J Trauma
-
Randomized Controlled Trial Clinical Trial
Erythromycin reduces delayed gastric emptying in critically ill trauma patients: a randomized, controlled trial.
Early enteral feeding has been shown to be beneficial in improving outcome in critically injured trauma patients. Delayed gastric emptying occurs frequently in trauma patients, increasing the time to achieve nutritional goals, and limiting the benefit of early enteral feedings. Intravenous erythromycin is an effective agent for improving gastric motility in diabetics and postgastrectomy patients. The purpose of this study is to determine the effectiveness of erythromycin for improving gastric motility in critically injured trauma patients. ⋯ Intravenous erythromycin improves gastric motility and enhances early nutritional intake in critically injured patients.
-
Blunt vascular neck injuries (BVNIs) are rare, often occult, and potentially devastating injuries. The purpose of this study was to identify a high-risk group, which would benefit from screening. ⋯ Screening should be undertaken for patients at increased risk for BVNI: those with risk factors identified in our regression analysis and factors previously reported.
-
Review Case Reports
Malrotation after locked intramedullary tibial nailing: three case reports and review of the literature.
Malrotation after interlocked tibial nailing is rarely documented. ⋯ Malrotation may cause functional deficits, but the long-term consequences of rotational deformities in the tibia have not been thoroughly studied. Malrotation after tibial nailing is probably more common than reported. Intraoperative comparison with the uninjured leg may be the best means available for avoiding this postoperative complication.
-
Optimizing intracranial pressure (ICP) and cerebral perfusion pressure (CPP) is important in the management of severe traumatic brain injury (TBI). In trauma patients with TBI and respiratory dysfunction, positive end-expiratory pressure (PEEP) is often required to support oxygenation. Increases in PEEP may lead to reduced CPP. We hypothesized that increases in PEEP are associated with compromised hemodynamics and altered cerebral perfusion. ⋯ In trauma patients with severe TBI, the strategy of increasing PEEP to optimize oxygenation is not associated with reduced cerebral perfusion or compromised oxygen transport.
-
Comparative Study
Lung-sparing techniques are associated with improved outcome compared with anatomic resection for severe lung injuries.
Pulmonary tractotomy was introduced in 1994 as a novel concept for lung salvage after penetrating wounds. Recently, tractotomy has been suggested to increase morbidity and, thus, its practice has been challenged. The purpose of this study was to compare the morbidity and mortality associated with nonanatomic and anatomic lung resection in the management of severe pulmonary injuries. ⋯ Nonanatomic resection is associated with an improved morbidity and mortality compared with anatomic resection in the management of severe lung injuries. Although not a randomized study, these findings encourage the continued application of lung-sparing procedures when feasible.