J Trauma
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Multicenter Study
Blunt traumatic thoracic aortic injuries: early or delayed repair--results of an American Association for the Surgery of Trauma prospective study.
The traditional approach to stable blunt thoracic aortic injuries (TAI) is immediate repair, with delayed repair reserved for patients with major associated injuries. In recent years, there has been a trend toward delayed repair, even in low-risk patients. This study evaluates the current practices in the surgical community regarding the timing of aortic repair and its effects on outcomes. ⋯ Delayed repair of stable blunt TAI is associated with improved survival, irrespective of the presence or not of major associated injuries. However, delayed repair is associated with a longer length of ICU stay and in the group of patients with no major associated injuries a significantly higher complication rate.
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Multicenter Study
Outcome after injury: memories, health-related quality of life, anxiety, and symptoms of depression after intensive care.
To examine the relationship between delusional memories from the Intensive Care Unit (ICU) stay, health related quality of life (HRQoL), anxiety, and symptoms of depression in patients with physical trauma, 6 months to 18 months after their ICU stay. ⋯ Our results highlight the importance of treating the delusional memories experienced by ICU patients with a trauma diagnosis as a postinjury factor with a potential to create anxiety and symptoms of depression and which may affect HRQoL after discharge.
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Multicenter Study Comparative Study
Warm fresh whole blood is independently associated with improved survival for patients with combat-related traumatic injuries.
Increased understanding of the pathophysiology of the acute coagulopathy of trauma has lead many to question the current transfusion approach to hemorrhagic shock. We hypothesized that warm fresh whole blood (WFWB) transfusion would be associated with improved survival in patients with trauma compared with those transfused only stored component therapy (CT). ⋯ In patients with trauma with hemorrhagic shock, resuscitation strategies that include WFWB may improve 30-day survival, and may be a result of less anticoagulants and additives with WFWB use in this population.
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Forward Surgical Teams (FST) provide forward deployed surgical care within the battle space. The next level of care in theater, the Combat Support Hospitals (CSH), are distinguished from the FST by advanced resource capabilities including more complex diagnostic imaging, laboratory support with blood banking, and intensive care units. This study was intended to assess the effect of FST capability on the outcome of seriously injured casualties in comparison to the CSH. ⋯ The disparity between the availability of the highest level of injury care and the ability to care for injury as soon as possible is an issue of central importance to both the civilian and military trauma care communities. Our analysis demonstrates that despite the operational and logistic challenges that burden the FST, this level of surgical care confers equivalent battlefield injury outcome results compared with the CSH.
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Randomized Controlled Trial Comparative Study
Prospective, randomized comparison of continuous thoracic epidural and thoracic paravertebral infusion in patients with unilateral multiple fractured ribs--a pilot study.
Thoracic epidural analgesia (TEA), a commonly used analgesic technique in patients with multiple fractured ribs, is technically demanding and associated with certain side effects or complications. Thoracic paravertebral block (TPVB) is a simple and effective method of providing continuous pain relief in these patients. However, it has never been compared with TEA in terms of efficacy and outcome in patients with fractured ribs. ⋯ Continuous bupivacaine infusion through TPVB is as effective as through TEA for pain management in patients with unilateral fractured ribs and the outcome after two techniques is comparable.