Surgery
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Randomized Controlled Trial Clinical Trial
Use of the rapid/shallow breathing index as an indicator of patient work of breathing during pressure support ventilation.
Measuring patient work of breathing (WOBpt) has been suggested to provide safe, aggressive weaning from mechanical ventilation. We compared WOBpt and pressure-time-product (PTP) to routine weaning parameters [breath rate (f), tidal volume (VT), frequency/tidal volume ratio (f/VT)] at different levels of pressure support ventilation (PSV). ⋯ Direct measurement of WOBpt is invasive, expensive, and' may be confusing to clinicians. Monitoring f/VT may be useful when changing PSV during weaning.
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Comparative Study
Management of blunt splenic trauma: significant differences between adults and children.
Although highly successful in children, nonoperative management of blunt splenic injury in adults is less defined. The purpose of this study was to determine whether mechanism of injury, grade of splenic injury, associated injuries, and pattern of injury differ between adults and children (younger than 15 years of age). ⋯ Rather than children simply being physically different, they are injured differently than adults, hence the high rate of nonoperative management.
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Recent reports have demonstrated an increase in the number of complications associated with delayed timing of fasciotomy for trauma. This study examines the effectiveness of early (less than 12 hours) versus late (more than 12 hours) fasciotomy in the injured extremity. ⋯ Fasciotomy for trauma is most efficacious when performed early. However, when performed late, it results in similar rates of limb salvage as compared with early fasciotomy but at the increased risk of infection. These results support aggressive use of fasciotomy in extremity trauma regardless of time of diagnosis.