The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2012
Comparative StudyComparison of hemodynamic measurements from invasive and noninvasive monitoring during early resuscitation.
Measurements obtained from the insertion of a pulmonary artery catheter (PAC) in critically ill and/or injured patients have traditionally assisted with resuscitation efforts. However, with the recent utilization of ultrasound in the intensive care unit setting, transthoracic echocardiography (TTE) has gained popularity. The purpose of this study is to compare serial PAC and TTE measurements and document levels of serum biomarkers during resuscitation. ⋯ Measurements of CO and SV were moderately strong in correlation and agreement which may suggest PAC measurements overestimate actual values. The significance of tricuspid regurgitation and mitral regurgitation during early resuscitation is unknown.
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J Trauma Acute Care Surg · Apr 2012
Prehospital dynamic tissue oxygen saturation response predicts in-hospital lifesaving interventions in trauma patients.
Tissue oximetry (StO2) plus a vascular occlusion test is a noninvasive technology that targets indices of oxygen uptake and delivery. We hypothesize that prehospital tissue oximetric values and vascular occlusion test response can predict the need for in-hospital lifesaving interventions (LSI). ⋯ Prehospital DeO2 is associated with need for LSI in our trauma population. Further study of DeO2 is warranted to determine whether it can be used as an adjunct triage criterion or an endpoint for resuscitation.
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyCrystalloid to packed red blood cell transfusion ratio in the massively transfused patient: when a little goes a long way.
Massive transfusion (MT) protocols have emphasized the importance of ratio-based transfusion of plasma and platelets relative to packed red blood cells (PRBCs); however, the risks attributable to crystalloid resuscitation in patients requiring MT remain largely unexplored. We hypothesized that an increased crystalloid:PRBC (C:PRBC) ratio would be associated with increased morbidity and poor outcome after MT. ⋯ In patients requiring MT, crystalloid resuscitation in a ratio greater than 1.5:1 per unit of PRBCs transfused was independently associated with a higher risk of MOF, ARDS, and ACS. These results suggest overly aggressive crystalloid resuscitation should be minimized in these severely injured patients. Further research is required to determine whether incorporation of the C:PRBC ratio into MT protocols improves outcome.
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J Trauma Acute Care Surg · Apr 2012
Continuously recorded oxygen saturation and heart rate during prehospital transport outperform initial measurement in prediction of mortality after trauma.
Available trauma scoring systems that predict need for higher echelons of care require data not available in the field. We hypothesized that analysis of continuous vital sign data in comparison to trauma registry data predicts mortality early in trauma patient management. ⋯ Injury Severity Score and Trauma-Injury Severity Score are predictive of mortality but rely on the inclusion of intra-abdominal and intrathoracic diagnostic data that are not readily available during field assessment. Automated vital signs data collection and analysis from a single noninvasive device with decision support has the potential to alleviate the dual burdens of patient triage and documentation required of the prehospital provider.
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J Trauma Acute Care Surg · Apr 2012
Multicenter StudyEpidemiology and predictors of cervical spine injury in adult major trauma patients: a multicenter cohort study.
Patients with cervical spine injuries are a high-risk group, with the highest reported early mortality rate in spinal trauma. ⋯ 3.5% of patients suffered cervical spine injury. Patients with a lowered GCS or systolic blood pressure, severe facial fractures, dangerous injury mechanism, male gender, and/or age ≥ 35 years are at increased risk. Contrary to common belief, head injury was not predictive for cervical spine involvement.