J Trauma
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Review Case Reports
Traumatic thoracobiliary fistula: report of a case successfully managed conservatively, with an overview of current diagnostic and therapeutic options.
Thoracobiliary fistula is a rare complication of hepatic trauma that may present a diagnostic and therapeutic challenge. We report a case of a thoracobiliary fistula complicating thoracoabdominal trauma. ⋯ Conservative therapy consists of a safe temporizing measure during the workup and may, on occasion, be the only therapy that is necessary provided that controlled drainage of the fistula is achieved. The current recommendation would be the exhaustion of nonoperative therapeutic modalities before resorting to surgical intervention.
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More than 20 years ago, critical care workers first observed that oxygenation improved when patients with acute respiratory distress syndrome were ventilated in the prone position. In recent reports, on turning prone, from 50 to 100% of patients improve oxygenation to a degree sufficient to allow a reduction in the level of positive end-expiratory pressure or fraction of inspired oxygen. ⋯ Although many questions regarding the role of prone ventilation are unanswered, of greatest importance is whether this technique reduces morbidity and mortality of patients with acute respiratory failure. Only carefully conducted, randomized trials can answer this question.