J Trauma
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Blunt SBI is infrequent and its diagnosis may be difficult, especially in the face of confounding variables. The purpose of this study was to evaluate methods for making the diagnosis of blunt SBI. ⋯ Alone or in combination, current diagnostic approaches lack sensitivity in the diagnosis of perforated SBI. Improvements in diagnostic methods and approaches are needed to ensure the prompt diagnosis of this uncommon but potentially devastating injury.
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Clinical Trial
Influence of low tidal volumes on gas exchange in acute respiratory distress syndrome and the role of recruitment maneuvers.
BACKGROUND Use of a low tidal volume (V(T)) strategy in the treatment of acute respiratory distress syndrome can lead to a decrease in oxygenation. This study evaluated the safety and efficacy of a recruitment maneuver (RM) in this setting. ⋯ An RM transiently improves gas exchange during low V(T)ventilation. RMs are well tolerated and no hemodynamic consequences were seen.
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The purpose of this study was to identify and analyze factors contributing to both airbag deployment and resulting head injuries (HIs) and to quantify the effect of airbag deployment on head injuries, in terms of odds of head injury and severity, in severe motor vehicle collisions (MVCs). ⋯ Airbag deployment did not significantly lower a driver's odds of head injury in a severe MVC, but it did significantly lower the severity of head injury. This is a significant finding, given that 72% of our study population sustained a head injury and the importance of lowering the severity of these head injuries in terms of patients' ultimate outcome. The most important factor associated with head injuries was ejection, which nearly doubled a driver's odds of head injury (odds ratio, 1.759; 95% confidence interval, 1.201-2.577). This reinforces the supplementary protective effect of an airbag and that "buckling up" and keeping occupants in the vehicle is of primary importance in the prevention of head injuries.
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Nuclear factor-kappa B (NF-kappa B) plays a critical role in the cellular response to a variety of stimuli, and it regulates the production of various inflammatory cytokines, adhesion molecules, and enzymes. Polymorphonuclear leukocytes (PMNLs) play a central role in systemic inflammatory response after severe insult. The role of NF-kappa B in activation of PMNLs, however, has not been clear. We developed a simple flow cytometric method for quantifying expression of intranuclear NF-kappa B in PMNLs, and we used it to evaluate NF-kappa B activity in patients with systemic inflammatory response syndrome (SIRS). ⋯ Our new flow cytometric method proved useful for quantifying intranuclear NF-kappa B expression in PMNLs. In PMNLs from SIRS patients, intranuclear NF-kappa B expression and oxidative activity were significantly elevated with positive correlation, and enhanced expression of NF-kappa B may play an important role in PMNL activation in SIRS.
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With rising health care costs, methods to decrease length of hospital stay without compromising care are necessary. One area that extends length of stay in trauma patients is inpatient anticoagulation to a therapeutic international normalized ratio. The 1998 American College of Chest Physicians guidelines recommend thromboprophylaxis with low-molecular-weight heparin (LMWH) and oral warfarin in this population. The LMWH Expedited Anticoagulation Program (LEAP) was created with the following goals: to decrease the number of inpatient warfarin days and to reduce overall number of hospital days. ⋯ LEAP has successfully decreased the number of inpatient days on warfarin and total hospital days for trauma patients requiring deep venous thrombosis prophylaxis. These results have substantially decreased health care costs and increased available hospital beds in this era of high hospital occupancy.