Surgery
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Intensive insulin therapy to control blood glucose levels has reduced mortality in surgical, but not medical, intensive care unit (ICU) patients. Control of blood glucose levels has also been shown to reduce morbidity in surgical ICU patients. There is very little data for use of intensive insulin therapy in the burn patient population. We sought to evaluate our experience with intensive insulin therapy in burn-injured ICU patients with regard to mortality, morbidity, and use of hospital resources. ⋯ Intensive insulin therapy for burn-injured patients admitted to the ICU was associated with a reduced incidence of pneumonia, ventilator-associated pneumonia, and urinary tract infection. Intensive insulin therapy did not result in a change in mortality or length of stay when adjusting for confounding variables. Measurement of a blood glucose level greater than 140 mg/dL should heighten the clinical suspicion for the presence of an infection in patients with burn injury.
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Composite tissue allotransplantation (CTA) is a newly emerging field of transplantation that involves the simultaneous transfer of multiple tissues with differing antigenicity. Hand transplantation, the most widely recognized form of CTA, aims to improve function and the quality of life of upper limb amputees. ⋯ The long-term success reported here should encourage wider application of the CTA in general and hand transplantation in particular. Methods of minimizing long-term immunosuppression need to be pursued.
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Central line-associated bloodstream infections occur commonly and are a potentially preventable source of morbidity in the critical care setting. The purpose of this study was to find a way to decrease central line-associated bloodstream infections. ⋯ The implementation of a central line bundle campaign resulted in a significant decrease in line-associated bloodstream infections. Based on our study, we recommend that this protocol be adopted nationwide.
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More elderly trauma patients are identified with preinjury use of clopidogrel, aspirin, or warfarin (CAW). The purpose of this study was to determine whether preinjury CAW use was an important predictor of mortality in patients aged >or=50 years with blunt, hemorrhagic brain injury (HBI). ⋯ Preinjury CAW use in older blunt, HBI patients is not associated with increased mortality. Age was a significant predictor of mortality independent of CAW use.
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Trauma patients who require therapeutic anticoagulation pose a difficult treatment problem. The purpose of this study was to determine: (1) the incidence of complications using therapeutic anticoagulation in trauma patients, and (2) if any patient factors are associated with these complications. ⋯ Trauma patients have a significant complication rate related to anticoagulation therapy, and predicting which patients will develop a complication remains unclear. Prospective studies are needed to determine which treatment regimen, if any, is appropriate to safely anticoagulate this high risk population.