The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jun 2016
Efficacy of a novel fluoroscopy-free endovascular balloon device with pressure release capabilities in the setting of uncontrolled junctional hemorrhage.
Resuscitative endovascular balloon occlusion of the aorta (REBOA) has emerged as an alternative to gauze packing (GP) in the setting of noncompressible torso hemorrhage. Our objective was to describe placement and physiologic impact of a novel REBOA device during uncontrolled junctional hemorrhage. We hypothesized that REBOA could be deployed without fluoroscopic guidance or intra-aortic barotrauma and could increase survival in the setting of profound shock physiology. ⋯ This study reinforces results found in previous studies that REBOA is an effective method to increase survival in the setting of noncompressible torso hemorrhage and is the first to show that this specific REBOA device can be blindly guided into the appropriate zone of the aorta without generating aortic wall injury during unmeasured balloon inflation.
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J Trauma Acute Care Surg · Jun 2016
Observational StudyThe acute respiratory distress syndrome following isolated severe traumatic brain injury.
Acute respiratory distress syndrome (ARDS) is common after traumatic brain injury (TBI) and is associated with worse neurologic outcomes and longer hospitalization. However, the incidence and associated causes of ARDS in isolated TBI have not been well studied. ⋯ Prognostic/epidemiologic study, level III.
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J Trauma Acute Care Surg · Jun 2016
A safe and effective management strategy for blunt cerebrovascular injury: Avoiding unnecessary anticoagulation and eliminating stroke.
Few injuries have produced as much debate with respect to management as have blunt cerebrovascular injuries (BCVIs). Recent work (American Association for the Surgery of Trauma 2013) from our institution suggested that 64-channel multidetector computed tomographic angiography (CTA) could be the primary screening tool for BCVI. Consequently, our screening algorithm changed from digital subtraction angiography (DSA) to CTA, with DSA reserved for definitive diagnosis of BCVI following CTA-positive study results or unexplained neurologic findings. The current study was performed to evaluate outcomes, including the potential for missed clinically significant BCVI, since this new management algorithm was adopted. ⋯ Diagnostic study, level III.
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J Trauma Acute Care Surg · Jun 2016
Exogenous S-nitrosoglutathione attenuates inflammatory response and intestinal epithelial barrier injury in endotoxemic rats.
Gut barrier injury in sepsis is a major contributor to distant organ dysfunction and bad clinical outcomes. Enteric glia-derived S-nitrosoglutathione (GSNO) has been recognized as a novel modulator of gut barrier integrity. In this study, we tested the potential therapeutic effect and mechanism of exogenous GSNO on endotoxin-induced inflammatory response and intestinal barrier injury in a rat model of endotoxemia. ⋯ The data indicate that GSNO protects against the LPS-induced systemic inflammatory response and attenuated intestinal inflammation and epithelial barrier injury in rats, possibly through the inhibition of the NF-κB pathway.