J Trauma
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Few previous studies have been conducted on the severe traumatic brain injury (sTBI)-associated coagulopathy in children. The purpose of this study was to evaluate the incidence and risk factors of sTBI coagulopathy in a pediatric cohort and to evaluate its impact on outcomes. ⋯ Incidence of coagulopathy in children suffering isolated sTBI is exceedingly high at 40% and reflect the head injury severity. A low GCS, increasing age, ISS ≥16 and intraparenchymal lesions proved to be independently associated with TBI coagulopathy.
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To examine the impact of an ongoing comprehensive performance improvement and patient safety (PIPS) program implemented in 2005 on mortality outcomes for trauma patients at an established American College of Surgeons (ACS)-verified Level I Trauma Center. ⋯ Implementation of a multifaceted trauma PIPS program aimed at improving trauma care significantly reduced in-hospital mortality in a mature ACS Level I trauma center. Optimal care of the injured patient requires uncompromising commitment to PIPS.
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Traumatic brain injury (TBI) accounts for the largest proportion of injury-related deaths and disability in the United States. The proportion of TBI-related deaths that occur after admission in a hospital remains high despite improvement in medical technology. We provide findings on the risk factors of in-hospital death and demonstrate the risk associated with sepsis occurring in the hospital environment. ⋯ Sepsis occurring in the hospital environment and associated with nosocomial etiologies is a strong risk factor for in-hospital death after TBI. Reducing the risk of infections and subsequent sepsis through adherence with infection control measures is a critical step to reduce in-hospital deaths among patients with TBI.
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Comparative Study
Erythropoietin improves skeletal muscle microcirculation through the activation of eNOS in a mouse sepsis model.
Sepsis and septic shock remain the major causes of morbidity and mortality in intensive care units. One mechanism that leads to organ failure is microcirculatory dysfunction. Erythropoietin (EPO) is a glycoprotein produced by the kidney that primarily regulates erythropoiesis, but it also can exert hemodynamic, anti-inflammatory, and tissue protective effects. We previously reported that administration of EPO to septic mice improves mouse skeletal muscle capillary perfusion and tissue bioenergetics. The objective of this study was to explore the potential mechanism(s) involved. ⋯ Our results suggest that eNOS plays an important role in mediating the beneficial effect of rHuEPO on microcirculation in this septic mouse model.