J Trauma
-
Comparative Study
Risk factors for mortality in traumatic cervical spinal cord injury: Brazilian data.
Predictive factors for mortality are different among countries; knowledge of risk factors is important for planning strategies to reduce mortality in trauma. The objective of this study was to identify predictors of death in traumatic cervical spinal cord injury (TSCI) in Brazil. ⋯ GCS score <9, mechanical ventilation, and vasopressor use were predictors of mortality with TCSI, and if these risk factors were absent, we observed low mortality rate.
-
Comparative Study
Transfusion of aged packed red blood cells results in decreased tissue oxygenation in critically injured trauma patients.
Blood transfusion is a common event in the treatment of injured patients. The effect of red blood cell transfusion on tissue oxygenation is unclear. The transfusion of older blood has been shown to be detrimental in retrospective studies. This study aims to study the effect of the age of the blood transfused on the tissue oxygenation using near infrared spectroscopy. ⋯ There was a decrease in peripheral tissue oxygenation in patients receiving older red blood cells. There was no oxygenation decrease in patients receiving blood less than 21 days. This indicates that factors in stored blood may influence the peripheral vasculature and oxygen delivery.
-
Comparative Study
Pulmonary contusion primes systemic innate immunity responses.
Traumatic injury may result in an exaggerated response to subsequent immune stimuli such as nosocomial infection. This "second hit" phenomenon and molecular mechanism(s) of immune priming by traumatic lung injury, specifically, pulmonary contusion, remain unknown. We used an animal model of pulmonary contusion to determine whether the injury resulted in priming of the innate immune response and to test the hypothesis that resuscitation fluids could attenuate the primed response to a second hit. ⋯ Pulmonary contusion primes innate immunity for an exaggerated response to a second hit with the Toll-like receptor 4 agonist, LPS. We observed synergistic increases in inflammatory mediator expression in the blood and a more severe lung injury in injured animals challenged with LPS. This priming effect was reduced when HTS was used to resuscitate the animal after lung contusion.
-
Comparative Study
Tympanic membrane perforation after combat blast exposure in Iraq: a poor biomarker of primary blast injury.
The US military has reported over 10,000 improvised explosive device attacks attributing to over 400 deaths in Iraq in 2005. Otologic blast injury and tympanic membrane (TM) perforation have traditionally been used as a predictor, or biomarker, of serious or occult primary blast injury (PBI). Although combat injuries from the US-Iraq conflict have been described, the utility of TM perforation as a marker of PBI has not. The objective of this study is to determine the incidence of tympanic perforation in patients subject to blast exposures and describe its utility as a biomarker of more serious primary barotrauma, as observed at a US military hospital in Iraq. ⋯ Both TM perforation and PBI are rare with improvised explosive devices and other explosive devices in the current Iraqi-US conflict. Contrary to previous belief and management guidelines, TM perforation had low sensitivity for serious or occult PBI and was not a good biomarker. On the basis of the findings of this study, the absence of TM perforation does not appear to exclude other serious PBI.
-
Comparative Study
Transfusion and pneumonia in the trauma intensive care unit: an examination of the temporal relationship.
Transfusion has been demonstrated to be associated with pneumonia in injured patients, and blood of older storage age may potentiate this morbidity. It remains unclear, however, whether this association is causal, as prior studies have not accounted for prepneumonia versus postpneumonia transfusion. We sought to evaluate the temporal relationship between transfusion and pneumonia and the influence of blood age on this relationship. ⋯ Prior reports of an association between transfusion and pneumonia may reflect transfusions received after pneumonia rather than etiologically relevant transfusions received before the onset of pneumonia. Transfusion of exclusively older blood, however, increased the risk of pneumonia, further suggesting the importance of blood age with respect to outcomes in trauma patients.