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Article: Postoperative Outcomes After Emergency Laparotomy in Nontrauma Settings: A Single-Center Experience.

Shahait, Awni D / Dolman, Heather / Mostafa, Gamal

2022 Volume 14, Issue 3, Page(s) e23426

Abstract: Introduction: Emergency laparotomy (EL) is a common operation that deals with a wide range of pathologies. Preoperative optimization is often lacking due to the urgent nature of the disease process with a reported mortality rate of up to 44%. This ... ...

Abstract	Introduction: Emergency laparotomy (EL) is a common operation that deals with a wide range of pathologies. Preoperative optimization is often lacking due to the urgent nature of the disease process with a reported mortality rate of up to 44%. This study examines the mortality of EL at an academic acute care surgery medical center. Methods: A retrospective analysis of nontrauma EL from January 2008 to December 2013 was conducted. Data included demographics, clinical features, preoperative laboratory studies, comorbidities, time to surgery, ICU admission, and 30-day mortality. Results: A total of 234 patients (123 males, 52.6%) were included in the study. EL was performed within four hours (immediate) of presentation in 93 (39.7%) patients, within 4-12 hours (early) in 53 (25.4%) patients, and within 12-24 hours (late) in 63 (30.1%) patients. Overall mortality was 16 (6.8%) at 30 days. Mortality was significantly higher with chronic obstructive pulmonary disease (p = 0.014), blood transfusion (p < 0.001), ICU admission (p < 0.001), ventilator days > four (p = 0.013), hyperlipidemia (p = 0.014), heart rate > 90 beats/minute (p = 0.003), temperature > 38°C or < 35°C (p = 0.013), and systolic blood pressure < 90 mmHg (p < 0.001). Conclusion: EL can be performed with lower mortality than previously reported. Specific predictors of mortality are identified and can be used for risk assessment.
Language	English
Publishing date	2022-03-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.23426
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Article ; Online: The National Provider Identifier Taxonomy: Does it Align With a Surgeon's Actual Clinical Practice?

Oliphant, Bryant W / Sangji, Naveen F / Dolman, Heather S / Scott, John W / Hemmila, Mark R

The Journal of surgical research

2022 Volume 282, Page(s) 254–261

Abstract: Introduction: The taxonomy code(s) associated with each National Provider Identifier (NPI) entry should characterize the provider's role (e.g., physician) and any specialization (e.g., orthopedic surgery). While the intent of the taxonomy system was to ... ...

Abstract	Introduction: The taxonomy code(s) associated with each National Provider Identifier (NPI) entry should characterize the provider's role (e.g., physician) and any specialization (e.g., orthopedic surgery). While the intent of the taxonomy system was to monitor medical appropriateness and the expertise of care provided, this system is now being used by researchers to identify providers and their practices. It is unknown how accurate the taxonomy codes are in describing a provider's true specialization. Methods: Department websites of orthopedic surgery and general surgery from three large academic institutions were queried for practicing surgeons. The surgeon's specialty and subspeciality information listed was compared to the provider's taxonomy code(s) listed on the National Plan and Provider Enumeration System (NPPES). The match rate between these data sources was evaluated based on the specialty, subspecialty, and institution. Results: There were 295 surgeons (205 general surgery and 90 orthopedic surgery) and 24 relevant taxonomies (8 orthopedic and 16 general or plastic) for analysis. Of these, 294 surgeons (99%) selected their general specialty taxonomy correctly, while only 189 (64%) correctly chose an appropriate subspecialty. General surgeons correctly chose a subspecialty more often than orthopedic surgeons (70 versus 51%, P = 0.002). The institution did not affect either match rate, however there were some differences noted in subspecialty match rates inside individual departments. Conclusions: In these institutions, the NPI taxonomy is not accurate for describing a surgeon's subspecialty or actual practice. Caution should be taken when utilizing this variable to describe a surgeon's subspecialization as our findings might apply in other groups.
MeSH term(s)	Humans ; Surgeons ; Specialization ; Orthopedics ; Orthopedic Procedures ; Medicine
Language	English
Publishing date	2022-11-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.09.008
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Article ; Online: A Cautionary Tale of Etanercept Use in Patients With Toxic Epidermal Necrolysis.

Faris, Janie / Wilson, Jordan / Dolman, Heather S / Isaacson, Andrew / Baylor, Alfred E / Tyburski, James G / White, Michael T

Journal of burn care & research : official publication of the American Burn Association

2020 Volume 42, Issue 3, Page(s) 586–589

Abstract: Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that can be life-threatening. In the United States, there are no established guidelines for the treatment of TEN. Supportive care including fluids and supportive therapies are the current ... ...

Abstract	Toxic epidermal necrolysis (TEN) is a severe cutaneous reaction that can be life-threatening. In the United States, there are no established guidelines for the treatment of TEN. Supportive care including fluids and supportive therapies are the current recommendations. Research surrounding TEN involves mostly case studies or small, uncontrolled studies. Recent literature describes the use of tumor necrosis factor blockers in the treatment of TEN with positive results. These case reports describe decreased time to reepithelization, hospital length of stay, and minimal side effects. Conversely, we present three fatalities after the administration of etanercept.
MeSH term(s)	Adult ; Aged ; Etanercept/adverse effects ; Fatal Outcome ; Female ; Humans ; Immunosuppressive Agents/adverse effects ; Lamotrigine/adverse effects ; Stevens-Johnson Syndrome/etiology ; Stevens-Johnson Syndrome/therapy ; Trimethoprim, Sulfamethoxazole Drug Combination/adverse effects
Chemical Substances	Immunosuppressive Agents ; Trimethoprim, Sulfamethoxazole Drug Combination (8064-90-2) ; Etanercept (OP401G7OJC) ; Lamotrigine (U3H27498KS)
Language	English
Publishing date	2020-10-29
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2224246-6
ISSN	1559-0488 ; 1559-047X
ISSN (online)	1559-0488
ISSN	1559-047X
DOI	10.1093/jbcr/iraa194
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Article ; Online: When More Is Still Not Enough: A Case of Ceftazidime-Avibactam Resistance in a Burn Patient.

Herbin, Shelbye R / Barber, Katie E / Isaacson, Andrew R / Dolman, Heather S / McGee, Jessica D / Baylor, Alfred E / Tyburski, James G / White, Michael T / Faris, Janie

Journal of burn care & research : official publication of the American Burn Association

2021 Volume 43, Issue 2, Page(s) 474–478

Abstract: Burn patients have numerous risk factors for multidrug-resistant organisms (MDROs) and altered pharmacokinetics, which both independently increase the risk of treatment failure. Data on appropriate antimicrobial dosing are limited in this population and ... ...

Abstract	Burn patients have numerous risk factors for multidrug-resistant organisms (MDROs) and altered pharmacokinetics, which both independently increase the risk of treatment failure. Data on appropriate antimicrobial dosing are limited in this population and therapeutic drug monitoring (TDM) for beta-lactams is impractical at most facilities. Technology is available that can detect genetic markers of resistance, but they are not all encompassing, and often require specialized facilities that can detect less common genetic markers. Newer antimicrobials can help combat MDROs, but additional resistance patterns may evolve during treatment. Considering drug shortages and antimicrobial formularies, clinicians must remain vigilant when treating infections. This case report describes the development of resistance to ceftazidime-avibactam in a burn patient. The patient was a 54-year-old burn victim with a 58% total body surface area (TBSA) thermal burn who underwent multiple courses of antibiotics for various Pseudomonal infections. The initial Pseudomonal wound infection was sensitive to cefepime, aminoglycosides, and meropenem. A subsequent resistant pseudomonal pneumonia was treated with ceftazidime-avibactam 2.5 g every 6 hours due to the elevated MIC to cefepime (16 mcg/mL) and meropenem (>8 mcg/mL). Although the patient improved over 7 days, the patient again spiked fevers and had increased white blood counts (WBC). Repeat blood cultures demonstrated a multidrug-resistant (MDR) Pseudomonas with a minimum inhibitory concentration (MIC) to ceftazidime-avibactam of 16 mcg/mL, which is above the Clinical and Laboratory Standards Institute (CLSI) breakpoint of 8 mcg/mL. At first, resistance was thought to have occurred due to inadequate dosing, but genetic work demonstrated multiple genes encoding beta-lactamases.
MeSH term(s)	Anti-Bacterial Agents ; Azabicyclo Compounds ; Burns/drug therapy ; Cefepime ; Ceftazidime/pharmacokinetics ; Ceftazidime/therapeutic use ; Drug Combinations ; Drug Resistance, Multiple, Bacterial ; Genetic Markers ; Humans ; Meropenem/pharmacology ; Microbial Sensitivity Tests ; Middle Aged ; beta-Lactamases/genetics
Chemical Substances	Anti-Bacterial Agents ; Azabicyclo Compounds ; Drug Combinations ; Genetic Markers ; avibactam, ceftazidime drug combination ; Cefepime (807PW4VQE3) ; Ceftazidime (9M416Z9QNR) ; beta-Lactamases (EC 3.5.2.6) ; Meropenem (FV9J3JU8B1)
Language	English
Publishing date	2021-08-24
Publishing country	England
Document type	Case Reports ; Journal Article
ZDB-ID	2224246-6
ISSN	1559-0488 ; 1559-047X
ISSN (online)	1559-0488
ISSN	1559-047X
DOI	10.1093/jbcr/irab160
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Article: Impact of Genitourinary Injuries on Patients Requiring an Emergency Laparotomy for Trauma.

Zimmerman, W Britt / Baylor, Alfred E / Hall Zimmerman, Lisa / Dolman, Heather / Ciullo, Jeremy R / Dornbush, Jessica / Isaacson, Andrew R / Mansour, Roozbeh / Wilson, Robert F / Tyburski, James G

Cureus

2020 Volume 12, Issue 1, Page(s) e6826

Abstract: Introduction In patients having emergency abdominal surgery for trauma, the presence of urologic injury tends to increase mortality and morbidity. Methods This retrospective study evaluated patients requiring emergency surgery for abdominal trauma at a ... ...

Abstract	Introduction In patients having emergency abdominal surgery for trauma, the presence of urologic injury tends to increase mortality and morbidity. Methods This retrospective study evaluated patients requiring emergency surgery for abdominal trauma at a Level 1 Trauma Center over 30 years (1980-2010). Special attention was given to patients with concomitant genitourinary (GU) injuries. Results Of 1105 patients requiring an emergency laparotomy for trauma, 242 (22%) had urologic injuries including kidney 178 (16%), ureter 47 (4%), and bladder 46 (4%). Of the 242 patients, 50 (20%) died early (<48 hours) and 13 (5%) died later, primarily due to infection. A concept of "seven deadly signs" of hypoperfusion was developed. In patients with GU injuries, the presence of any deadly sign of hypoperfusion increased the mortality rate from 4% (6/152) to 63% (56/90), p<0.001. Of the 53 patients having a nephrectomy, 36 (68%) had one or more deadly signs and 27 (75%) died. Of 17 without deadly signs, only 2 (12%) died (p=0.001). Of 167 GU patients receiving blood, 59 (35%) developed infection vs 3/75(4%) in those receiving no blood (p<0.001). Conclusions The presence of deadly signs of severe injury and hypoperfusion on admission was the major factor determining mortality. With a severely injured kidney plus any deadly signs of hypoperfusion, special efforts should be made to avoid a nephrectomy.
Language	English
Publishing date	2020-01-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.6826
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Article ; Online: Impact of inappropriate initial antibiotics in critically ill surgical patients with bacteremia.

Abraham, Katri / Dolman, Heather S / Zimmerman, Lisa Hall / Faris, Janie / Edelman, David A / Baylor, Alfred / Wilson, Robert F / Tyburski, James G

American journal of surgery

2016 Volume 211, Issue 3, Page(s) 593–598

Abstract: Background: Bloodstream infections in critically ill patients are associated with mortality as high as 60% and a prolonged hospital stay. We evaluated the impact of inappropriate antibiotic therapy (IAAT) in a critically ill surgical cohort with ... ...

Abstract	Background: Bloodstream infections in critically ill patients are associated with mortality as high as 60% and a prolonged hospital stay. We evaluated the impact of inappropriate antibiotic therapy (IAAT) in a critically ill surgical cohort with bacteremia. Methods: This retrospective study evaluated adults with intensive care unit admission greater than 72 hours and bacteremia. Two groups were evaluated: appropriate antibiotic therapy (AAT) vs IAAT. Results: In 72 episodes of bacteremia, 57 (79%) AAT and 15 (21%) IAAT, mean age was 54 ± 17 years and APACHE II of 17 ± 8. Time to appropriate antibiotics was longer for IAAT (3 ± 5 IAAT vs 1 ± 1 AAT days, P = .003). IAAT was seen primarily with Acinetobacter spp (33% IAAT vs 9% AAT, P = .01) and Enterococcus faecium (26% IAAT vs 7% AAT, P = .03). If 2 or more bacteremic episodes occurred, Acinetobacter spp. was more likely, 32% vs 2%, P = .001. Conclusions: AAT selection is imperative in critically patients with bacteremia to reduce the significant impact of inappropriate selection. Repeated episodes of bacteremia should receive special attention.
MeSH term(s)	APACHE ; Anti-Bacterial Agents/therapeutic use ; Bacteremia/drug therapy ; Bacteremia/microbiology ; Bacteremia/mortality ; Critical Illness ; Female ; Hospital Mortality ; Humans ; Inappropriate Prescribing ; Intensive Care Units ; Male ; Middle Aged ; Retrospective Studies ; Surgical Procedures, Operative
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2015.10.025
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Article ; Online: Hydromorphone vs fentanyl for epidural analgesia and anesthesia.

Nguyen, Melissa N / Zimmerman, Lisa Hall / Meloche, Kathy / Dolman, Heather S / Baylor, Alfred E / Fuleihan, Samir / Wilson, Robert F / Tyburski, James G

American journal of surgery

2016 Volume 211, Issue 3, Page(s) 565–570

Abstract: Background: Epidural analgesia/anesthesia is used during surgery because it dramatically relieves pain and attenuates the stress response. Because limited data exist regarding the relative merits of hydromorphone (HM) and fentanyl (FENT), the objective ... ...

Abstract	Background: Epidural analgesia/anesthesia is used during surgery because it dramatically relieves pain and attenuates the stress response. Because limited data exist regarding the relative merits of hydromorphone (HM) and fentanyl (FENT), the objective was to determine which was more safe and effective. Methods: Prospective case-matched, observational study evaluated elective surgery patients: 30 HM and 60 FENT. Variables were measured perioperatively. Results: Of the 90 patients, mean age was 52 years; simplified acute physiology score was 26 ± 10; and American Society of Anesthesiologists score was 2.4 HM vs 2.7 FENT, P = .03. HM patients were more apt to be excessively sedated (16% HM vs 1% FENT, P = .007) and have poor mental unresponsiveness (6% HM vs 0% FENT, P = .04). The incidence of hypotension was not different, 76% HM vs 80% FENT, not significant. Conclusions: In a closely case-matched population, FENT caused less excessive sedation and unresponsiveness. FENT patients had better intraoperative urine output and tended to have less repeated episodes of hypotension.
MeSH term(s)	APACHE ; Analgesia, Epidural ; Analgesics, Opioid/therapeutic use ; Anesthesia/methods ; Female ; Fentanyl/therapeutic use ; Humans ; Hydromorphone/therapeutic use ; Male ; Middle Aged ; Pain Management ; Pain Measurement ; Prospective Studies ; Surgical Procedures, Operative ; Treatment Outcome
Chemical Substances	Analgesics, Opioid ; Hydromorphone (Q812464R06) ; Fentanyl (UF599785JZ)
Language	English
Publishing date	2016-03
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2015.12.003
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Article ; Online: Bicarbonate therapy in severely acidotic trauma patients increases mortality.

Wilson, Robert F / Spencer, Amy R / Tyburski, James G / Dolman, Heather / Zimmerman, Lisa Hall

The journal of trauma and acute care surgery

2013 Volume 74, Issue 1, Page(s) 45–50; discussion 50

Abstract: Background: Normally, end-tidal CO(2) is within 2 mm Hg of arterial PO(2) (PaCO(2)). However, if dead space in the lungs increases owing to shock with poor lung perfusion, the arterial-end tidal PCO(2) difference [P(a-ET)CO(2)] increases. We have found ... ...

Abstract	Background: Normally, end-tidal CO(2) is within 2 mm Hg of arterial PO(2) (PaCO(2)). However, if dead space in the lungs increases owing to shock with poor lung perfusion, the arterial-end tidal PCO(2) difference [P(a-ET)CO(2)] increases. We have found that in severely injured patients, P(a-ET)CO(2) of less than 10 mm Hg is associated with survival and P(a-ET)CO(2) of greater than 16 mm Hg is usually fatal. Our initial studies suggested that intravenously administered bicarbonate increases P(a-ET)CO(2). Methods: This retrospective therapeutic study evaluated the effects of intravenously administered bicarbonate in a cohort of 225 severely acidotic (arterial pH ≤ 7.10) trauma patients who underwent emergency surgery from 1989 through 2011. Patients were divided into groups: early deaths (<48 hours), deaths in the operating room, deaths within 48 hours, and survivors. Winter's formula was defined as PaCO(2) = (HCO(3)) (1.5) + 8 ± 4. Results: Of the 225 patients, the mean (SD) initial arterial pH was 6.92 (0.16) with HCO(3) of 11.0 (3.5) mEq/L. According to the Winter's formula, PaCO(2) should have been 24 (4) mm Hg but actually was 50 (14) mm Hg. In 73 patients, the effect of an average of two to eight vials of bicarbonate increased HCO(3) from 10.5 (3.1) mEq/L to 16.8 (4.0) mEq/L. In addition, PaCO(2) increased from 44 (9) mm Hg to 51 (11) mm Hg and end-tidal CO(2) stayed relatively constant (26 [6] to 25 [5]). This resulted in a increase in P(a-ET)CO(2) from 17 (9) mm Hg to 24 (13) mm Hg, affecting survival. In the final values after resuscitation, the P(a-ET)CO(2) in the 75 patients who survived was 10 (6) mm Hg, while the 103 patients who died in the operating room or within 48 hours of surgery had a P(a-ET)CO(2) of 23 (10) mm Hg (p < 0.001). Conclusion: In severely acidotic, critically injured patients, reducing the PaCO(2) to less than 40 mm Hg and decreasing the P(a-ET)CO(2) to 10 (6) mm Hg should be attempted, using as little HCO(3) therapy as possible. Bicarbonate should be given only if severe acidosis persists despite resuscitation and if PaCO(2) levels near those which are appropriate can be obtained. Level of evidence: Therapeutic study, level IV.
MeSH term(s)	Acidosis/blood ; Acidosis/complications ; Acidosis/therapy ; Adult ; Bicarbonates/administration & dosage ; Bicarbonates/adverse effects ; Carbon Dioxide/blood ; Female ; Humans ; Hydrogen-Ion Concentration ; Infusions, Intravenous ; Male ; Multiple Trauma/blood ; Multiple Trauma/complications ; Multiple Trauma/mortality ; Shock, Traumatic/blood ; Shock, Traumatic/complications ; Shock, Traumatic/mortality ; Survival Rate
Chemical Substances	Bicarbonates ; Carbon Dioxide (142M471B3J)
Language	English
Publishing date	2013-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0b013e3182788fc4
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Article ; Online: Impact of minimizing diagnostic blood loss in the critically ill.

Dolman, Heather S / Evans, Kelly / Zimmerman, Lisa Hall / Lavery, Todd / Baylor, Alfred E / Wilson, Robert F / Tyburski, James G

Surgery

2015 Volume 158, Issue 4, Page(s) 1083–7; discussion 1087–8

Abstract: Background: The use of a small-volume phlebotomy tube (SVPT) versus conventional-volume phlebotomy tube (CVPT) has led to a decrease in daily blood loss. Blood loss due to phlebotomy can lead ultimately to decreased rates of anemia and blood ... ...

Abstract	Background: The use of a small-volume phlebotomy tube (SVPT) versus conventional-volume phlebotomy tube (CVPT) has led to a decrease in daily blood loss. Blood loss due to phlebotomy can lead ultimately to decreased rates of anemia and blood transfusions, which can be important in the critically ill patient. Methods: We compared SVPT vs CVPT retrospectively in critically ill adult patients age ≥18 years admitted to a surgical intensive care unit for ≥48 hours. CVPT were evaluated from January 2011 to May 2011 and SVPT from June 2012 to October 2012. Results: Amount of blood drawn for laboratory tests and transfusions were evaluated in 248 patients (116 SVPT vs 132 CVPT). When compared with CVPT, total blood volume removed (mean ± SD) with SVPT was less overall, 174 ± 182 mL vs 299 ± 355 mL, P = .001. Daily blood draws also were less, 22.5 ± 17.3 mL vs 31.7 ± 15.5 mL, P < .001. The units of packed red blood cells given were not significant, 4.4 ± 3.6 units vs 6.0 ± 8.2 units, P = .16. Conclusion: The use of SVPT blood sampling led to a decreased amount of blood drawn. Strategies that use SVPT in a larger cohort also may decrease the number of transfusions in selected patients. Every effort should be made to use SVPT.
MeSH term(s)	Adolescent ; Adult ; Aged ; Aged, 80 and over ; Anemia/etiology ; Anemia/prevention & control ; Critical Care/methods ; Critical Illness ; Erythrocyte Transfusion/statistics & numerical data ; Female ; Humans ; Male ; Middle Aged ; Phlebotomy/adverse effects ; Phlebotomy/instrumentation ; Phlebotomy/statistics & numerical data ; Retrospective Studies ; Treatment Outcome ; Young Adult
Language	English
Publishing date	2015-10
Publishing country	United States
Document type	Comparative Study ; Evaluation Studies ; Journal Article
ZDB-ID	202467-6
ISSN	1532-7361 ; 0039-6060
ISSN (online)	1532-7361
ISSN	0039-6060
DOI	10.1016/j.surg.2015.05.018
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Article ; Online: Effects of vitamin D deficiency in critically ill surgical patients.

Flynn, Lisa / Zimmerman, Lisa Hall / McNorton, Kelly / Dolman, Mortimer / Tyburski, James / Baylor, Alfred / Wilson, Robert / Dolman, Heather

American journal of surgery

2012 Volume 203, Issue 3, Page(s) 379–82; discussion 382

Abstract: Background: The incidence of vitamin D deficiency in critically ill patients is reported to be up to 50%, with a 3-fold increase in predicted mortality, but limited data exist concerning vitamin D deficiency in critically ill surgical patients.: ... ...

Abstract	Background: The incidence of vitamin D deficiency in critically ill patients is reported to be up to 50%, with a 3-fold increase in predicted mortality, but limited data exist concerning vitamin D deficiency in critically ill surgical patients. Methods: Sixty-six adult surgical intensive care unit patients who had 25-hydroxyvitamin D serum levels evaluated from January 2010 to February 2011 were prospectively identified. Patients were divided into groups according to vitamin D level (<20 vs ≥20 ng/mL). Results: Of the 66 patients evaluated, 49 (74%) had vitamin D levels < 20 ng/mL, and 17 (26%) had vitamin D levels ≥ 20 ng/mL. Patients with vitamin D levels < 20 versus ≥ 20 ng/mL had longer lengths of hospital stay. Lengths of intensive care unit stay were clinically longer, although not significant. Infection rates tended to be higher (P = .09), and a higher incidence of sepsis was seen in the patients with vitamin D levels < 20 ng/mL. Conclusions: Vitamin D levels < 20 ng/mL have a significant impact on length of stay, organ dysfunction, and infection rates. More data are needed on the value of supplementation to improve these outcomes.
MeSH term(s)	Adult ; Aged ; Critical Illness/mortality ; Critical Illness/therapy ; Female ; Hospital Mortality ; Humans ; Infection/etiology ; Intensive Care Units/statistics & numerical data ; Length of Stay/statistics & numerical data ; Male ; Middle Aged ; Multiple Organ Failure/etiology ; Prospective Studies ; Risk ; Sepsis/etiology ; Vitamin D/analogs & derivatives ; Vitamin D/blood ; Vitamin D Deficiency/blood ; Vitamin D Deficiency/complications
Chemical Substances	Vitamin D (1406-16-2) ; 25-hydroxyvitamin D (A288AR3C9H)
Language	English
Publishing date	2012-03
Publishing country	United States
Document type	Journal Article
ZDB-ID	2953-1
ISSN	1879-1883 ; 0002-9610
ISSN (online)	1879-1883
ISSN	0002-9610
DOI	10.1016/j.amjsurg.2011.09.012
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