The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Oct 2012
ReviewThe immune response to surgery and trauma: Implications for treatment.
Infection after surgery and trauma is a major cause of increased morbidity, mortality, and cost. Alterations of the hosts immune system following these insults is believed to be responsible for the increased risk of infection. The hosts' immune response to tissue injury is widely believed to follow a bimodal response, with the systemic inflammatory response syndrome (SIRS) followed by the compensated anti-inflammatory response syndrome (CARS). Recent data, however, suggests that his paradigm may not be correct. ⋯ Tissue injury following surgery and trauma results in depressed CMI leading to an increased risk of infections. The peri-operative use of IMDs appear to reverse this immunosuppression and decrease the risk of postoperative complications. While β-adrenoreceptor blockage may be beneficial in these patients, particularly when combined with a IMD, additional research is required.
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J Trauma Acute Care Surg · Oct 2012
Comparative StudyThe association of early transfusion with acute lung injury in patients with severe injury.
Packed red blood cell (PRBC) transfusion is associated with acute lung injury (ALI) development after trauma, but this risk may not be constant through time after trauma. We hypothesized that the relationship between PRBC delivery and ALI risk varies through time after injury. ⋯ Prognostic/epidemiologic study, level II.
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J Trauma Acute Care Surg · Oct 2012
ReviewPhysiopathology of anemia and transfusion thresholds in isolated head injury.
Blood transfusion strategies among patients with critical illness use a restrictive hemoglobin threshold. However, among patients with head injury, no outcome differences have been shown between either liberal or restrictive strategies. Several studies and literature reviews suggest that anemia is associated with markers of tissue ischemia. The paucity of prospective data confuses the association between surrogates of tissue ischemia and neurological outcome. ⋯ The generalization of transfusion triggers is common practice. Evidence-based approaches to transfusions strategies in head injury are lacking and not based on an understanding of cerebral physiopathology.
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J Trauma Acute Care Surg · Oct 2012
Comparative StudyNew swine model of infected soft tissue blast injury.
War injuries, especially blast injuries, have a high risk of infection. However, no animal models of infected war injuries have been built in large animals, which retards both the understanding and the treatment optimization of infected war injuries. ⋯ The infected soft tissue blast injury wounds mimic those in human, and they can be used to address key points of treatment optimization.
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J Trauma Acute Care Surg · Oct 2012
Comparative StudyManagement of pediatric blunt splenic injury at a rural trauma center.
Patterns for nonoperative management of pediatric blunt splenic injuries (BSIs) vary significantly within and between institutions. The indications for repeated imaging, duration of activity restrictions, as well as the impact of volume and type of trauma center (pediatric vs. adult) on outcomes remain unclear. ⋯ Therapeutic/epidemiologic study, level IV.