The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jan 2017
Mitochondrial DNA damage associated molecular patterns in ventilator-associated pneumonia: Prevention and reversal by intratracheal DNase I.
Previous studies in isolated perfused rat lungs have revealed that endothelial barrier disruption after intratracheal administration of Pseudomonas aeruginosa (strain 103; PA103) only occurs after accumulation of extracellular mitochondrial DNA (mtDNA) damage-associated molecular patterns (DAMPs) in the perfusate and is suppressed by addition of DNase to the perfusion medium. Herein, we tested the hypothesis that intratracheal DNase-a route of administration readily translatable to patient with ventilator-associated pneumonia (VAP)-also enhances degradation of mtDNA and prevents bacteria-induced lung injury. ⋯ These findings in isolated perfused rat lungs and a cohort of severely injured patients reveal an association between bacterial pneumonia and accumulation of mtDNA DAMPs in the lung and serum. Furthermore, administration of intratracheal DNase I prevented and reversed pulmonary endothelial dysfunction evoked by PA103.
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J Trauma Acute Care Surg · Jan 2017
ReviewExtracorporeal membrane oxygenation for adult respiratory distress syndrome in trauma patients: A case series and systematic literature review.
Venovenous extracorporeal membrane oxygenation (vv-ECMO) is an established salvage therapy for severe respiratory failure, and may provide an alternative form of treatment for trauma-induced adult respiratory distress syndrome (ARDS) when conventional treatments have failed. The need for systemic anticoagulation is a relative contraindication for patients with bleeding risks, especially in multitraumatic injury. ⋯ Therapeutic study, level V.
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J Trauma Acute Care Surg · Jan 2017
Comparative StudySarcopenia as a predictor of mortality in elderly blunt trauma patients: Comparing the masseter to the psoas using computed tomography.
Sarcopenia, or age-related loss of muscle mass, is measurable by computed tomography (CT). In elderly trauma patients, increased mortality is associated with decreased psoas muscle cross-sectional area (P-Area) on abdominal CT. Fall is the leading cause of injury in the elderly, and head CT is more often obtained. Masseter muscle cross-sectional area (M-Area) is readily measured on head CT. Hypothesizing that M-Area is a satisfactory surrogate for P-Area, we compared the two as markers of sarcopenia and increased mortality in elderly trauma patients. ⋯ Prognostic study, level III.
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J Trauma Acute Care Surg · Jan 2017
Observational StudyAbnormalities in fibrinolysis at the time of admission are associated with deep vein thrombosis, mortality, and disability in a pediatric trauma population.
Abnormalities in fibrinolysis are common and associated with increased mortality in injured adults. While hyperfibrinolysis (HF) and fibrinolysis shutdown (SD) are potential prognostic indicators and treatment targets in adults, these derangements are not well described in a pediatric trauma cohort. ⋯ Prognostic and epidemiologic study, level III.
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J Trauma Acute Care Surg · Jan 2017
Volumetric analysis of day of injury computed tomography is associated with rehabilitation outcomes after traumatic brain injury.
Day-of-injury (DOI) brain lesion volumes in traumatic brain injury (TBI) patients are rarely used to predict long-term outcomes in the acute setting. The purpose of this study was to investigate the relationship between acute brain injury lesion volume and rehabilitation outcomes in patients with TBI at a level one trauma center. ⋯ Prognostic/epidemiologic study, level V.