Articles: mortality.
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Penetrating chest injuries account for 1-13% of thoracic trauma hospital admissions and most of these are managed with a conservative approach. Nevertheless, 18-30% of cases managed only with tube thoracostomy have residual clotted blood, considered the major risk factor for the development of fibrothorax and empyema. In addition, 4-23% of chest injury patients present persistent pneumothorax and 15-59% present an injury to the diaphragm, which is missed in 30% of cases. In order to make a correct diagnosis, reduce the number of missed injuries, chronic sequelae and late mortality we propose performing surgical exploration of all patients with a penetrating injury of the pleural cavity. ⋯ VATS is a safe and effective way to diagnose and manage penetrating thoracic injuries, and its extensive use leads to a reduction in the number of missed, potentially fatal lesions as well as in chronic sequelae.
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Kidney dysfunction in the intensive care unit (ICU) results in increased morbidity, mortality, and health care costs; however, long-term mortality has not been described across strata of severity in kidney dysfunction. ⋯ Severity of kidney dysfunction in patients in the ICU is associated with an incremental increase in long-term mortality. Although patients classified with either mild or moderate kidney dysfunction had an increased risk for death, use of serum creatinine level alone was poor at discriminating long-term outcome, suggesting this measure alone should not be used for defining long-term prognosis.
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Pediatr Crit Care Me · Sep 2006
CommentConsidering the use of induced hypothermia in a pediatric patient with traumatic brain injury: a critical appraisal of two meta-analyses.
To review whether induced hypothermia after traumatic brain injury affects morbidity and mortality based on the results of two meta-analyses. ⋯ The discrepancies in the results of these contemporaneous meta-analyses may stem, in part, from differences in their trial selection strategies as well as from sources of trial heterogeneity. Nevertheless, McIntyre et al. uncovered the equivalent of a dose-dependent reduction in the risk of death with induced hypothermia, supporting further study of this neuroprotective strategy. Although these meta-analyses included trials containing adult patients, a phase II trial of induced hypothermia in pediatric traumatic brain injury has established its feasibility and safety in infants and children. As in adult patients, induced hypothermia for traumatic brain injury in children can be considered an optional therapy for refractory intracranial hypertension but should not be regarded as standard of care.