J Trauma
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Using an arbitrary day cutoff or clinical signs to decide the duration of antibiotic therapy for ventilator-associated pneumonia (VAP) may be suboptimal for some patients. We sought to determine whether antibiotic duration for VAP can be safely abbreviated in trauma patients using repeat bronchoalveolar lavage (BAL). ⋯ Repeat BAL decreased the duration of antibiotic therapy for VAP in trauma patients. More adequately powered investigations are needed to appropriately determine the effects of this strategy on patient outcome.
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Inferior vena cava (IVC) diameter immediately after fluid resuscitation has not yet been investigated in trauma patients with shock on arrival. ⋯ In trauma patients, inadequate dilatation of the IVC by fluid resuscitation, might indicate insufficient circulating blood volume despite normalization of blood pressure. In this small study, IVC diameter appeared a better predictor of recurrence of shock than blood pressure, heart rate, or arterial base excess. A larger prospective study is called for to clearly establish the sensitivity and specificity of this method.
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Hip fractures are primarily a disease of the elderly. Advanced age and associated comorbidities in this patient population can lead to adverse outcomes. We routinely admit our hip fracture patients to the Trauma Service (TS). The goal of this study is to see if this policy has had a positive impact on patient outcome. ⋯ Our policy of admitting elderly hip fracture patients to the TS has resulted in a mortality and LOS among the lowest reported in the literature. This data suggest that there is a clear benefit to admitting elderly hip fractures to the TS.
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The objective of this study was to analyze the preventable and potentially preventable deaths occurring at a mature Level I trauma center. ⋯ Preventable or potentially preventable deaths are rare but do occur at an academic Level I trauma center. Delay in treatment and error in judgment are the leading causes of preventable and potentially preventable deaths.
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The intestinal epithelial cell modulates the effect of alcohol on neutrophil inflammatory potential.
Ethanol (EtOH) intoxication increases posttraumatic infectious complications. EtOH is thought to be immunosuppressive, but the effect of the interaction with the gut and associated microflora on host defense is unknown. We studied the ability of intestinal epithelial cells and bacteria to modulate EtOH effects on polymorphonuclear (PMN) cell function in vitro. ⋯ EtOH direct downregulates PMN inflammatory potential, but its impact of the intestinal epithelial cells produces a proinflammatory microenvironment for PMNs. The interaction of EtOH on the intestinal milieu may lead to neutrophil activation and increased organ injury after trauma in the intoxicated patient.