The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Mar 2014
Multicenter StudyHemostatic resuscitation is neither hemostatic nor resuscitative in trauma hemorrhage.
Trauma hemorrhage continues to carry a high mortality rate despite changes in modern practice. Traditional approaches to the massively bleeding patient have been shown to result in persistent coagulopathy, bleeding, and poor outcomes. Hemostatic (or damage control) resuscitation developed from the discovery of acute traumatic coagulopathy and increased recognition of the negative consequences of dilutional coagulopathy. These strategies concentrate on early delivery of coagulation therapy combined with permissive hypotension. The efficacy of hemostatic resuscitation in correcting coagulopathy and restoring tissue perfusion during acute hemorrhage has not been studied. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Mar 2014
Multicenter StudyTemporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal.
While the incidence of postinjury multiple-organ failure (MOF) has declined during the past decade, temporal trends of its morbidity, mortality, presentation patterns, and health care resources use have been inconsistent. The purpose of this study was to describe the evolving epidemiology of postinjury MOF from 2003 to 2010 in multiple trauma centers sharing standard treatment protocols. ⋯ Epidemiologic study, level III.
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J Trauma Acute Care Surg · Feb 2014
Multicenter StudyMulticenter review of diaphragm pacing in spinal cord injury: successful not only in weaning from ventilators but also in bridging to independent respiration.
Ventilator-dependent spinal cord-injured (SCI) patients require significant resources related to ventilator dependence. Diaphragm pacing (DP) has been shown to successfully replace mechanical ventilators for chronic ventilator-dependent tetraplegics. Early use of DP following SCI has not been described. Here, we report our multicenter review experience with the use of DP in the initial hospitalization after SCI. ⋯ Therapeutic study, level V.
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J Trauma Acute Care Surg · Feb 2014
Multicenter StudyGunshot wounds and blast injuries to the face are associated with significant morbidity and mortality: results of an 11-year multi-institutional study of 720 patients.
Gunshot wounds and blast injuries to the face (GSWBIFs) produce complex wounds requiring management by multiple surgical specialties. Previous work is limited to single institution reports with little information on processes of care or outcome. We sought to determine those factors associated with hospital complications and mortality. ⋯ Therapeutic/care management, level III.
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J Trauma Acute Care Surg · Jan 2014
Multicenter StudyDetermining optimal threshold for glucose control in organ donors after neurologic determination of death: a United Network for Organ Sharing Region 5 Donor Management Goals Workgroup prospective analysis.
The appropriate level of glucose control in organ donors after neurologic determination of death (DNDD) remains uncertain. We hypothesized that a glucose target of 180 mg/dL would be appropriate for optimizing organ transplantation rates and outcomes. ⋯ Therapeutic study, level II.