The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2012
Comparative StudyHost susceptibility to gram-negative pneumonia after lung contusion.
Lung contusion (LC) induces inflammation with high local concentrations of proinflammatory mediators stimulating chemotaxis and activation of neutrophils. LC is also a risk factor for development of pneumonia; however, the reason for this increased susceptibility is not clearly identified. We hypothesize that LC creates acute changes in the host pulmonary innate immune system that leads to vulnerability from a "second" hit bacterial infection. ⋯ Acute inflammation after LC acts to modulate the presence of inflammatory cells necessary to combat gram-negative bacteria. This results in decreased bacterial clearance and increased mortality from pneumonia.
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J Trauma Acute Care Surg · Mar 2012
Comparative StudyLessons learned from airway pressure release ventilation.
The aim of this article is to review a single institution's experience with airway pressure release ventilation (APRV) with respect to safety, complications, and efficacy at correcting hypercarbia and hypoxemia. ⋯ III.
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J Trauma Acute Care Surg · Mar 2012
Comparative StudySurgical management of acute odontoid fractures: surgery-related complications and long-term outcomes in a consecutive series of 97 patients.
The purpose of this study was to determine the incidence of surgery for odontoid fractures and to study surgical mortality, surgical morbidity, and long-term outcome in a large, contemporary, consecutive, single-institution, surgical series of odontoid fractures. ⋯ The annual incidence of open fixation of odontoid fractures was 0.45 per 100,000 inhabitants, and the incidence increased with age. The median age at time of surgery was 73.0 years, and the surgical mortality was 4%. Increased odds of nonbony fusion were observed in more displaced fractures and after anterior screw fixations. There were no significant differences between patients treated with anterior screw fixation versus posterior wiring with respect to neck pain, but patients fused with a posterior approach reported significantly more neck stiffness.
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J Trauma Acute Care Surg · Mar 2012
Comparative StudyThe use of temporary abdominal closure in low-risk trauma patients: helpful or harmful?
Temporary abdominal closure (TAC) has become a widely used technique in severely injured patients. However, there is growing concern that TAC is being overutilized. We sought to identify less severely injured patients who underwent TAC and to compare their outcomes with patients managed with a single-stage laparotomy (SSL). ⋯ : III, therapeutic study.