J Trauma
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The significance of serial white blood cell (WBC) counts in trauma patients with a suspected hollow viscus injury (HVI) is unknown. The purpose of this study was to examine the role of serial WBC counts in the diagnosis of a HVI. ⋯ Multiple variables likely impact the WBC count in trauma patients. WBC count elevation on admission is nonspecific and does not predict the presence of a HVI. With serial measurements, WBC counts >or=20.0 are independently associated with a HVI, whereas counts
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The short-term efficacy and safety of percutaneous embolization for the treatment of hemodynamically unstable patients with grade 5 renal injuries secondary to blunt trauma has been previously established; however, there has been no published intermediate-term follow-up. The purpose of this study is to report intermediate-term follow-up and complications for this treatment modality. ⋯ Management of grade 5 renal injuries with percutaneous embolization is safe and is not associated with intermediate-term adverse events.
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Comparative Study
Cardiopulmonary effects of matching positive end-expiratory pressure to abdominal pressure in concomitant abdominal hypertension and acute lung injury.
To evaluate the cardiopulmonary effects of positive end-expiratory pressure (PEEP) equalization to intra-abdominal pressure (IAP) in an experimental model of intra-abdominal hypertension (IAH) and acute lung injury (ALI). ⋯ Simultaneous IAH and ALI produce important impairments in the respiratory physiology. PEEP equalization to AP may improve the respiratory performance, nevertheless with a secondary hemodynamic derangement.
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Emergent endotracheal intubation (ETI) is considered the standard of care for patients with severe traumatic brain injury (TBI). However, recent evidence suggests that the procedure may be associated with increased mortality, possibly reflecting inadequate training, suboptimal patient selection, or inappropriate ventilation. ⋯ Prehospital intubation seems to improve outcomes in more critically injured TBI patients. Air medical outcomes are better than predicted for both intubated and nonintubated TBI patients. Iatrogenic hyper- and hypoventilations are associated with worse outcomes.
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Delivery of Surgical Critical Care in the United States is facing multiple challenges including increasing complexity of care, escalating costs, shortage of well-trained physicians, and controversies about appropriate training and credentialing methods. In this position paper, the Surgical Critical Care Program Directors Society discusses some of these important issues and suggests a number of possible solutions.