J Trauma
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Randomized Controlled Trial Comparative Study Clinical Trial
Positioning of a double-lumen endobronchial tube without the aid of any instruments: an implication for emergency management.
Lung isolation and preservation of normal lung are the first lines of therapy in life-threatening massive hemoptysis. If bleeding continues but the side of origin is uncertain, use of a double-lumen tube (DLT) is reasonable. Utilizing a blind method to locate the bronchial cuff of a left-sided DLT without using any instrument, a DLT (Broncho-Cath, Mallinckrodt Medical Ltd., Athlone, Ireland) was successfully positioned without delay in a patient with massive hemoptysis, where auscultation could be misleading or useless and fiberoptic bronchoscope (FOB) was inapplicable. This study was performed to discern whether this blind method could substitute for FOB verification or auscultation in most circumstances where these two methods are unavailable or inapplicable. ⋯ This method, which requires no specific instrument and no time-consuming technique, can be taught easily and may be used in a situation where the rapidity of lung isolation or collapse is the key to saving life. We conclude that this blind method can be an alternative to the FOB and/or auscultation for the positioning of DLT in an emergency situation.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Perioperative antibiotic use in high-risk penetrating hollow viscus injury: a prospective randomized, double-blind, placebo-control trial of 24 hours versus 5 days.
The purpose of this study was to compare the safety and therapeutic efficacy of a 24-hour versus 5-day course of ampicillin/sulbactam for the prevention of postoperative infections in high-risk patients sustaining hollow viscus injury from penetrating abdominal trauma. ⋯ High-risk patients with colon or other hollow viscus injuries from penetrating abdominal trauma are at no greater risk for surgical-site or nonsurgical-site infection when treated with only a 24-hour course of a broad-spectrum antibiotic.
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To determine the incidence of C-spine injury (CSI) associated with gunshot wounds (GSWs) to the head. ⋯ C-spine immobilization and diagnostic radiography are probably not necessary in patients with isolated GSWs to the head and may complicate and delay emergency airway management.
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Comparative Study
Effect of rate and inspiratory flow on ventilator-induced lung injury.
We examined the effects of decreasing respiratory rate (RR) at variable inspiratory times (It) and reducing inspiratory flow on the development of ventilator-induced lung injury. ⋯ High-pressure ventilation for 6 hours using conventional flow patterns produces severe lung injury, irrespective of RR or It. Reduction of inspiratory flow at similar PIP provides pulmonary protection.
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Comparative Study
Characteristics of infection and leukocyte count in severely head-injured patients treated with mild hypothermia.
This study was designed to characterize the infectious complications and kinetics of leukocyte count in severely head-injured patients treated with mild hypothermia. ⋯ Infectious complications were more severe and leukocyte counts were lower in patients treated with mild hypothermia, who also had the highest initial intracranial pressures, than in patients treated with conventional therapies. Measures against increased susceptibility to infection and leukocyte suppression should be explored.