J Trauma
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Comparative Study
In-house versus on-call attending trauma surgeons at comparable level I trauma centers: a prospective study.
The purpose of this study was to prospectively compare patient outcomes based on the presence of in-house versus on-call attending trauma surgeons at comparable Level I trauma centers. ⋯ The ability of the OC institution to be similar to the IH institution in its provision of clinical care and mortality rate is accomplished in an environment where trauma attending surgeons live within a 15-minute response time to the trauma center. Using a voice-paged trauma alert activation with accurate information and sufficient warning, evaluation, provision of care, and clinical outcome of the acutely injured patient can be provided equally by in-house trauma attending surgeons and trauma attending surgeons on-call from home.
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Comparative Study
Resuscitation with lactated Ringer's solution in rats with hemorrhagic shock induces immediate apoptosis.
We hypothesize that different resuscitative fluids may immediately affect the degree of apoptosis after hemorrhagic shock. ⋯ Resuscitation with LR solution after hemorrhagic shock increased immediate cell death by apoptosis in both the small intestine and liver. There was no significant increase in apoptosis in the animals resuscitated with hypertonic saline, whole blood, or in unresuscitated animals. Thus, the type of resuscitation fluid used may affect the apoptotic cellular response to shock.
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Elevated intra-abdominal pressure (IAP) increases intracranial pressure (ICP) and reduces cerebral perfusion pressure (CPP). We evaluated a nonsurgical means of reducing IAP to reverse this process. ⋯ Elevations in IAP led to increased ICP and decreased CPP. CNAP ameliorated these intracranial disturbances. With normal IAP, CNAP impaired cerebral perfusion.
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Randomized Controlled Trial Multicenter Study Clinical Trial
Bactericidal/permeability-increasing protein (rBPI21) in patients with hemorrhage due to trauma: results of a multicenter phase II clinical trial. rBPI21 Acute Hemorrhagic Trauma Study Group.
Infection and organ failure are the most common causes of death or serious complication in trauma patients surviving initial resuscitation and operation. Of the many possible causes of these complications, bacterial translocation and release of harmful cytokines and oxygen free radicals may play an important role in the pathogenesis of the complications associated with traumatic hemorrhage. Recombinant human bactericidal/permeability-increasing protein (rBPI21) has antibacterial and antiendotoxin properties, reduces cytokine levels, and increases survival in animal models of hemorrhagic shock. The primary objective of this study was to evaluate the safety and efficacy of prophylactic rBPI21 infusion in patients with hemorrhage due to trauma. ⋯ rBPI21 was well-tolerated and demonstrated a favorable trend in reducing the composite primary end point of mortality or serious complication through day 15, especially respiratory complications, in patients with hemorrhage due to trauma. A phase III study is currently in progress.