American journal of surgery
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The investigators present a series of adults with severe acute respiratory distress syndrome (ARDS) who were treated with extracorporeal membrane oxygenation (ECMO) at a regional referral center. ⋯ ECMO provides support that prevents ventilator-induced lung injury while the lungs heal. The investigators present a series of 36 adults with refractory hypoxemic ARDS (ratio of partial pressure of oxygen to fraction of inspired oxygen <50) from 17 different facilities who, treated with ECMO at a single referral center, had a 60% survival rate.
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Surgical trainees are evaluated based on the Accreditation Council for Graduate Medical Education 6 core competencies. The ability for a learner to recognize strengths and weaknesses in these areas allows for critical self-improvement. ⋯ Residents appear to have a more critical self-analysis than attending surgeons, with senior residents, general surgery residents, and highest one third-performing residents being the most critical of their own performance. Poorly performing residents appeared to lack insight into their abilities. This method of self-evaluation helps trainees reflect on their performance and highlights trainees who lack self-awareness and need counseling for improvement.
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Comparative Study Clinical Trial
Correlation of conventional thrombelastography and rapid thrombelastography in trauma.
Conventional thrombelastography has been in use for over 6 decades and provides a functional assay of coagulation. Rapid thrombelastography was developed to provide more rapid comprehensive analysis of coagulation status in an emergency setting. The purpose of this study was to determine the correlation of rapid thrombelastographic values with conventional thrombelastographic values in trauma patients. ⋯ Overall, there is a strong correlation between rapid thrombelastography and conventional thrombelastography in terms of overall clot strength and platelet function. There is a moderate correlation in assessing the degree of fibrin cross-linking and a poor correlation in evaluating thrombolysis. These correlations should be considered when evaluating coagulation status using rapid thrombelastography.
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The contribution of rib fractures to prolonged pain and disability may be underappreciated and undertreated. Clinicians are traditionally taught that the pain and disability of rib fractures resolves in 6 to 8 weeks. ⋯ Prolonged chest wall pain is common, and the contribution of rib fractures to disability is greater than traditionally expected. Further investigation into more effective therapies that prevent prolonged pain and disability after rib fractures is needed.
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Comparative Study
Reducing time on for extra-corporeal membrane oxygenation for adults with H1N1 pneumonia with the use of the Volume Diffusive Respirator.
The investigators compared a series of adult survivors of severe H1N1 pneumonia treated with extracorporeal membrane oxygenation (ECMO) with members of the Extracorporeal Life Support Organization registry for patients with H1N1 with regard to ventilator management while on ECMO. ⋯ These data suggest that the VDR enhanced pulmonary recovery from severe H1N1 pneumonia in adults. Shorter times on ECMO may improve the risk/benefit and cost/benefit ratios associated with ECMO care.