The journal of trauma and acute care surgery
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J Trauma Acute Care Surg · Jul 2014
Randomized Controlled TrialEarly propranolol administration to severely injured patients can improve bone marrow dysfunction.
Bone marrow (BM) dysfunction is common in severely injured trauma patients, resulting from elevated catecholamines and plasma granulocyte colony-stimulating factor (G-CSF) as well as prolonged mobilization of hematopoietic progenitor cells (HPCs). We have previously shown that propranolol (β-blocker [BB]) reduces HPC mobilization in a rodent model of injury and hemorrhagic shock. We hypothesize that BB would prevent BM dysfunction in humans following severe injury. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Jun 2014
Randomized Controlled Trial Multicenter StudyDo all trauma patients benefit from tranexamic acid?
This study tested the hypothesis that early routine use of tranexamic acid (TXA) reduces mortality in a subset of the most critically injured trauma intensive care unit patients. ⋯ Therapeutic study, level IV.
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J Trauma Acute Care Surg · Jun 2014
Randomized Controlled Trial Multicenter StudyCritical illness-related corticosteroid insufficiency after multiple traumas: a multicenter, prospective cohort study.
Given that the observed prevalence and time course of critical illness-related corticosteroid insufficiency (CIRCI) remain inconsistent in trauma patients, the present study was designed to investigate the prevalence, time course, and effect of CIRCI on the outcome of critically ill patients with multiple injuries. ⋯ Prognostic study, level II.
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J Trauma Acute Care Surg · Apr 2014
Randomized Controlled Trial Comparative StudyThromboelastogram-guided enoxaparin dosing does not confer protection from deep venous thrombosis: a randomized controlled pilot trial.
The incidence of deep venous thrombosis (DVT) remains high in general surgery and trauma patients despite widespread prophylaxis with enoxaparin. A recent study demonstrated decreased incidence of DVT if patients on enoxaparin had a change in R time (ΔR) of greater than 1 minute when heparinase-activated thromboelastography (TEG) was compared with normal TEG. We hypothesized that using ΔR-guided dosing would result in decreased DVT rates. ⋯ Therapeutic study, level III.
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J Trauma Acute Care Surg · Apr 2014
Randomized Controlled Trial Comparative StudyColloid with high fresh frozen plasma/red blood cell resuscitation does not reduce postoperative fluid needs.
Recent data suggest that intraoperative (Phase I) colloid (human serum albumin [HSA]) and a high fresh frozen plasma (FFP)/red blood cell (RBC) resuscitation will reduce postoperative (Phase II) fluid uptake. This study compares a noncolloid (balanced electrolyte solution [BES]) plus low (≤ 0.35) FFP/RBC resuscitation (Group A) with an HSA plus high (>0.35) FFP/RBC resuscitation. ⋯ Therapeutic study, level IV.