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https://www.readbyqxmd.com/read/28727608/evaluation-of-non-invasive-hemoglobin-monitoring-in-trauma-patients-with-low-hemoglobin-levels
#1
Medhat Gamal, Bassant Abdelhamid, Dina Zakaria, Omnia Abd El Dayem, Ashraf Rady, Maher Fawzy, Ahmed Hasanin
OBJECTIVE: Bleeding is a leading cause of death among trauma patients. Delayed assessment of blood hemoglobin level might result in either unnecessary blood transfusion in non-indicated patients or delayed blood transfusion in critically bleeding patients. In this study, we evaluate the precision of non-invasive hemoglobin monitoring in trauma patients with low hemoglobin levels. METHODS: We included trauma patients with low hemoglobin levels (less than 8 g/dL) scheduled for surgical intervention...
July 19, 2017: Shock
https://www.readbyqxmd.com/read/28720216/the-effects-of-red-cell-transfusion-donor-age-on-nosocomial-infection-among-trauma-patients
#2
Tyler J Loftus, Ryan M Thomas, Travis W Murphy, Linda L Nguyen, Frederick A Moore, Scott C Brakenridge, Philip A Efron, Alicia M Mohr
BACKGROUND: We hypothesized that packed red blood cell (PRBC) transfusions from older donors would be associated with fewer nosocomial infections among trauma patients. METHODS: We performed a four-year retrospective analysis of 264 consecutive adult trauma patients who received ≥1 PRBC transfusion during admission. The capacity of donor age to predict nosocomial infection was assessed by logistic regression. RESULTS: Thirty-three percent of all patients developed a nosocomial infection...
July 12, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28719428/blood-product-utilization-among-trauma-and-nontrauma-massive-transfusion-protocols-at-an-urban-academic-medical-center
#3
Eshan U Patel, Paul M Ness, Christi E Marshall, Thomas Gniadek, David T Efron, Peter M Miller, Joseph A Zeitouni, Karen E King, Evan M Bloch, Aaron A R Tobian
BACKGROUND: Hospital-wide massive transfusion protocols (MTPs) primarily designed for trauma patients may lead to excess blood products being prepared for nontrauma patients. This study characterized blood product utilization among distinct trauma and nontrauma MTPs at a large, urban academic medical center. METHODS: A retrospective study of blood product utilization was conducted in patients who required an MTP activation between January 2011 and December 2015 at an urban academic medical center...
July 14, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28716309/arginine-vasopressin-copeptin-and-the-development-of-relative-avp-deficiency-in-hemorrhagic-shock
#4
Carrie A Sims, Yuxia Guan, Meredith Bergey, Rebecca Jaffe, Lilias Holmes-Maguire, Niels Martin, Patrick Reilly
BACKGROUND: Arginine vasopressin (AVP) is critical for maintaining vasomotor tone and low levels have been associated with the development of irreversible shock. We investigated the clinical relationship between AVP, copeptin (the C-terminal fragment of the AVP precursor), and the development of relative AVP deficiency following hemorrhagic shock. METHODS: A prospective, observational study of 21 hypotensive (SBP<90 mmHg X 2) or presumptively bleeding trauma patients was conducted...
June 24, 2017: American Journal of Surgery
https://www.readbyqxmd.com/read/28704250/abnormal-calcium-levels-during-trauma-resuscitation-are-associated-with-increased-mortality-increased-blood-product-use-and-greater-hospital-resource-consumption-a-pilot-investigation
#5
Emily J MacKay, Michael D Stubna, Daniel N Holena, Patrick M Reilly, Mark J Seamon, Brian P Smith, Lewis J Kaplan, Jeremy W Cannon
BACKGROUND: Admission hypocalcemia predicts both massive transfusion and mortality in severely injured patients. However, the effect of calcium derangements during resuscitation remains unexplored. We hypothesize that any hypocalcemia or hypercalcemia (either primary or from overcorrection) in the first 24 hours after severe injury is associated with increased mortality. METHODS: All patients at our institution with massive transfusion protocol activation from January 2013 through December 2014 were identified...
July 10, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28700540/clinical-and-radiological-presentations-and-management-of-blunt-splenic-trauma-a-single-tertiary-hospital-experience
#6
Gaby Jabbour, Ammar Al-Hassani, Ayman El-Menyar, Husham Abdelrahman, Ruben Peralta, Mohammed Ellabib, Hisham Al-Jogol, Mohammed Asim, Hassan Al-Thani
BACKGROUND Splenic injury is the leading cause of major bleeding after blunt abdominal trauma. We examined the clinical and radiological presentations, management, and outcome of blunt splenic injuries (BSI) in our institution. MATERIAL AND METHODS A retrospective study of BSI patients between 2011 and 2014 was conducted. We analyzed and compared management and outcome of different splenic injury grades in trauma patients. RESULTS A total of 191 BSI patients were identified with a mean (SD) age of 26.9 years (13...
July 12, 2017: Medical Science Monitor: International Medical Journal of Experimental and Clinical Research
https://www.readbyqxmd.com/read/28700412/parathyroid-hormone-as-a-marker-for-hypoperfusion-in-trauma-a-prospective-observational-study
#7
Scott C Fligor, Katie M Love, Bryan R Collier, Daniel I Lollar, Mark E Hamill, Andrew D Benson, Eric H Bradburn
BACKGROUND: Hyperparathyroidism is common in critical illness. Intact parathyroid hormone has a half-life of 3 to 5 minutes due to rapid clearance by the liver, kidneys, and bone. In hemorrhagic shock, decreased clearance may occur, thus making parathyroid hormone a potential early marker for hypoperfusion. We hypothesized that early hyperparathyroidism predicts mortality and transfusion in trauma patients. METHODS: A prospective observational study was performed at a Level 1 trauma center in consecutive adult patients receiving the highest level of trauma team activation...
July 12, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28697023/clot-dynamics-and-mortality-the-ma-r-ratio
#8
Stephanie A Savage, Ben L Zarzaur, Timothy H Pohlman, Brian L Brewer, Louis J Magnotti, Martin A Croce, Garrett H Lim, Ali C Martin
INTRODUCTION: The coagulopathy of trauma, illustrated by a short R-time, is common and well understood. The physiology behind this may be early thrombin burst with rapid clot formation. Rapid consumption of fibrinogen, however, may result in weak clot and substrate depletion, resulting in low MA. While these characteristics are interesting, utilizing TEG to identify those at risk for subsequent bleeding diathesis, especially in those who do not demonstrate early signs of physiologic derangement, is challenging...
July 8, 2017: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/28688890/any-changes-in-recent-massive-transfusion-practices-in-a-tertiary-level-institution
#9
Romi Sinha, David Roxby
BACKGROUND & OBJECTIVES: A previous review of transfusion practices in our institution between 1998 and 2008 showed a trend of high ratios of red cells (RC) to plasma (FFP) and platelets to RC towards the later years of review period. The aim of the study was to further evaluate transfusion practices in the form of blood product usage and outcomes following massive transfusion (MT) METHODS: All adult patients with critical bleeding who received a MT (defined as ≥10 units of RC in 24h) in 2008 and between January 2010 and December 2014 were identified...
June 8, 2017: Transfusion and Apheresis Science
https://www.readbyqxmd.com/read/28685464/hemoglobin-based-oxygen-carrier-hboc-development-in-trauma-previous-regulatory-challenges-lessons-learned-and-a-path-forward
#10
Peter E Keipert
Historically, hemoglobin-based oxygen carriers (HBOCs) were being developed as "blood substitutes," despite their transient circulatory half-life (~ 24 h) vs. transfused red blood cells (RBCs). More recently, HBOC commercial development focused on "oxygen therapeutic" indications to provide a temporary oxygenation bridge until medical or surgical interventions (including RBC transfusion, if required) can be initiated. This included the early trauma trials with HemAssist (®) (BAXTER), Hemopure (®) (BIOPURE) and PolyHeme (®) (NORTHFIELD) for resuscitating hypotensive shock...
2017: Advances in Experimental Medicine and Biology
https://www.readbyqxmd.com/read/28678652/postoperative-c-reactive-protein-concentration-and-clinical-outcome-comparison-of-open-cystectomy-to-robot-assisted-laparoscopic-cystectomy-with-extracorporeal-or-intracorporeal-urinary-diversion-in-a-prospective-study
#11
Pernille Skjold Kingo, Rikke Nørregaard, Michael Borre, Jørgen Bjerggaard Jensen
OBJECTIVE: This study aimed to compare clinical outcome and postoperative systemic inflammatory response using C-reactive protein (CRP) levels, to quantify the degree of tissue injury in open mini-laparotomy cystectomy (OMC) versus robot-assisted laparoscopic cystectomy with extracorporeal (RALC-EUD) or intracorporeal urinary diversion (RALC-IUD). MATERIALS AND METHODS: From September 2012 to September 2015, 309 patients diagnosed with bladder cancer underwent radical cystectomy with urinary diversion...
July 5, 2017: Scandinavian Journal of Urology
https://www.readbyqxmd.com/read/28675362/liver-resections-in-a-high-volume-center-form-standard-procedures-to-extreme-surgery-and-ultrasound-guided-resections
#12
Florin Botea, Mihnea Ionescu, Vladislav Braşoveanu, Doina Hrehoreţ, Sorin Alexandrescu, Mihai Grigorie, Oana Stanciulea, Diana Nicolaescu, Dana Tomescu, Gabriela Droc, Daniela Ungureanu, Ruxandra Fota, Adina Croitoru, Liana Gheorghe, Cristian Gheorghe, Ioana Lupescu, Mugur Grasu, Mirela Boroş, Radu Dumitru, Mihai Toma, Vlad Herlea, Irinel Popescu
Background: Liver resection (LR) is the treatment of choice for most benign and malignant focal liver lesions, as well as in selected patients with liver trauma. Few other therapies can compete with LR in selected cases, such as liver transplantation in hepatocellular carcinoma (HCC) and ablative therapies in small HCCs or liver metastases. The present paper analyses a single center experience in LR, reviewing the indications of LR, the operative techniques and their short-term results. MATERIAL AND METHOD: Between January 2000 and December 2016, in "œDan Setlacec" Center of General Surgery and Liver Transplantation were performed 3165 LRs in 3016 patients, for pathologic conditions of the liver...
May 2017: Chirurgia
https://www.readbyqxmd.com/read/28673368/compliance-of-tranexamic-acid-administration-to-trauma-patients-at-a-level-one-trauma-centre
#13
Abeer Ghawnni, Angela Coates, Julian Owen
Introduction Current practice for the treatment of traumatic hemorrhage includes fluid resuscitation and the administration of blood products. The administration of tranexamic acid (TXA) within 8 hours of injury has been shown to significantly reduce mortality in a large, prospective, randomized controlled trial. As a result, TXA is widely used in trauma centres to manage trauma patients with major bleeding. The primary aim of this study was to assess the compliance of TXA administration at a level-one trauma centre in Hamilton, Ontario, Canada...
July 4, 2017: CJEM
https://www.readbyqxmd.com/read/28668947/perioperative-systemic-inflammatory-response-following-robot-assisted-laparoscopic-cystectomy-vs-open-mini-laparotomy-cystectomy-a-prospective-study
#14
Pernille Skjold Kingo, Johan Palmfeldt, Rikke Nørregaard, Michael Borre, Jørgen Bjerggaard Jensen
INTRODUCTION: Surgeries, such as radical cystectomy (RC), induce a systemic inflammatory response (SIR). SIR plays an important role in controlling the human immune system. This study aims at comparing the SIR in robot-assisted laparoscopic cystectomy (RALC) to open mini-laparotomy cystectomy (OMC) with a urinary diversion (UD). Comparison was based on immunologic markers of SIR, thus quantifying the degree of tissue trauma. MATERIALS AND METHODS: Forty-two male patients underwent RC with an ileal conduit...
July 1, 2017: Urologia Internationalis
https://www.readbyqxmd.com/read/28644101/safety-and-cost-efficiency-of-a-restrictive-transfusion-protocol-in-patients-with-traumatic-brain-injury
#15
Laura B Ngwenya, Catherine G Suen, Phiroz E Tarapore, Geoffrey T Manley, Michael C Huang
OBJECTIVE Blood loss and moderate anemia are common in patients with traumatic brain injury (TBI). However, despite evidence of the ill effects and expense of the transfusion of packed red blood cells, restrictive transfusion practices have not been universally adopted for patients with TBI. At a Level I trauma center, the authors compared patients with TBI who were managed with a restrictive (target hemoglobin level > 7 g/dl) versus a liberal (target hemoglobin level > 10 g/dl) transfusion protocol. This study evaluated the safety and cost-efficiency of a hospital-wide change to a restrictive transfusion protocol...
June 23, 2017: Journal of Neurosurgery
https://www.readbyqxmd.com/read/28639537/prehospital-identification-of-trauma-patients-requiring-transfusion-results-of-a-retrospective-study-evaluating-the-use-of-the-trauma-induced-coagulopathy-clinical-score-ticcs-in-33-385-patients-from-the-traumaregister-dgu-%C3%A2
#16
Martin Tonglet, Rolf Lefering, Jean Marc Minon, Alexandre Ghuysen, Vincenzo D'Orio, Frank Hildebrand, Hans-Christoph Pape, Klemens Horst
BACKGROUND: Identifying trauma patients that need emergent blood product transfusion is crucial. The Trauma Induced Coagulopathy Clinical Score (TICCS) is an easy-to-measure score developed to meet this medical need. We hypothesized that TICCS would assist in identifying patients that need a transfusion in a large cohort of severe trauma patients from the TraumaRegister DGU(®) (TR-DGU). MATERIALS AND METHODS: A total of 33,385 severe trauma patients were extracted from the TR-DGU for retrospective analysis...
June 22, 2017: Acta Chirurgica Belgica
https://www.readbyqxmd.com/read/28637551/outcomes-of-geriatric-trauma-patients-on-preinjury-anticoagulation-a-multicenter-study
#17
Darwin Ang, Stan Kurek, Mark McKenney, Scott Norwood, Brian Kimbrell, Erik Barquist, Huazhi Liu, Annette O'Dell, Michele Ziglar, James Hurst
Outpatient anticoagulation in the geriatric trauma patient is a challenging clinical problem. The aim of this study is to determine clinical outcomes associated with class of preinjury anticoagulants (PA) used by this population. This is a multicenter retrospective cohort study among four Level II trauma centers. A total of 1642 patients were evaluated; 684 patients were on anticoagulation and 958 patients were not. Patients on PA were compared with those who were not. Drug classes were divided into thromboxane A2 inhibitors, vitamin K factor-dependent inhibitors, antithrombin III activation, platelet P2Y12 inhibitors, and thrombin inhibitors...
June 1, 2017: American Surgeon
https://www.readbyqxmd.com/read/28633147/tranexamic-acid-safely-reduced-blood-loss-in-hemi-and-total-hip-arthroplasty-for-acute-femoral-neck-fracture-a-randomized-clinical-trial
#18
Chad D Watts, Matthew T Houdek, S Andrew Sems, William W Cross, Mark W Pagnano
OBJECTIVES: We aimed to determine whether (1) tranexamic acid (TXA) reduces the incidence of transfusion (2) TXA reduces the calculated blood loss, and (3) there are any observable differences in 30- and 90-day complications with TXA administration during arthroplasty for femoral neck fracture (FNF). DESIGN: Prospective, double-blinded, randomized controlled trial. SETTING: Level 1 Academic Trauma Center. PATIENTS/PARTICIPANTS: One hundred thirty-eight patients who presented with a low-energy, isolated, FNF (AO 31B) treated with either hemi- or total hip arthroplasty within 72 hours of injury were randomized to either the TXA group (69 patients) or placebo group (69 patients)...
July 2017: Journal of Orthopaedic Trauma
https://www.readbyqxmd.com/read/28632435/relative-effects-of-plasma-fibrinogen-concentrate-and-factor-xiii-on-rotem-coagulation-profiles-in-an-in-vitro-model-of-massive-transfusion-in-trauma
#19
David E Schmidt, Märit Halmin, Agneta Wikman, Anders Östlund, Anna Ågren
Massive traumatic haemorrhage is aggravated through the development of trauma-induced coagulopathy, which is managed by plasma transfusion and/or fibrinogen concentrate administration. It is yet unclear whether these treatments are equally potent in ensuring adequate haemostasis, and whether additional factor XIII (FXIII) administration provides further benefits. In this study, we compared ROTEM whole blood coagulation profiles after experimental massive transfusion with different transfusion regimens in an in vitro model of dilution- and transfusion-related coagulopathy...
June 20, 2017: Scandinavian Journal of Clinical and Laboratory Investigation
https://www.readbyqxmd.com/read/28625450/vasoplegic-syndrome-an-update-on-perioperative-considerations
#20
REVIEW
Henry Liu, Ling Yu, Longqiu Yang, Michael S Green
Vasoplegic syndrome (VS) is increasingly recognized as an important clinical entity in perioperative medicine. VS is characterized by significant arterial hypotension, normal or high cardiac output, low systemic vascular resistance, and increased requirements for intravenous volume and vasopressors. Tremendous variations exist regarding incidence reported in the literature and management at different institutions; and the incidence of VS is likely significantly higher than many anesthesiologists believe. Thus the aims of this article are to review the pertinent aspects related to VS and alert clinical anesthesiologists to this under-recognized yet very challenging clinical condition...
August 2017: Journal of Clinical Anesthesia
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