The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Aug 2013
Comparative Study"Fluidless" resuscitation with permissive hypotension via impedance threshold device therapy compared with normal saline resuscitation in a porcine model of severe hemorrhage.
One approach to improve outcomes after trauma and hemorrhage is to follow the principles of permissive hypotension by avoiding intravascular overpressure and thereby preventing dislodgement of platelet plugs early in the clotting process. We hypothesized that augmentation of negative intrathoracic pressure (nITP) by treatment with an impedance threshold device would improve hemodynamics without compromising permissive hypotension or causing hemodilution, whereas aggressive fluid resuscitation with normal saline (NS) would result in hemodilution and SBPs that are too high for permissive hypotension and capable of clot dislodgement. ⋯ In this porcine model of hemorrhagic shock, nITP therapy significantly improved SBP and pulse pressure for 30 minutes without overcompensation compared with controls with no treatment. By contrast, aggressive fluid resuscitation with NS but not nITP resulted in a significant rise in SBP to more than 100 mm Hg within minutes of initiating therapy that could cause a further reduction in hematocrit and clot dislodgment.
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J Trauma Acute Care Surg · Aug 2013
Use and complications of operative control of arterial inflow in combat casualties with traumatic lower-extremity amputations caused by improvised explosive devices.
Proximal traumatic lower-extremity amputation has become the signature injury of the war in Afghanistan. Casualties present in extremis and often require immediate operative control of arterial inflow to prevent exsanguination. This study evaluated the use of this strategy and its complications. ⋯ Epidemiologic study, level III; prognostic study, level IV.
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Recent innovations in care have improved survival following injury. Coincidentally, the population of elderly injured patients with preexisting comorbidities has increased. We hypothesized that this increase in elderly injured patients may have combined with recent care innovations to alter the causes of death after trauma. ⋯ Mortality caused by preexisting medical conditions has increased, while markedly fewer deaths resulted from the complications of injury. Future improvements in outcomes will require improvement in the management of elderly trauma patients with comorbid conditions.
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J Trauma Acute Care Surg · Aug 2013
Model-based prediction of autoregulatory exhaustion in response to lower-body negative pressure-induced shock.
We assessed the ability of a normalized autonomic nervous system (ANS) stress measure defined as an increase in the percentage of pulse rate from a baseline homeostasis state to identify corresponding changes in circulating blood volume to quantitatively recognize hypovolemia and predict subsequent autoregulatory exhaustion. Autoregulatory exhaustion is defined as the point where decreased circulatory volume exceeds the compensatory mechanism capacity to maintain flow and pressure. We derived frequency-based measures of pulse rate and pulse strength using a reflective pulse oximeter waveform of a photoplethysmograph placed on the forehead. ⋯ Results demonstrate the potential to use model-based measures to serve as a definitive presymptom predictive tool to recognize an impending hypovolemic condition, making this approach suitable for chronic care or for the management of hemodialysis patient where resting baseline measures can be obtained.
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J Trauma Acute Care Surg · Aug 2013
Return-to-duty rates among US military combat-related amputees in the global war on terror: job description matters.
The purpose of this study was to identify the differences seen between military occupation services (MOS) in terms of amputation patterns, subsequent disabling conditions, and their ability to return to duty. ⋯ All amputees, regardless of MOS, are not likely to return to active duty and especially unlikely to be found fit for duty, except for members of the USA SF. The reason(s) for the increased return to duty for USA SF personnel remains unknown but a lack of posttraumatic stress disorder may be a contributing factor.