J Trauma
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Multicenter Study
Anemia and blood transfusion in trauma patients admitted to the intensive care unit.
Anemia is a common occurrence in the intensive care unit (ICU). Although resuscitation, including the use of blood, is a mainstay of early treatment of trauma victims, the safety and efficacy of red blood cell (RBC) transfusion has come under scrutiny recently. The issue of blood use in critically injured patients requires evaluation. ⋯ Anemia is common in critically injured trauma patients and persists throughout the duration of critical illness. These patients receive a large number of RBC transfusions during their ICU course with aged blood.
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Lung protective ventilatory strategies using low tidal volume and high positive end-expiratory pressure (PEEP) have become standard practice. Such strategies, however, may invalidate measurement of lung injury severity by traditional methods that are based on plain chest radiograph findings, oxygenation, minute ventilation, lung compliance, and PEEP level, such as the Murray lung injury score (LIS). Many of these criteria are potentially therapy dependent and may change with different ventilatory strategies. The purpose of this study was to determine whether measurement of lung injury severity based simply on oxygenation criteria (PaO(2)/FIO(2)) was as accurate as the Murray LIS currently used in multiple organ failure (MOF) scoring. ⋯ The P/F score is a simple method of quantifying lung injury severity in trauma patients that better predicts mortality compared with the more complicated modified Murray lung injury score currently in use. The P/F score should replace more complex and potentially therapy-dependent scores.
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Little data are available regarding the impact that prolonged prophylactic antibiotic use (>48 hours) has on the development of nosocomial pneumonia. This retrospective study was conducted to assess the effect that prolonged prophylactic antibiotic use has on the development of nosocomial pneumonia and antibiotic use complications. ⋯ Justification for the use and duration of prolonged (>48 hours) prophylactic antibiotics requires careful reevaluation because this practice is associated with significant clinical complications that lead to increased use of patient resources, lengthened hospital stay, and higher cost.
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Comparative Study
The utility of the pelvic radiograph in the assessment of pediatric pelvic fractures.
Computed tomographic (CT) scanning is sensitive in detecting pelvic fractures in the pediatric patient. Pelvic fractures in the pediatric population rarely require emergent intervention, thus providing time to obtain the optimal imaging study. The objective of this study was to compare pelvic radiographs and abdominal pelvic CT scans of all pediatric trauma patients with pelvic injury to determine the role of pelvic imaging in the immediate trauma resuscitation. ⋯ The pelvic radiograph lacked the sensitivity of the pelvic CT scan for detecting pelvic fractures in all anatomic areas evaluated. Pelvic CT scan also offers additional information regarding soft tissue injury not available on most pelvic radiographs. In the trauma patient that will undergo abdominopelvic CT scanning as part of the trauma evaluation, a pelvic radiograph may be superfluous. Screening pelvic radiography should be reserved for the rare unstable patient or the patient in whom an abdominopelvic CT scan is not otherwise indicated.