European journal of trauma and emergency surgery : official publication of the European Trauma Society
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The arterial pressure waveform is a composite of multiple interactions, and there may be more sensitive and specific features associated with hemorrhagic shock and intravascular volume depletion than systolic and/or diastolic blood pressure (BP) alone. The aim of this study was to characterize the arterial pressure waveform in differing grades of hemorrhage. ⋯ In this swine model of volume-controlled hemorrhage, hypotension was a predominating early feature. While most waveform features mirrored those of BP, specific features such as the variance may be able to distinguish differing magnitudes of hemorrhage despite little change in conventional measures.
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Eur J Trauma Emerg Surg · Feb 2021
Underlying disease determines the risk of an open abdomen treatment, final closure, however, is determined by the surgical abdominal history.
Temporary abdominal closure is frequently used in several situations such as abbreviated surgery in damage control situations or when closing is impossible due to organ distention or increased abdominal pressure. The ultimate goal is to eventually close the fascia; however, little is known about factors predicting abdominal closure. The purpose of this study was to identify characteristics associated with the need for open abdomen as well as indicating the possibility of delayed fascial closure after a period of open abdominal treatment. ⋯ In this study, male sex and physiological derangement, reflected by acidosis, were independent predictors of open abdominal treatment. Furthermore, the success of delayed fascial closure depends on number of abdominal surgical procedures. Moreover, based on our experiences, we suggest to change modalities early on, to prevent multiple fruitless attempts to close the abdomen.
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Eur J Trauma Emerg Surg · Feb 2021
Multicenter Study Comparative StudyVenous thromboembolism (VTE) prophylaxis in severely injured patients: an international comparative assessment.
Venous thromboembolisms (VTE) are a major concern after acute survival from trauma. Variations in treatment protocols for trauma patients exist worldwide. This study analyzes the differences in the number of VTE events and the associated complications of thromboprophylaxis between two level I trauma populations utilizing varying treatment protocols. ⋯ A more early commencement protocol resulted in almost twice as much chemical prophylaxis being started within the first 48 h in comparison with a more delayed initiation of treatment. Interestingly, most episodes of VTE developed while receiving recommended prophylaxis. Early chemical thromboprophylaxis did not significantly increase the bleeding complications and it appears to be safe to start early.
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Eur J Trauma Emerg Surg · Feb 2021
Aggressive crystalloid adversely affects outcomes in a pediatric trauma population.
Crystalloid resuscitation for trauma patients is deleterious, and minimizing crystalloid use is advocated. The purpose of this study was to evaluate the adverse effects of high-volume resuscitation in pediatric blunt trauma patients. ⋯ Significant unfavorable outcomes were noted following excessive crystalloid resuscitation within the first 48 h among pediatric patients with blunt trauma. Our findings support the notion that excessive fluid resuscitation should be avoided.
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Eur J Trauma Emerg Surg · Feb 2021
Management of Gustilo type IIIB open tibial shaft fractures with limited resources: experience from an African trauma center.
We sought to evaluate the management of Gustilo type IIIB open tibia diaphyseal fractures in an African trauma center with respect to soft tissue defect management and bone union achievement. Functional outcome assessment was the secondary objective. ⋯ To our knowledge, this is the first series reporting flap reconstructions performed by orthopedic surgeons for Gustilo type IIIB tibia fractures in an African hospital. Local pedicled flap transfers permitted the achievement of soft tissue coverage and bone union in most cases. Subsequent bone grafting was required in one-third of the cases.