J Trauma
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Meta Analysis
Efficacy of hypertonic saline dextran fluid resuscitation for patients with hypotension from penetrating trauma.
The purpose of this study was to assess whether the administration of hypertonic saline dextran (HSD) was detrimental when administered to patients who were hypotensive because of penetrating injuries to the torso. The administration of HSD causes an immediate and sustained increase in blood pressure that could contribute to an increase in bleeding in the presence of uncontrolled hemorrhage. We prospectively designed a series of questions to be addressed by a meta-analysis of individual patient data using a computerized data file and case report forms from a multicenter study of HSD. ⋯ For patients with penetrating injuries to the torso that result in hypotension, initial fluid resuscitation with HSD is beneficial in improving survival, especially if surgery is subsequently required.
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Medical training in the Israel Defense Forces (IDF) is currently based on the principles of the Advanced Trauma Life Support course of the American College of Surgeons termed Military Trauma Life Support. The Advanced Trauma Life Support guidelines provide a systematic standardized approach to the treatment of trauma casualties that has been very successful in civilian trauma. On the battlefield, however, these guidelines have been modified according to the combat environment. ⋯ In uncontrolled hemorrhagic shock, where internal bleeding has temporarily stopped because of hypotension, vasoconstriction, and thrombus formation, aggressive fluid resuscitation with lactated Ringer's solution to achieve normal hemodynamic parameters is prohibited, because it may induce internal rebleeding and hemodynamic decompensation. When evacuation time exceeds 60 minutes, the use of crystalloids and colloids is indicated. If brain injury is suspected, fluid resuscitation should be aimed toward normalization of hemodynamic parameters.
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Meta Analysis
Allogeneic blood transfusion increases the risk of postoperative bacterial infection: a meta-analysis.
Immunosuppression is a consequence of allogeneic (homologous) blood transfusion (ABT) in humans and is associated with an increased risk in cancer recurrence rates after potentially curative surgery as well as an increase in the frequency of postoperative bacterial infections. Although a meta-analysis has been reported demonstrating the relationship between ABT and colon cancer recurrence, no meta-analysis has been reported demonstrating the relationship of ABT to postoperative bacterial infection. ⋯ These results demonstrate that ABT is an associated and apparently significant and frequently overlooked risk factor for the development of postoperative bacterial infection in the surgical patient. Allogeneic blood transfusion is a greater risk factor in the traumatically injured patient when compared with the elective surgical patient for the development of postoperative bacterial infection.
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Coagulopathy resulting from hydroxyethyl starch (HES) administration is well documented for high-molecular-weight, highly substituted HES solutions. These are the only starch-based synthetic colloids approved for volume replacement in the United States. Recent developments in European colloid solutions revolve around designing new starch molecules. ⋯ This solution is without significant influence on coagulation. Actual experimental work is concentrating on modulating the inflammatory response of monocytes and endothelial cells after infusion of colloid solutions. This may help prevent or even correct capillary leak, and the intravascular persistence of infused colloidal might be prolonged.