The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2012
One hundred percent fascial approximation can be achieved in the postinjury open abdomen with a sequential closure protocol.
Multiple techniques have been introduced to obtain fascial closure for the open abdomen. Vacuum-assisted closure has reduced but not eliminated the use of either split-thickness skin grafts to cover the exposed bowel or mesh (prosthetic or biological) approximation of the fascia. We hypothesized that a sequential closure technique performed by a systematic protocol would achieve a higher rate of primary fascial closure than other described techniques. ⋯ A methodical approach with sequential fascial closure achieves 100% fascial approximation in our experience. This technique reduces the morbidity of the open abdomen and the cost of either complex abdominal reconstruction or biological mesh insertion.
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J Trauma Acute Care Surg · Jan 2012
Differences in management and mortality with a bronchoalveolar lavage-based diagnostic protocol for ventilator-associated pneumonia.
Directed antibiotic therapy based on accurate bacteriology is critical to ventilator-associated pneumonia (VAP) treatment. Bronchoalveolar lavage (BAL) has been reported to be more accurate than endotracheal sputum aspirate (ESA) in VAP diagnosis. Our objective was to determine the frequency with which BAL results differ from ESA cultures and the outcomes of VAP with a BAL-based VAP protocol. ⋯ Use of a BAL-based diagnostic protocol affects management of trauma patients with VAP by improving identification of causative microorganisms and is associated with low overall mortality and VAP-attributable mortality.
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To study the incidence and outcome of pulmonary edema in patients admitted with near hanging. ⋯ Pulmonary edema can be due to neurogenic, cardiogenic, postobstructive causes or an interplay of the three. Takotsubo cardiomyopathy/myocardial stunning related pulmonary edema seems more common than the others. Pulmonary edema occurred irrespective of level of consciousness or electrocardiographic changes and was not associated with mortality. Victims of near hanging with pulmonary edema can be effectively treated with supportive therapy.
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J Trauma Acute Care Surg · Jan 2012
Hypothermia reduces resuscitation fluid volumes required to maintain blood pressure in a rat hemorrhagic shock model.
To examine the hypothesis that resuscitative hypothermia would (1) reduce fluid requirements and reactive oxygen species production during a period of resuscitation and (2) improve survival after hemorrhagic shock (HS) in rats. ⋯ In a rat HS model, hypothermia during resuscitation from HS reduces resuscitation fluid volume required to maintain blood pressure and restores Vitamin E to the baseline level, and appears to have no adverse impact on long survival after HS.