J Trauma
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Comparative Study
Resuscitation of severe chest trauma with four different hemoglobin-based oxygen-carrying solutions.
The purpose of this study was to test whether polynitroxylation (PN) improved the therapeutic profile of hemoglobin-based oxygen-carrying compounds (HBOCs) that were unpolymerized (alphaalphaHb) or 70% polymerized (polyHb) in a clinically relevant model that combines pulmonary injury and reperfusion. To our knowledge, four different HBOC formulations have never been compared in the same trauma model. ⋯ After resuscitation from chest trauma, we observed the following: (1) all HBOCs reduced fluid requirements and increased right and left ventricular afterload versus NaCl, which further compromised an already marginal cardiac performance; (2) mortality was less with polyHbs relative to alphaalphaHb, but the pressor action was unchanged; (3) the pressor action was less with polynitroxylated compounds relative to the unmodified HBOC, but this chemical modification had no effect on mortality; and (4) the pressor action of HBOCs must be attenuated by strategies other than polymerization or polynitroxylation for these compounds to be safe, effective resuscitants in humans.
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To evaluate the necessity of abdominal screening beyond physical examination in awake and alert blunt trauma patients who require emergent extra-abdominal trauma surgery. ⋯ Before emergent extra-abdominal trauma surgery, abdominal evaluation with physical examination is sufficient to identify surgically significant abdominal injury in the awake and alert blunt trauma patient. Screening with additional studies does not impact patient outcome.
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Trauma surgeons use a variety of methods to prevent venous thromboembolism (VT). The rationale for their use frequently is based on conclusions from research on nontrauma populations. Existing recommendations are based on expert opinion and consensus statements rather than systematic analysis of the existing literature and synthesis of available data. The objective is to produce an evidence-based report on the methods of prevention of VT after injury. ⋯ The trauma literature on VT prophylaxis provides inconsistent data. There is no evidence that any existing method of VT prophylaxis is clearly superior to the other methods or even to no prophylaxis. Our results cast serious doubt on the existing policies on VT prophylaxis, and we call for a large, high-quality, multicenter trial that can provide definitive answers.
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Comparative Study
Midline shift after severe head injury: pathophysiologic implications.
To investigate the mechanism of the adverse effect of midline shift after severe traumatic brain injury. ⋯ Midline shift after severe traumatic brain injury is associated with reduced CMRo2, regardless of whether or not SDH is present. The deleterious effects of subdural blood may be related more to the mass effect of large SDHs than to the biochemical abnormalities caused by small amounts of blood in the subdural space.
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To determine the factors predictive of mortality in patients with unstable pelvic fractures after successful transcatheter arterial embolization. ⋯ The success rate of embolization was 100% in stopping arterial hemorrhage of unstable pelvic fractures. The survival rate after successful embolization was 82.4%. Patients who had rapid blood transfusion before embolization had a poor final outcome. The risk of dying increased by 62% for every 1 unit/h increase of transfusion rate.