European journal of trauma and emergency surgery : official publication of the European Trauma Society
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Eur J Trauma Emerg Surg · Apr 2019
Treatment of combined traumatic brain injury and hemorrhagic shock with fractionated blood products versus fresh whole blood in a rat model.
Treatment of combined traumatic brain injury and hemorrhagic shock, poses a particular challenge due to the possible conflicting consequences. While restoring diminished volume is the treatment goal for hypovolemia, maintaining adequate cerebral perfusion pressure and avoidance of secondary damage remains a treatment goal for the injured brain. Various treatment modalities have been proposed, but the optimal resuscitation fluid and goals have not yet been clearly defined. A growing body of evidence suggests that in hypovolemic shock, resuscitation with fresh whole blood (FWB) may be superior to component therapy without platelets (which are likely to be unavailable in the pre-hospital setting). Nevertheless, the effects of this approach have not been studied in the combined injury. Previously, in a rat model of combined injury we have found that mild resuscitation to MABP of 80 mmHg with FWB is superior to fluid resuscitation or aggressive resuscitation with FWB. In this study, we investigate the physiological and neurological outcomes in a rat model of combined traumatic brain injury (TBI) and hypovolemic shock, submitted to treatment with varying amounts of FWB, compared to similar resuscitation goals with fractionated blood products-red blood cells (RBCs) and plasma in a 1:1 ratio regimen. ⋯ In this study, we find that mild resuscitation with goals of restoring MAP to 80 mmHg (which is lower than baseline) with FWB, provided better hemodynamic stability and survival. However, the best neurological outcomes were found in the group resuscitated with FWB. Thus, we suggest that resuscitation with FWB is a feasible modality in the combined TBI + hypovolemic shock scenario, and may result in improved outcomes compared to platelet-free component blood products.
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Eur J Trauma Emerg Surg · Apr 2019
Multicenter StudyA seven-center examination of the relationship between monthly volume and mortality in trauma: a hypothesis-generating study.
The relationship between trauma volumes and patient outcomes continues to be controversial, with limited data available regarding the effect of month-to-month trauma volume variability on clinical results. This study examines the relationship between monthly trauma volume variations and patient mortality at seven Level I Trauma Centers located in the Eastern United States. We hypothesized that higher monthly trauma volumes may be associated with lower corresponding mortality. ⋯ This hypothesis-generating study suggests that greater monthly trauma volumes appear to be associated with lower mortality. In addition, our data also suggest that across all participating centers mortality may be a function of relative month-to-month volume variation. When normalized to institution-specific, annually-adjusted "median" monthly trauma contacts, we show that months with patient volumes ≤ 33% median may be associated with subtly but not negligibly (1.4-2.3%) higher mortality than months with patient volumes ≥ 134% median.
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Eur J Trauma Emerg Surg · Apr 2019
ReviewDecision-making for complex scapula and ipsilateral clavicle fractures: a review.
Complex scapula with ipsilateral clavicle fracures remains a challange and treatment recommendations are still missing. This review provides an overview of the evolution of the definition, classification and treatment strategies for complex scapula and ipsilateral clavicle fractures. As with other rare conditions, consensus has not been reached on the most suitable management strategies to treat these patients. The aim of this review is twofold: to compile and summarize the currently available literature on this topic, and to recommend treatment approaches. ⋯ The role of instability in complex scapula with ipsilateral clavicle fractures remains unclear. The question of stability is preoperatively less relevant than the question of whether the dislocated fragments lead to compromised shoulder function.
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Eur J Trauma Emerg Surg · Apr 2019
Percutaneous cholecystostomy for severe (Tokyo 2013 stage III) acute cholecystitis.
To evaluate the impact of percutaneous cholecystostomy (PC) on severe acute cholecystitis (AC). ⋯ This study confirms that PC is a valuable tool in the treatment of severe AC. Randomized trials are needed to clarify the criteria for patient selection and to optimize the timing for both cholecystostomy and cholecystectomy.