The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Apr 2014
Evaluation of 8.0-cm needle at the fourth anterior axillary line for needle chest decompression of tension pneumothorax.
Five-centimeter needles at the second intercostal space midclavicular line (2MCL) have high failure rates for decompression of tension pneumothorax. This study evaluates 8-cm needles directed at the fourth intercostal space anterior axillary line (4AAL). ⋯ Therapeutic/care management study, level IV.
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J Trauma Acute Care Surg · Apr 2014
Multicenter StudyDecompressive craniectomy or medical management for refractory intracranial hypertension: an AAST-MIT propensity score analysis.
Moderate/severe traumatic brain injury (TBI) management involves minimizing cerebral edema to maintain brain oxygen delivery. While medical therapy (MT) consisting of diuresis, hyperosmolar therapy, ventriculostomy, and barbiturate coma is the standard of care, decompressive craniectomy (DC) for refractory intracranial hypertension (ICH) has gained renewed interest. Since TBI treatment guidelines consider DC a second-tier intervention after MT failure, we sought to determine if early DC (<48 hours) was associated with improved survival in patients with refractory ICH. ⋯ Therapeutic care/management, level III.
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J Trauma Acute Care Surg · Apr 2014
There's no place like home: boarding surgical ICU patients in other ICUs and the effect of distances from the home unit.
Intensive care units (ICUs) function frequently at capacity, requiring incoming critically ill patients to be placed in alternate geographically distinct ICUs. In some medical ICU populations, "boarding" in an overflow ICU has been associated with increased mortality. We hypothesized that surgical ICU patients experience more complications when boarding in an overflow ICU and that the frequency of these complications are greatest in boarders farthest from the home unit (HU). ⋯ Epidemiologic study, level III. Therapeutic study, level IV.
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J Trauma Acute Care Surg · Apr 2014
Multicenter StudyDeveloping best practices to study trauma outcomes in large databases: an evidence-based approach to determine the best mortality risk adjustment model.
The National Trauma Data Bank (NTDB) is an invaluable resource to study trauma outcomes. Recent evidence suggests the existence of great variability in covariate handling and inclusion in multivariable analyses using NTDB, leading to differences in the quality of published studies and potentially in benchmarking trauma centers. Our objectives were to identify the best possible mortality risk adjustment model (RAM) and to define the minimum number of covariates required to adequately predict trauma mortality in the NTDB. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Apr 2014
Randomized Controlled Trial Comparative StudyColloid with high fresh frozen plasma/red blood cell resuscitation does not reduce postoperative fluid needs.
Recent data suggest that intraoperative (Phase I) colloid (human serum albumin [HSA]) and a high fresh frozen plasma (FFP)/red blood cell (RBC) resuscitation will reduce postoperative (Phase II) fluid uptake. This study compares a noncolloid (balanced electrolyte solution [BES]) plus low (≤ 0.35) FFP/RBC resuscitation (Group A) with an HSA plus high (>0.35) FFP/RBC resuscitation. ⋯ Therapeutic study, level IV.