology, 2003
We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after... more We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period
We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after... more We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period June 2004-October 2005 at Henry Dunant Hospital, Athens, Greece. C-reactive protein (CRP) and procalcitonin were assayed from 222 patients preoperatively, and 1-3 days following OPCABG. Variables independently associated with infection were identified by a multivariable logistic regression model. Eighteen of 360 (5%) patients developed postoperative infections; 1.7% developed superficial wound infection, 1.4% pneumonia, 1.1% bacteremia, 0.3% mediastinitis, and 0.3% intra-aortic balloon pump related infection. The mean increase of CRP and procalcitonin levels in the first two or three days, respectively, after surgery was significantly higher (P-0.05) in patients with infection. Independent risk factors of infection (P-0.05) were history of major nervous system disorder, left ventricula...
Interactive Cardiovascular and Thoracic Surgery, 2007
We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after... more We evaluated the frequency, risk factors, and characteristics of infections in 360 patients after off-pump coronary artery bypass grafting (OPCABG). A prospective study was performed during the period
European Journal of Cardio-Thoracic Surgery, 2008
The aim of this study was to prospectively evaluate frequency, characteristics, and predictors of... more The aim of this study was to prospectively evaluate frequency, characteristics, and predictors of nosocomial infections (NI) in a tertiary care centre. Methods: Study population included 925 patients (mean age 62.3 AE 12.5, 32.3% females, 22.9% diabetics, 6.8% with previous cardiac procedures) operated on between June 2005 and December 2006 (CABG 48.72%, valvular procedures 30.05%, thoracic aortic 10.9%, heart transplantations 3.78% and miscellanea 6.55%, procedure status: elective 72.9%, urgent 15.9% and emergent 11.2%). The study population was divided in two groups according to development of NI. Primary endpoints were multiorgan failure (MOF) and hospital mortality in the two groups. Secondary endpoints were length of intubation, intensive care unit (ICU) stay and overall hospitalisation. Univariate and multivariate analysis of NI predictors was conducted between 115 perioperative variables. Results: Eighty-three patients (9%) developed a NI. Infections affected respiratory tract in 51.8%, blood stream in 20.5 and wound infection in 27.7 (13.3% deep wound). Staphylococcal species (60.6%) predominated in blood stream and surgical wound infections while Gram-negative species predominated in respiratory infections. Patients affected by NI experienced significantly higher incidence of MOF (12% vs 0.8%) and hospital mortality (24.1 vs 6.9%). Development of NI significantly lengthened all the steps of postoperative process of care (length of intubation: 49.9
Crit Care, 2005
Globalization in business, politics and other aspects of our everyday life is viewed by many as a... more Globalization in business, politics and other aspects of our everyday life is viewed by many as an inevitable reality. The English language has undoubtedly benefited significantly from the new era, in gradually penetrating into other cultures in many fields such as music, arts, education, and more recently science. Previous reports indicate that such penetration is also evident in the field of biomedical sciences [1,2], primarily supported by the paper and online publication in the English language of the majority of about 6,000 journals indexed in PubMed. The adoption of a universal language in science, namely English, could facilitate communication between individuals from different countries and enhance the timely interchange of ideas among researchers and scientists with potential benefits to scientific advancement and development [3]. Language barriers could also potentially be eliminated and
International Journal of Antimicrobial Agents, 2016
Highlights Significant variability in early colistin concentrations following a loading dose ha... more Highlights Significant variability in early colistin concentrations following a loading dose has been observed. Data from observational studies do not support higher effectiveness of a loading dose. Three ongoing RCTs evaluating the efficacy of a loading dose on mortality. Direct administration of colistin instead of colistimethate sodium could predict patient outcomes more reliably. Higher doses and topical administration when applicable could enhance colistin effectiveness.
Journal of the American Geriatrics Society, 2006
OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of you... more OBJECTIVES: To compare the outcomes of critically ill oldest-old patients (!90) with those of younger patients. DESIGN: Prospective cohort study. SETTING: General intensive care unit (ICU) of a tertiary care hospital in Athens, Greece. PARTICIPANTS: The oldest-old and younger patients. MEASUREMENTS: In-hospital and ICU mortality and stay, demographics, comorbidity, and complications. RESULTS: Of 5,505 consecutive patients admitted to the ICU, 60 (1.1%) were in the oldest-old group (aged 90-98). Their mean length of ICU and hospital stay AE standard deviation was 5.3 AE 6.8 and 23.3 AE 35.7 days, respectively. ICU mortality was 20%. Total in-hospital mortality was 40%, compared with 8.9% (P 5.001) in younger patients. Acute Physiology and Chronic Health Evaluation II score was independently associated with in-hospital mortality (odds ratio 5 1.18, 95% confidence interval 5 1.05-1.33). Of 24 oldest-old patients who died, 22 (91.7%) died in the ICU or in the ward within 30 days after ICU discharge. CONCLUSION: All-cause in-hospital mortality was higher in the oldest-old group than in younger patients, but the mortality of this cohort of patients did not seem to reach a figure that would make physicians, relatives, and healthcare administrators decide against ICU care in this population.
Critical care (London, England), 2005