Journal of the American College of Surgeons
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Comparative Study
Effect of fluid resuscitation on acute skeletal muscle ischemia-reperfusion injury after hemorrhagic shock in rats.
Severe extremity wounds with vascular injury are common in military trauma, and tourniquets are commonly used for hemorrhage control. The complications of tourniquet use in the setting of trauma are not well studied. This study investigated the combined effect of hemorrhagic shock and fluid resuscitation with Hextend (HX; BioTime, Inc) or lactated Ringer's (LR) on skeletal muscle subjected to tourniquet-induced ischemia-reperfusion injury. ⋯ Resuscitation with HX or lactated Ringer's does not adversely affect muscle viability in ischemia-reperfusion injury. HX may be a better clinical choice when skeletal muscle ischemia-reperfusion injury is a risk, despite greater edema.
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There is increasing financial pressure to maximize clinical productivity for academic physicians. We examined whether clinical performance feedback alone could contribute to improving the clinical productivity of surgeons in an academic department of surgery. ⋯ Performance feedback was associated with a small (6.0%) but significant improvement in productivity in this academic surgical faculty group. Performance feedback can be useful and should be used in conjunction with other management tools for this population.