The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Oct 2019
Randomized Controlled TrialKetamine/propofol admixture vs etomidate for intubation in the critically ill: KEEP PACE Randomized clinical trial.
Periintubation hypotension is associated with poor outcomes in the critically ill. We aimed to determine if an admixture of ketamine and propofol for emergent endotracheal intubation in critically ill patients was superior to etomidate. Primary endpoint was the change in mean arterial pressure from baseline to 5 minutes postdrug administration. ⋯ Therapeutic/Care Management, level II.
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J Trauma Acute Care Surg · Oct 2019
The Association between Self-Declared Acute Care Surgery Services and Operating Room Access: Results from a National Survey.
Timely access to the operating room (OR) for emergency general surgery (EGS) diseases is key to optimizing outcomes. We conducted a national survey on EGS structures and processes to examine if implementation of acute care surgery (ACS) would improve OR accessibility compared with a traditional general surgeon on call (GSOC) approach. ⋯ Therapeutic, Level III.
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J Trauma Acute Care Surg · Oct 2019
Transition from abdominal aortic and junctional tourniquet to zone 3 resuscitative endovascular balloon occlusion of the aorta is feasible with hemodynamic support after porcine class IV hemorrhage.
Traumatic hemorrhage remains a major cause of death in rural civilian and combat environments. Potential interventions to control hemorrhage from the pelvis and lower junctional regions include the abdominal aortic and junctional tourniquet (AAJT) and resuscitative endovascular balloon occlusion of the aorta (REBOA). The AAJT requires low technical skills and may thus be used by nonmedical professionals, but is associated with time-dependent ischemic complications. In combination with delayed patient evacuation, it may therefore be deleterious. Transition to zone 3 REBOA in higher levels of care may be a possibility to maintain hemostasis, mitigate adverse effects and enable surgery in patients resuscitated with the AAJT. It is possible that a transition between the interventions could lead to hemodynamic penalties. Therefore, we investigated the feasibility of replacing the AAJT with zone 3 REBOA in a porcine model of uncontrolled femoral hemorrhage. ⋯ Laboratory animal study, level IV.
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J Trauma Acute Care Surg · Oct 2019
Comparative StudyTiming of tracheostomy placement among children with severe traumatic brain injury: A propensity-matched analysis.
Early tracheostomy has been associated with shorter hospital stay and fewer complications in adult trauma patients. Guidelines for tracheostomy have not been established for children with severe traumatic brain injury (TBI). The purpose of this study was to (1) define nationwide trends in time to extubation and time to tracheostomy and (2) determine if early tracheostomy is associated with decreased length of stay and fewer complications in children with severe TBI. ⋯ Prognostic and epidemiological, retrospective comparative study, level III.
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J Trauma Acute Care Surg · Oct 2019
The value of failure to rescue in determining hospital quality for pediatric trauma.
In adult trauma patients, high- and low-mortality trauma hospitals have similar rates of major complications but differ based on failure to rescue (mortality following a major complication), which has become a marker of hospital quality. The aim of this study is to examine whether failure to rescue is also an appropriate hospital quality indicator in pediatric trauma. ⋯ Prognostic and epidemiological, level III.