The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2017
Multicenter StudyIncompatible type A plasma transfusion in patients requiring massive transfusion protocol: Outcomes of an Eastern Association for the Surgery of Trauma multicenter study.
With a relative shortage of type AB plasma, many centers have converted to type A plasma for resuscitation of patients whose blood type is unknown. The goal of this study is to determine outcomes for trauma patients who received incompatible plasma transfusions as part of a massive transfusion protocol (MTP).
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J Trauma Acute Care Surg · Jul 2017
Multicenter StudyRoutine inclusion of long-term functional and patient-reported outcomes into trauma registries: The FORTE project.
The National Academies of Sciences, Engineering, and Medicine (formerly the Institute of Medicine) recently recommended inclusion of postdischarge health-related quality of life (HRQoL) and patient-reported outcomes (PROs) metrics to benchmark the quality of trauma care. Currently, these measures are not routinely collected at most trauma centers. We sought to determine the feasibility and value of adding such long-term outcome measures to trauma registries. ⋯ Prognostic/epidemiologic, level II; Therapeutic, level III.
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J Trauma Acute Care Surg · Jul 2017
Clinical TrialThe effect of blood transfusion on compensatory reserve: A prospective clinical trial.
Bleeding activates the body's compensatory mechanisms, causing changes in vital signs to appear late in the course of progressive blood loss. These vital signs are maintained even when up to 30% to 40% of blood volume is lost. Laboratory tests such as hemoglobin, hematocrit, lactate, and base deficit levels do not change during acute phase of bleeding. The compensatory reserve measurement (CRM) represents a new paradigm that measures the total of all physiological compensatory mechanisms, using noninvasive photoplethysmography to read changes in arterial waveforms. This study compared CRM to traditional vital signs and laboratory tests in actively bleeding patients. ⋯ Care management, level II.
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J Trauma Acute Care Surg · Jul 2017
Multicenter StudyLoop ileostomy versus total colectomy as surgical treatment for Clostridium difficile-associated disease: An Eastern Association for the Surgery of Trauma multicenter trial.
The mortality of patients with Clostridium difficile-associated disease (CDAD) requiring surgery continues to be very high. Loop ileostomy (LI) was introduced as an alternative procedure to total colectomy (TC) for CDAD by a single-center study. To date, no reproducible results have been published. The objective of this study was to compare these two procedures in a multicentric approach to help the surgeon decide what procedure is best suited for the patient in need. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jul 2017
Incremental balloon deflation following complete resuscitative endovascular balloon occlusion of the aorta results in steep inflection of flow and rapid reperfusion in a large animal model of hemorrhagic shock.
To avoid potential cardiovascular collapse after resuscitative endovascular balloon occlusion of the aorta (REBOA), current guidelines recommend methodically deflating the balloon for 5 minutes to gradually reperfuse distal tissue beds. However, anecdotal evidence suggests that this approach may still result in unpredictable aortic flow rates and hemodynamic instability. We sought to characterize aortic flow dynamics following REBOA as the balloon is deflated in accordance with current practice guidelines. ⋯ This study is the first to characterize aortic flow during balloon deflation following REBOA. A steep inflection point occurs during balloon deflation that results in an abrupt increase in aortic flow and a concomitant decrease in MAP. Furthermore, the onset of distal aortic flow was inconsistent across study animals and did not correlate with initial balloon volume or relative deflation volume. Future studies to define the factors that affect aortic flow during balloon deflation are needed to facilitate controlled reperfusion following REBOA.