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Trauma & critical care

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https://www.readbyqxmd.com/read/29672869/age-of-transfused-blood-in-critically-ill-adult-trauma-patients-a-prespecified-nested-analysis-of-the-age-of-blood-evaluation-randomized-trial
#1
Robert S Green, Mete Erdogan, Jacques Lacroix, Paul C Hébert, Alan T Tinmouth, Elham Sabri, Tinghua Zhang, Dean A Fergusson, Alexis F Turgeon
BACKGROUND: Blood transfusion is common in the resuscitation of patients with traumatic injury. However, the clinical impact of the length of storage of transfused blood is unclear in this population. STUDY DESIGN AND METHODS: We undertook a prespecified nested analysis of 372 trauma victims of the 2510 critically ill patients from 64 centers treated as part of the Age of Blood Evaluation (ABLE) randomized controlled trial. Patients were randomized according to their trauma status to receive either a transfusion of fresh blood stored not more than 7 days or standard-issue blood...
April 19, 2018: Transfusion
https://www.readbyqxmd.com/read/29670613/innate-immunity-in-the-persistent-inflammation-immunosuppression-and-catabolism-syndrome-and-its-implications-for-therapy
#2
REVIEW
Hiroyuki Horiguchi, Tyler J Loftus, Russell B Hawkins, Steven L Raymond, Julie A Stortz, McKenzie K Hollen, Brett P Weiss, Elizabeth S Miller, Azra Bihorac, Shawn D Larson, Alicia M Mohr, Scott C Brakenridge, Hironori Tsujimoto, Hideki Ueno, Frederick A Moore, Lyle L Moldawer, Philip A Efron
Clinical and technological advances promoting early hemorrhage control and physiologic resuscitation as well as early diagnosis and optimal treatment of sepsis have significantly decreased in-hospital mortality for many critically ill patient populations. However, a substantial proportion of severe trauma and sepsis survivors will develop protracted organ dysfunction termed chronic critical illness (CCI), defined as ≥14 days requiring intensive care unit (ICU) resources with ongoing organ dysfunction...
2018: Frontiers in Immunology
https://www.readbyqxmd.com/read/29661290/factors-affecting-the-caloric-and-protein-intake-over-time-in-critically-ill-trauma-patients
#3
Tobias Haltmeier, Kenji Inaba, Beat Schnüriger, Stefano Siboni, Elizabeth Benjamin, Lydia Lam, Damon Clark, Demetrios Demetriades
BACKGROUND: Major trauma leads to increased nutritional requirements. However, little is known about the actual amount of calories and protein administered and the factors affecting the intake over time in critically ill trauma patients. METHODS: Prospective study including 100 trauma patients admitted to the Los Angeles County + University of Southern California Medical Center intensive care unit between March 2014 and October 2014. Inclusion criteria were age > 16 y, surgery at admission, and no oral nutrition...
June 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29661285/extending-surgeon-response-times-in-tier-2-traumas-does-not-adversely-affect-patient-outcomes
#4
Steven Anthony Zimmerman, Christopher S Reed, Alexander N Reed, Ronald J Jones, Annette Chard, Donald N Reed
BACKGROUND: The presence of a trauma surgeon during patient resuscitations is required at most American College of Surgeons-verified trauma centers despite little evidence showing improved patient outcomes in the less-than-critically injured (Tier 2) trauma patients. This study was designed to identify the impact of extending required surgeon response times on outcomes in tier 2 trauma patients. METHODS: An American College of Surgeons-verified level 2 trauma center extended the maximum allowed surgeon response time for tier 2 activations from 60 min to 120 min on November 1, 2011...
June 2018: Journal of Surgical Research
https://www.readbyqxmd.com/read/29661267/comparison-of-electronic-versus-manual-mass-casualty-incident-triage
#5
Claudie Bolduc, Nisreen Maghraby, Patrick Fok, The Minh Luong, Valerie Homier
IntroductionMass-casualty incidents (MCIs) easily overwhelm a health care facility's human and material resources through the extraordinary influx of casualties. Efficient and accurate triage of incoming casualties is a critical step in the hospital disaster response.Hypothesis/ProblemTraditionally, triage during MCIs has been manually performed using paper cards. This study investigated the use of electronic Simple Triage and Rapid Treatment (START) triage as compared to the manual method. METHODS: This observational, crossover study was performed during a live MCI simulation at an urban, Canadian, Level 1 trauma center on May 26, 2016...
April 17, 2018: Prehospital and Disaster Medicine
https://www.readbyqxmd.com/read/29660009/critical-care-in-the-military-health-system-a-24-h-point-prevalence-study
#6
Raymond Fisher, Christopher J Colombo, Cristin A Mount, Elizabeth A Mann-Salinas, Adam W Bostick, Konrad Davis, James K Aden, Kevin K Chung, Mary S McCarthy, Jeremy C Pamplin
Background: Healthcare expenditures are a significant economic cost with critical care services constituting one of its largest components. The Military Health System (MHS) is the largest, global healthcare system of its kind. In this project, we sought to describe critical care services and the patients who receive them in the MHS. Methods: We surveyed 26 military treatment facilities (MTFs) representing 38 critical care services or intensive care units (ICUs)...
April 11, 2018: Military Medicine
https://www.readbyqxmd.com/read/29651626/current-topics-in-the-management-of-acute-traumatic-spinal-cord-injury
#7
Christopher D Shank, Beverly C Walters, Mark N Hadley
Acute traumatic spinal cord injury (SCI) affects more than 250,000 people in the USA, with approximately 17,000 new cases each year. It continues to be one of the most significant causes of trauma-related morbidity and mortality. Despite the introduction of primary injury prevention education and vehicle safety devices, such as airbags and passive restraint systems, traumatic SCI continues to have a substantial impact on the healthcare system. Over the last three decades, there have been considerable advancements in the management of patients with traumatic SCI...
April 12, 2018: Neurocritical Care
https://www.readbyqxmd.com/read/29644869/pearls-and-pitfalls-in-imaging-of-blunt-traumatic-thoracic-aortic-injury-a-pictorial-review
#8
Neeral R Patel, Elizabeth Dick, Nicola Batrick, Michael Jenkins, Elika Kashef
Blunt thoracic aortic injury (TAI) occurs most frequently as a sequelae of high impact deceleration such as high velocity road traffic accidents and falls from height. The burden of mortality and morbidity is high, however advances in pre-hospital care, diagnostic imaging and endovascular therapies have improved outcomes in this group of patients. Emergent treatment depends on accurate, early diagnosis by the radiologist. It is therefore of paramount importance that radiologists are familiar with both the direct (intimal flap, pseudoaneurysm, aortic contour irregularity and contrast extravasation) and indirect (periaortic haematoma) imaging findings of TAI...
April 12, 2018: British Journal of Radiology
https://www.readbyqxmd.com/read/29642744/evaluation-of-continuous-infusion-vancomycin-administration-in-a-critically-ill-trauma-population
#9
Brittany D Bissell, Gina Riggi, Christopher Morrison
Vancomycin is a first-line antibiotic for empiric treatment of gram-positive infections in the trauma intensive care unit. When dosed intermittently, difficulties arise from trough collection and drug monitoring. The objective of this study was to evaluate time to goal vancomycin levels comparing a continuous infusion protocol when compared to standard intermittent infusion dosing. This was a retrospective cohort of patients admitted to the trauma intensive care unit between July 2011 and July 2015 receiving vancomycin for at least 48 hours...
January 1, 2018: Journal of Intensive Care Medicine
https://www.readbyqxmd.com/read/29629983/impact-of-icu-structure-and-processes-of-care-on-outcomes-after-severe-traumatic-brain-injury-a-multicenter-cohort-study
#10
Victoria A McCredie, Aziz S Alali, Damon C Scales, Gordon D Rubenfeld, Brian H Cuthbertson, Avery B Nathens
OBJECTIVES: It is uncertain whether dedicated neurocritical care units are associated with improved outcomes for critically ill neurologically injured patients in the era of collaborative protocol-driven care. We examined the association between dedicated neurocritical care units and mortality and the effects of standardized management protocols for severe traumatic brain injury. DESIGN: We surveyed trauma medical directors from centers participating in the American College of Surgeons Trauma Quality Improvement Program to obtain information about ICU structure and processes of care...
April 6, 2018: Critical Care Medicine
https://www.readbyqxmd.com/read/29628674/the-intensive-care-unit-perspective-of-becoming-a-level-i-trauma-center-challenges-of-strategy-leadership-and-operations-management
#11
Richard H Savel, Wess Cohen, Dena Borgia, Ronald J Simon
The primary purpose of this narrative is to elucidate the numerous significant changes that occur at the intensive care unit (ICU) level as a medical center pursues becoming a Level I trauma center. Specifically, we will focus on the following important areas: (1) leadership and strategy issues behind the decision to move forward with becoming a trauma center; (2) preparation needed to take a highly functioning surgical ICU and align it for the inevitable changes that happen as trauma go-live occurs; (3) intensivist staffing changes; (4) roles for and training of advanced practice practitioners; (5) graduate medical education issues; (6) optimizing interactions with closely related services; (7) nursing, staffing, and training issues; (8) bed allocation issues; and (9) reconciling the advantages of a "unified adult critical care service" with the realities of the central relationship between trauma and surgical critical care...
January 2018: Journal of Emergencies, Trauma, and Shock
https://www.readbyqxmd.com/read/29622470/clinician-tasking-in-ambulance-control-improves-the-identification-of-major-trauma-patients-and-pre-hospital-critical-care-team-tasking
#12
Neil Sinclair, Paul A Swinton, Michael Donald, Lisa Curatolo, Peter Lindle, Steph Jones, Alasdair R Corfield
INTRODUCTION: Trauma remains the fourth leading cause of death in western countries and is the leading cause of death in the first four decades of life. NICE guidance in 2016 advocated the attendance of pre-hospital critical care trauma team (PHCCT) in the pre-hospital stage of the care of patients with major trauma. Previous publications support dispatch by clinicians who are also actively involved in the delivery of the PHCCT service; however there is a lack of objective outcome measures across the current reviewed evidence base...
March 30, 2018: Injury
https://www.readbyqxmd.com/read/29619335/role-of-neomycin-polymyxin-sulfate-solution-bladder-wash-for-prevention-of-catheter-associated-urinary-tract-infection-in-traumatic-brain-injury-patient-admitted-to-intensive-care-unit-a-prospective-randomized-study
#13
Neeraj Kumar, Yashpal Singh, Ghanshyam Yadav, S K Mathur, Umesh Kumar Bhadani
Background: Catheter - associated urinary tract infection (CAUTI) remains a critical threat for patients in intensive care unit especially in traumatic brain injury patients with low Glasgow coma score (GCS). Almost all patients in ICU receive antibiotic either prophylactic or therapeutic based on local antibiogram of particular ICU or hospital. For prophylaxis, systemic antibiotics are used. It will be helpful to avoid systemic side effects by introducing antibiotics locally through bladder irrigation...
January 2018: International Journal of Critical Illness and Injury Science
https://www.readbyqxmd.com/read/29613958/the-impact-of-age-on-the-innate-immune-response-and-outcomes-after-severe-sepsis-septic-shock-in-trauma-and-surgical-intensive-care-unit-patients
#14
Scott C Brakenridge, Philip A Efron, Julie A Stortz, Teczan Ozrazgat-Baslanti, Gabriela Ghita, Zhongkai Wang, Azra Bihorac, Alicia M Mohr, Babette A Brumback, Lyle L Moldawer, Frederick A Moore
INTRODUCTION: Advancing age is a strong risk factor for adverse outcomes across multiple disease processes. However, septic surgical and trauma patients are unique in they incur two or more inflammatory insults. The effects of advanced age on sepsis pathophysiology and outcomes remain unclear. METHODS: We performed a single center, prospective observational cohort study of Surgical ICU patients with severe sepsis/septic shock. Peripheral blood was collected for genomic, cytokine and biomarker analysis at 0...
April 2, 2018: Journal of Trauma and Acute Care Surgery
https://www.readbyqxmd.com/read/29608545/adherence-to-20-emergency-general-surgery-best-practices-results-of-a-national-survey
#15
Angela M Ingraham, M Didem Ayturk, Catarina I Kiefe, Heena P Santry
OBJECTIVE: To examine national adherence to emergency general surgery (EGS) best practices. BACKGROUND: There is a national crisis in access to high-quality care for general surgery emergencies. Acute care surgery (ACS), a specialty leveraging strengths of trauma systems, may ameliorate this crisis. A critical component of trauma care is adherence to clinical guidelines. We previously established best practices for EGS using RAND Appropriateness Methodology and pilot data...
March 30, 2018: Annals of Surgery
https://www.readbyqxmd.com/read/29606685/en-route-critical-care-transfer-from-a-role-2-to-a-role-3-medical-treatment-facility-in-afghanistan
#16
Amanda M Staudt, Shelia C Savell, Kimberly A Biever, Jennifer D Trevino, Krystal K Valdez-Delgado, Mithun Suresh, Jennifer M Gurney, Stacy A Shackelford, Joseph K Maddry, Elizabeth A Mann-Salinas
BACKGROUND: En route care is the transfer of patients requiring combat casualty care within the US military evacuation system. No reports have been published about en route care of patients during transfer from a forward surgical facility (role 2) to a combat support hospital (role 3) for comprehensive care. OBJECTIVE: To describe patients transferred from a role 2 to a role 3 US military treatment facility in Afghanistan. METHODS: A retrospective review of data from the Joint Trauma System Role 2 Database was conducted...
April 2018: Critical Care Nurse
https://www.readbyqxmd.com/read/29605169/burnout-and-posttraumatic-stress-in-paediatric-critical-care-personnel-prediction-from-resilience-and-coping-styles
#17
Rocío Rodríguez-Rey, Alba Palacios, Jesús Alonso-Tapia, Elena Pérez, Elena Álvarez, Ana Coca, Santiago Mencía, Ana Marcos, Juan Mayordomo-Colunga, Francisco Fernández, Fernando Gómez, Jaime Cruz, Olga Ordóñez, Ana Llorente
INTRODUCTION: Our aims were (1) to explore the prevalence of burnout syndrome (BOS) and posttraumatic stress disorder (PTSD) in a sample of Spanish staff working in the paediatric intensive care unit (PICU) and compare these rates with a sample of general paediatric staff and (2) to explore how resilience, coping strategies, and professional and demographic variables influence BOS and PTSD. MATERIALS AND METHODS: This is a multicentre, cross-sectional study. Data were collected in the PICU and in other paediatric wards of nine hospitals...
March 28, 2018: Australian Critical Care: Official Journal of the Confederation of Australian Critical Care Nurses
https://www.readbyqxmd.com/read/29597227/from-continuous-renal-replacement-therapies-to-multiple-organ-support-therapy
#18
Zaccaria Ricci, Stefano Romagnoli, Claudio Ronco, Gaetano La Manna
The incidence of the multiple organ dysfunction syndrome (MODS) is rapidly increasing in intensive care units (ICU). It usually combines with sepsis and is the most frequent cause of death in the ICU patients. The nature of the ICU patients has changed in the last years. It includes a variety of patients with severe cases due to major surgical interventions, trauma, hemodynamic instability, sepsis, and so on but also older people than previous times. All these situations can easily lead to MODS. In the prior years, the only available and efficient therapy was renal replacement therapy (RRT) for treating acute renal failure, but the development of technology also gives us devices to support the other systems...
2018: Contributions to Nephrology
https://www.readbyqxmd.com/read/29596686/hypertrophic-scar-severity-at-autograft-sites-is-associated-with-increased-pain-and-itch-after-major-thermal-burn-injury
#19
Matthew C Mauck, Jeffrey W Shupp, Felicia Williams, Marie Ashley Villard, Samuel W Jones, James Hwang, Jennifer Smith, Rachel Karlnoski, David J Smith, Bruce A Cairns, Samuel A McLean
Approximately three quarters of major thermal burn injury (MThBI) survivors suffer from hypertrophic scarring (HTS) and over half experience chronic pain or itch. In survivors of MThBI, HTS and chronic pain or itch are considered one of the greatest unmet challenges of postburn injury care and psychosocial reintegration. Although scarring, itch, and pain have been clinically associated, there are no prospective, multisite studies examining tissue autograft site pain or itch and scar outcomes. The authors collected a representative cohort (n = 56) of MThBI survivors who received autografting within 14 days of injury and evaluated graft-site pain or itch severity (0-10 Numeric Rating Scale) and HTS using a validated scar photograph assessment scale 6 months following MThBI...
December 4, 2017: Journal of Burn Care & Research: Official Publication of the American Burn Association
https://www.readbyqxmd.com/read/29596291/interprofessional-simulations-promote-knowledge-retention-and-enhance-perceptions-of-teamwork-skills-in-a-surgical-trauma-burn-intensive-care-unit-setting
#20
Katie L George, Beth Quatrara
BACKGROUND: The current state of health care encompasses highly acute, complex patients, managed with ever-changing technology. The ability to function proficiently in critical care relies on knowledge, technical skills, and interprofessional teamwork. Integration of these factors can improve patient outcomes. Simulation provides "hands-on" practice and allows for the integration of teamwork into knowledge/skill training. However, simulation can require a significant investment of time, effort, and financial resources...
May 2018: Dimensions of Critical Care Nursing: DCCN
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