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https://www.readbyqxmd.com/read/28538644/validation-of-a-clinical-trial-composite-endpoint-for-patients-with-necrotizing-soft-tissue-infections
#1
Eileen M Bulger, Addison May, Wayne Dankner, Greg Maislin, Bryce Robinson, Anat Shirvan
OBJECTIVE: Our objective was to develop and validate a composite endpoint for patients with necrotizing soft tissue infections (NSTI) that incorporates: local tissue injury, systemic organ dysfunction, and mortality. METHODS: The Necrotizing Infection Clinical Composite Endpoint (NICCE) was defined as follows:(i) Alive at day 28 (ii) ≤3 debridements prior to day 14 (iii) No amputation beyond first debridement (iv) Modified SOFA score (mSOFA) at day 14 ≤1. To be considered a success, all individual criteria must be met...
May 22, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28537938/should-all-massively-transfused-patients-be-treated-equally-an-analysis-of-massive-transfusion-ratios-in-the-nontrauma-setting
#2
Eric W Etchill, Sara P Myers, Lauren M McDaniel, Matthew R Rosengart, Jay S Raval, Darrell J Triulzi, Andrew B Peitzman, Jason L Sperry, Matthew D Neal
OBJECTIVES: Although balanced resuscitation has become integrated into massive transfusion practice, there is a paucity of evidence supporting the delivery of high ratios of plasma and platelet to RBCs in the nontrauma setting. This study investigated the administration of blood component ratios in the massively transfused nontrauma demographic. DESIGN: Retrospective analysis of a prospective, observational cohort of massively bleeding patients. SETTING: Surgical and critically ill patients at a tertiary medical center between 2011 and 2015...
May 23, 2017: Critical Care Medicine
https://www.readbyqxmd.com/read/28532896/healing-of-fracture-nonunions-treated-with-low-intensity-pulsed-ultrasound-lipus-a-systematic-review-and-meta-analysis
#3
Ross Leighton, J Tracy Watson, Peter Giannoudis, Costas Papakostidis, Andrew Harrison, R Grant Steen
INTRODUCTION: Bone fractures fail to heal and form nonunions in roughly 5% of cases, with little expectation of spontaneous healing thereafter. We present a systematic review and meta-analysis of published papers that describe nonunions treated with low-intensity pulsed ultrasound (LIPUS). METHODS: Articles in PubMed, Ovid MEDLINE, CINAHL, AMED, EMBASE, Cochrane Library, and Scopus databases were searched, using an approach recommended by the Methodological Index for Non-Randomized Studies (MINORS), with a Level of Evidence rating by two reviewers independently...
May 15, 2017: Injury
https://www.readbyqxmd.com/read/28531789/do-picu-patients-meet-technical-criteria-for-performing-indirect-calorimetry
#4
Megan R Beggs, Gonzalo Garcia Guerra, Bodil M K Larsen
BACKGROUND & AIMS: Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown...
October 2016: Clinical Nutrition ESPEN
https://www.readbyqxmd.com/read/28525509/analgesic-choice-in-management-of-rib-fractures-paravertebral-block-or-epidural-analgesia
#5
Mahdi Malekpour, Ammar Hashmi, James Dove, Denise Torres, Jeffrey Wild
BACKGROUND: Rib fractures are commonly encountered in the setting of trauma. The aim of this study was to assess the association between the clinical outcome of rib fracture and epidural analgesia (EA) versus paravertebral block (PVB) using the National Trauma Data Bank (NTDB). METHODS: Using the 2011 and 2012 versions of the NTDB, we retrieved completed records for all patients above 18 years of age who were admitted with rib fractures. Primary outcome was in-hospital mortality...
June 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28520687/3-nacl-adenosine-lidocaine-mg2-alm-bolus-and-4-hours-drip-infusion-reduces-noncompressible-hemorrhage-by-60-in-a-rat-model
#6
Hayley L Letson, Geoffrey P Dobson
BACKGROUND: Noncompressible torso hemorrhage is the leading cause of potentially survivable trauma in far-forward combat environments. Our aim was to examine the effect of small-volume 3% NaCl adenosine, lidocaine, and Mg (ALM) bolus and 0.9% NaCl/ALM "drip" on survivability and cardiac/gut/kidney function in a rat model of hepatic hemorrhage and shock. METHODS: Male Sprague-Dawley rats (428 ± 4 g) were anesthetized and randomly assigned to one of five groups (n = 16): (1) Sham, (2) No treatment, (3) Saline controls, (4) ALM therapy, and (5) Hextend...
June 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28515754/traumatic-tension-pneumopericardium-and-amputation-of-the-left-main-bronchus
#7
Lech Krawczyk, Tomasz P Byrczek, Agata Łuczyk, Bogusz D Jagoda, Rafał Kazanowski, Michał J Stasiowski
A 27-year-old woman sustained a blunt chest trauma after a car accident. Computed tomography revealed tension pneumopericardium, bilateral pneumothorax, and a suspected rupture of the left main bronchus. Emergent pericardial needle aspiration was successfully performed. Bronchial amputation was confirmed by bronchofiberoscopy. Despite total detachment of the distal part of the bronchial tree, the ventilation of the left lung was maintained without air leakage by use of pleural drains. Bronchial obturation resulted from the injury, and was effectively treated by bronchoscopic sputum suction at the distal end of the bronchus...
March 2017: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
https://www.readbyqxmd.com/read/28495265/continuous-positive-airway-pressure-for-children-with-undifferentiated-respiratory-distress-in-ghana-an-open-label-cluster-crossover-trial
#8
Patrick T Wilson, Frank Baiden, Joshua C Brooks, Marilyn C Morris, Katie Giessler, Damien Punguyire, Gavin Apio, Akua Agyeman-Ampromfi, Sara Lopez-Pintado, Justice Sylverken, Kwadwo Nyarko-Jectey, Harry Tagbor, Rachel T Moresky
BACKGROUND: In low-income and middle-income countries, invasive mechanical ventilation is often not available for children at risk of death from respiratory failure. We aimed to determine if continuous positive airway pressure (CPAP), a form of non-invasive ventilation, decreases all-cause mortality in children with undifferentiated respiratory distress in Ghana. METHODS: This open-label, cluster, crossover trial was done in two Ghanaian non-tertiary hospitals where invasive mechanical ventilation is not routinely available...
June 2017: Lancet Global Health
https://www.readbyqxmd.com/read/28495240/risk-factors-for-pulmonary-complication-following-operative-fixation-of-spine-fractures
#9
Douglas S Weinberg, Brian Z Hedges, Jonathan E Belding, Timothy A Moore, Heather A Vallier
BACKGROUND CONTEXT: Previous studies have suggested pulmonary complications are common among patients undergoing fixation for traumatic spine fractures. This leads to prolonged hospital stay, worse functional outcomes, and increased economic burden. However, only limited prognostic information exists regarding which patients are at greatest risk for pulmonary complications. PURPOSE: To identify factors predictive of perioperative pulmonary complications in patients undergoing fixation of spine fractures...
May 8, 2017: Spine Journal: Official Journal of the North American Spine Society
https://www.readbyqxmd.com/read/28495204/intracranial-pressure-monitoring-in-severe-traumatic-brain-injuries-a-closer-look-at-level-1-trauma-centers-in-the-united-states
#10
Piccinini Alice, Lewis Meghan, Benjamin Elizabeth, Aiolfi Alberto, Inaba Kenji, Demetriades Demetrios
INTRODUCTION: The Brain Trauma Foundation (BTF) recently updated recommendations for intracranial pressure (ICP) monitoring in severe traumatic brain injury (TBI). The effect of ICP monitoring on outcomes is controversial, and compliance with BTF guidelines is variable. The purpose of this study was to assess both compliance and outcomes at level I trauma centers. MATERIALS AND METHODS: The American College of Surgeons Trauma Quality Improvement Program database was queried for all patients admitted to level I trauma centers with isolated blunt severe TBI (AIS>3, GCS<9) who met criteria for ICP monitoring...
April 20, 2017: Injury
https://www.readbyqxmd.com/read/28495203/treatment-of-air-leak-in-polytrauma-patients-with-blunt-chest-injury
#11
Gabriel Halat, Lukas L Negrin, Konstantina Chrysou, Beatrix Hoksch, Ralph A Schmid, Gregor J Kocher
INTRODUCTION: Precise diagnostics and an adequate therapeutic approach are mandatory in the treatment of air leak in polytrauma patients with blunt chest trauma. The aim of this study was to evaluate the incidence, characteristics, and management of air leak following this injury pattern. PATIENTS AND METHODS: Data from 110 polytrauma patients was collected retrospectively. Fifty-four patients received initial treatment by chest tube placement for pneumothorax. These patients were classified into two groups, one with severe air leak and one with minor air leak...
May 1, 2017: Injury
https://www.readbyqxmd.com/read/28493038/perioperative-implications-of-thoracic-decortications-a-retrospective-cohort-study
#12
Jay Gorman, Duane Funk, Sadeesh Srinathan, John Embil, Linda Girling, Stephen Kowalski
PURPOSE: An increasing number of thoracic decortications have been performed in Manitoba, from five in 2007 to 45 in 2014. The primary objective of this study was to define the epidemiology of decortications in Manitoba. The secondary objective was to compare patients who underwent decortication due to primary infectious vs non-infectious etiology with respect to their perioperative outcomes. METHODS: Data for this cohort study were extracted from consecutive charts of all adult patients who underwent a decortication in Manitoba from 2007-2014 inclusive...
May 10, 2017: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
https://www.readbyqxmd.com/read/28486318/asking-a-better-question-development-and-evaluation-of-the-need-for-trauma-intervention-nfti-metric-as-a-novel-indicator-of-major-trauma
#13
Jacob W Roden-Foreman, Nakia R Rapier, Luanna Yelverton, Michael L Foreman
Many existing metrics, such as Injury Severity Score (ISS), cannot fully describe many trauma patients because of comorbidities. This study developed and evaluated the Need For Trauma Intervention (NFTI) metric as a novel indicator of major trauma. The NFTI metric was developed from an analysis of 2,396 trauma patients at a Level I trauma center. Six commonly recorded registry variables were found to be indicative of major trauma and comprised the NFTI criteria: receiving packed red blood cells within 4 hr; discharge from the emergency department (ED) to the operating room within 90 min; discharge from the ED to interventional radiology; discharge from the ED to the intensive care unit (ICU) with an ICU length of stay (LOS) of 3 or more days; mechanical ventilation outside of procedural anesthesia within 3 days; or death within 60 hr...
May 2017: Journal of Trauma Nursing: the Official Journal of the Society of Trauma Nurses
https://www.readbyqxmd.com/read/28483217/routine-airway-surveillance-in-pediatric-tracheostomy-patients
#14
REVIEW
Ozgul Gergin, Eelam Adil, Kosuke Kawai, Karen Watters, Ethan Moritz, Reza Rahbar
OBJECTIVES: The aim of this study is to review airway findings in children with tracheostomies who underwent surveillance direct laryngoscopy and bronchoscopy (DLB) to determine the yield of routine airway evaluation in these patients. STUDY DESIGN: Retrospective chart review at tertiary referral children's hospital. METHODS: A retrospective chart review was conducted of all of the children with tracheostomies who underwent DLB after tracheostomy between 1984 and 2015...
June 2017: International Journal of Pediatric Otorhinolaryngology
https://www.readbyqxmd.com/read/28482805/management-of-potentially-life-threatening-emergencies-at-74-primary-level-hospitals-in-mongolia-results-of-a-prospective-observational-multicenter-study
#15
Naranpurev Mendsaikhan, Davaa Gombo, Ganbold Lundeg, Christian Schmittinger, Martin W Dünser
BACKGROUND: While the capacities to care for and epidemiology of emergency and critically ill patients have been reported for secondary and tertiary level hospitals in Mongolia, no data exist for Mongolian primary level hospitals. METHODS: In this prospective, observational multicenter study, 74 primary level hospitals of Mongolia were included. We determined the capacities of these hospitals to manage medical emergencies. Furthermore, characteristics of patients presenting with potentially life-threatening emergencies to these hospitals were evaluated during a 6 month period...
May 8, 2017: BMC Emergency Medicine
https://www.readbyqxmd.com/read/28481839/high-ratio-plasma-resuscitation-does-not-improve-survival-in-pediatric-trauma-patients
#16
Jeremy W Cannon, Michael A Johnson, Robert C Caskey, Matthew A Borgman, Lucas P Neff
BACKGROUND: Damage control resuscitation (DCR) including balanced resuscitation with high ratios of plasma (PLAS) and platelets (PLT) to packed red blood cells (PRBC) improves survival in adult patients. We sought to evaluate the effect of a high ratio PLAS to PRBC resuscitation strategy in massively transfused pediatric patients with combat injuries. METHODS: The Department of Defense Trauma Registry (DoDTR) was queried from 2001-2013 for pediatric trauma patients (<18 years)...
May 6, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28459401/-value-of-procalcitonin-on-predicting-the-severity-and-prognosis-in-patients-with-early-ards-a-prospective-observation-study
#17
Zhixin Yu, Musen Ji, Xiulan Hu, Jun Yan, Zhaochen Jin
OBJECTIVE: To investigate the value of procalcitonin (PCT) on predicting the severity and prognosis in patients with early acute respiratory distress syndrome (ARDS). METHODS: A prospective observation study was conducted. A total of 113 patients with ARDS undergoing mechanical ventilation admitted to intensive care unit (ICU) of Affiliated People's Hospital of Jiangsu University from October 2012 to April 2016 were enrolled. Based on oxygenation index (PaO2/FiO2), the patients were classified into mild, moderate, and severe groups according to Berlin Definition...
January 2017: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
https://www.readbyqxmd.com/read/28448324/intraoperative-use-of-the-ventrain-for-single-lung-ventilation-after-iatrogenic-trauma-to-the-left-main-bronchus-during-thoracoscopy-a-case-report
#18
Veronika M Evers, Rogier V Immink, Willem J P van Boven, Mark I van Berge Henegouwen, Markus W Hollmann, Denise P Veelo
In a patient undergoing thoracoscopic esophagectomy and concomitant wedge resection, an iatrogenic lesion in the left main bronchus was observed following deflation of the right lung. Because the bronchial cuff of the double-lumen tube was visible through the lesion, repair was only possible after deflation of the bulging cuff. Positive pressure ventilation would result in air leakage jeopardizing ventilation and oxygenation. This challenging situation was resolved using the Ventrain device to oxygenate the patient through a small-bore catheter placed through the lumen beyond the bronchial defect...
April 26, 2017: A & A Case Reports
https://www.readbyqxmd.com/read/28432539/early-onset-ventilator-associated-pneumonia-in-patients-with-severe-traumatic-brain-injury-incidence-risk-factors-and-consequences-in-cerebral-oxygenation-and-outcome
#19
Pierre Esnault, Cédric Nguyen, Julien Bordes, Erwan D'Aranda, Ambroise Montcriol, Claire Contargyris, Jean Cotte, Philippe Goutorbe, Christophe Joubert, Arnaud Dagain, Henry Boret, Eric Meaudre
BACKGROUND: Early-onset ventilator-associated pneumonia (EOVAP) occurs frequently in severe traumatic brain-injured patients, but potential consequences on cerebral oxygenation and outcome have been poorly studied. The objective of this study was to describe the incidence, risk factors for, and consequences on cerebral oxygenation and outcome of EOVAP after severe traumatic brain injury (TBI). METHODS: We conducted a retrospective, observational study including all intubated TBI admitted in the trauma center...
April 21, 2017: Neurocritical Care
https://www.readbyqxmd.com/read/28430760/resuscitative-endovascular-balloon-occlusion-of-the-aorta-or-resuscitative-thoracotomy-with-aortic-clamping-for-noncompressible-torso-hemorrhage-a-retrospective-nationwide-study
#20
Shotaro Aso, Hiroki Matsui, Kiyohide Fushimi, Hideo Yasunaga
BACKGROUND: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is an emerging treatment for noncompressible torso hemorrhage. It remains unclear if REBOA is superior to resuscitative thoracotomy with aortic cross-clamping (RT) in terms of improving outcomes. This study compared in-hospital outcomes between REBOA and RT in trauma patients with uncontrolled hemorrhagic shock, using data from a national inpatient database in Japan. METHODS: Using the Diagnosis Procedure Combination database, we identified patients who received REBOA or RT within 1 day after admission from July 1, 2010, to March 31, 2014...
May 2017: Journal of Trauma and Acute Care Surgery
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