J Trauma
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The purpose of this study was to determine whether admission non-computed tomography (CT) criteria can exclude intra-abdominal injury in stable patients sustaining blunt abdominal trauma. ⋯ After blunt abdominal trauma, admission non-CT criteria can at best identify 12% of patients without intra-abdominal injuries and 22% of patients without major injuries.
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Comparative Study
The rate of induction of hypothermic arrest determines the outcome in a Swine model of lethal hemorrhage.
Lethal injuries can be surgically repaired under asanguineous hypothermic condition (suspended animation) with excellent outcome. However, the optimal rate for the induction of hypothermic metabolic arrest following uncontrolled lethal hemorrhage (ULH) is unknown. ⋯ Hypothermic metabolic arrest can be used to maintain viability of key organs during repair of lethal injuries. Survival is influenced by the rate of cooling with the best outcome following rapid induction of hypothermia.
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After major burn injury, severe hemodynamic fluctuations occur in a relatively short time, requiring invasive hemodynamic monitoring. The noninvasive esophageal Doppler monitor offers an alternative to the pulmonary artery catheter. This study compares the cardiac output of the esophageal Doppler monitor with that of a pulmonary artery catheter during the large volume shifts seen in extensive early escharectomy. ⋯ For major burn patients undergoing early escharectomy, the esophageal Doppler monitor allows changes in hemodynamics to be followed, but does not accurately measure the absolute values of cardiac output.
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Serum elevations of interleukin-6 (IL-6) correlate with multiple organ dysfunction syndrome and mortality in critically injured trauma patients. Data from rodent models of controlled hemorrhage suggest that recombinant IL-6 (rIL-6) infusion protects tissue at risk for ischemia-reperfusion injury. Exogenous rIL-6 administered during shock appears to abrogate inflammation, providing a protective rather than a deleterious influence. In an examination of this paradox, the current study aimed to determine whether rIL-6 decreases inflammation in a clinically relevant large animal model of uncontrolled hemorrhagic shock, (UHS), and to investigate the mechanism of protection. ⋯ Exogenous rIL-6 blunts lung mRNA levels of the proinflammatory cytokine G-CSF. The administration of rIL-6 does not increase the local expression of IL-6 nor TNFalpha mRNA in the lung. Additionally, rIL-6 infusion does not appear to cause systemic toxicity.
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Massive fluid resuscitation often is required for patients with intraabdominal trauma. Subsequently, fascial closure is not always possible in this subset of patients. Under these circumstances, an initial step can be the use of a temporary abdominal closure method. The authors currently use a vacuum-assisted closure to manage the open abdomen for some of their trauma patients. They present their experience over the past 3 years. ⋯ Patients requiring temporary abdominal closure have a significant in-hospital mortality rate of 33%. Delayed primary closure with vacuum assistance was achieved for 71.9% of the surviving patients. Maintaining a negative or total positive fluid balance of less than 20 L before the last attempted fascial closure improves successful closure rates, as seen in 19 of 22 patients (86.4%). The vacuum-assisted closure technique also enabled successful primary closure for two patients with extreme delay (>8 days). Elevated serum lactate levels are significantly correlated with early and in-hospital mortality. A significant decrease in lactate level during the first 12 hours is associated with achievement of primary closure.