The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2015
Portable mechanical ventilation with closed-loop control of inspired fraction of oxygen maintains oxygenation in the setting of hemorrhage and lung injury.
Closed-loop controllers (CLCs) embedded within portable mechanical ventilators may allow for autonomous weaning. The ability of CLCs to maintain adequate oxygenation in the setting of hemorrhage and lung injury is unknown. We hypothesized that a portable ventilator with a CLC for inspired fraction of oxygen (FIO2) could provide oxygenation in a porcine model of hemorrhage and lung injury. ⋯ Adequate oxygenation can be maintained in the setting of hemorrhage and lung injury using a portable ventilator embedded with a CLC of FIO2 based on pulse oximetry. These devices may be valuable for providing advanced medical care in resource-limited environments.
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J Trauma Acute Care Surg · Jul 2015
Effect of ascorbic acid concentrations on hemodynamics and inflammation following lyophilized plasma transfusion.
Compared with lyophilized plasma (LP) buffered with other acids, LP with ascorbic acid (AA) attenuates systemic inflammation and DNA damage in a combat relevant polytrauma swine model. We hypothesize that increasing concentrations of AA in transfused LP will be safe, will be hemodynamically well tolerated, and will attenuate systemic inflammation following polytraumatic injury and hemorrhage in swine. ⋯ Concentrations of AA were well tolerated and did not diminish the procoagulant activity of LP. Within our tested range of concentrations, AA can safely be used to buffer LP.
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J Trauma Acute Care Surg · Jul 2015
Peer-to-peer physician feedback improves adherence to blood transfusion guidelines in the surgical intensive care unit.
Translation of evidence to practice regarding adherence to published guidelines for transfusion of red blood cells (RBCs) in critically ill patients is sometimes suboptimal. We sought to use a multimodal intervention founded on peer-to-peer feedback and monthly audit to increase adherence to restrictive RBC transfusion guidelines. ⋯ Therapeutic/care management study, level IV.
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J Trauma Acute Care Surg · Jul 2015
Maintaining an open trauma intensive care unit bed for rapid admission can be cost-effective.
In 2012, we implemented a ready open trauma intensive care unit (TICU) bed process. Our hypothesis was that this process would decrease emergency department (ED) length of stay (LOS) in a cost-effective manner without worsening clinical outcomes. ⋯ Cost analysis, level III.
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J Trauma Acute Care Surg · Jul 2015
Chronic restraint stress after injury and shock is associated with persistent anemia despite prolonged elevation in erythropoietin levels.
Following severe traumatic injury, critically ill patients have a prolonged hypercatacholamine state that is associated with bone marrow (BM) dysfunction and persistent anemia. However, current animal models of injury and shock result in a transient anemia. Daily restraint stress (chronic stress [CS]) has been shown to increase catecholamines. We hypothesize that adding CS following injury or injury and shock in rats will prolong the hypercatecholaminemia and prolong the initial anemia, despite elevated erythropoietin (EPO) levels. ⋯ Exposing injured animals to CS results in prolonged elevation of NE and EPO, which is associated with worsening BM erythroid function and persistent anemia. Chronic restraint stress following injury and shock provides a clinically relevant model to further evaluate persistent injury-associated anemia seen in critically ill trauma patients. Furthermore, alleviating CS after severe injury is a potential therapeutic target to improve BM dysfunction and anemia.