J Trauma
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Recent reports have documented the rate of heterotopic ossification (HO) formation in the residual limbs of combat-related amputees from the US Armed Forces injured in Operations Iraqi and Enduring Freedom. Final amputation level within the zone of injury and blast as the mechanism of injury were identified as possible risk factors for the occurrence and grade of HO. There has been no previous description of HO in combat-related amputees from the UK service personnel. The purpose of this study was to examine potential differences in the prevalence of HO between UK and US Allied Forces, with particular attention to these risk factors, patient exposures, and any treatment differences between these two groups. ⋯ Although no difference was identified in the overall prevalence of HO, there are inconsistencies in the possible underlying causes of HO between the two cohorts. Further research is required in an ongoing effort to determine a causal relationship between treatment and subsequent HO formation.
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Trauma surgery is in constant evolution as is the use of damage control laparotomy (DCL). The purpose of this study was to report the change in usage of DCL over time and its effect on outcome. ⋯ The use of DCL was significantly decreased by 78% during the study with significantly improved outcome. The improved outcome and decreased resource utilization can reduce health care costs and charges. Although DCL may be a vital aspect of trauma surgery, it can be used more selectively with improved outcome.
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Comparative Study
Maximizing oxygen delivery during mechanical ventilation with a portable oxygen concentrator.
Transportation of the critically ill or injured war fighter requires the coordinated care and judicious use of resources. Availability of oxygen (O2) supplies for the mechanically ventilated patient is crucial. Size and weight of cylinders makes transport difficult and presents an increased risk of fire. A proposed solution is to use a portable oxygen concentrator (POC) for mechanical ventilation. We tested the SeQual Eclipse II POC paired with the Impact 754 and Pulmonetics LTV-1200 ventilators in the laboratory and evaluated the fraction of inspired oxygen (FIO2) across a range of minute volumes. ⋯ Oxygen is a finite resource, which is cumbersome to transport and may present a fire hazard. The relatively high FIO2 delivered by the POC makes this method of O2 delivery a viable alternative to O2 cylinders. However, patients requiring an FIO2 of 1.0 would require additional compressed oxygen. This system allows O2 delivery up to 76% solely using electricity. An integrated ventilator or POC capable of automatically compensating VT for POC output is desirable. Further patient testing needs to be done to validate these laboratory findings.
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As the population of the United States ages and as the healthcare system undergoes significant change, cost effectiveness of care will become more important, particularly for older injured patients. The purpose of this study was to evaluate the cost per 2-year survivor stratified by age after moderate- to severe-nonneurologic injury. ⋯ Although costs are similar by age at time of discharge, cost per 2-year survivor increases as age increases. However, cost per 2-year survivor does not exceed current cost-utility thresholds for any age group. Any future healthcare financing reforms should include aggressive funding for injury prevention efforts aimed at vulnerable populations instead of rationing care once an injury occurs.