J Trauma
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High-frequency oscillatory ventilation (HFOV) may be used as a rescue therapy for adults with acute respiratory distress syndrome who have failed conventional ventilation (CV). We undertook a prospective study to investigate the determinants of mortality and the sequential evolution of organ failures in HFOV-treated adult acute respiratory distress syndrome patients. ⋯ Survivors had early improvements in OSF scores after HFOV application. Organ failure system scoring may be used for deciding on HFOV initiation and for evaluating the effects of HFOV.
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Comparative Study
Heating pad for the bleeding: external warming during hemorrhage improves survival.
Hypothermia is common during hemorrhagic shock. To warm the victims or not has been controversial. This study aims to investigate the effect of warming during the initial time of hemorrhage on body temperature, blood pressure, and survival in rat hemorrhagic shock models. ⋯ Warming during hemorrhage may prevent exacerbation of hypothermia and hypotension and therefore improve survival.
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Percutaneous tracheostomy is a routine procedure in the intensive care unit (ICU). Some surgeons perform percutaneous tracheostomies using bronchoscopy believing that it increases safety. The purpose of this study was to evaluate percutaneous tracheostomy in the trauma population and to determine whether the use of a bronchoscope decreases the complication rate and improves safety. ⋯ Percutaneous tracheostomy was safely and effectively performed by an experienced surgical team both with and without bronchoscopic guidance with no difference in the complication rates. This study suggests that the use of bronchoscopic guidance during tracheostomy is not routinely required but may be used as an important adjunct in selected patients, such as those with HALO cervical fixation, obesity, or difficult anatomy.
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To evaluate the outcome and highlight the operative tips of using the reverse posterior interosseous artery (PIA) flap in the treatment of severe contractures of the first web space. ⋯ The reverse PIA flap is suited for defect cover in the treatment of severe contractures of the first web space. A usual pitfall using the reverse PIA flap is that the skin paddle is inadvertently outlined over the proximal 1 of 3 forearm to increase its distal reach, which usually leads to postoperative venous congestion. However, if the distal flap pole is placed at or distal to the midpoint from the lateral epicondyle to the radial side of the ulnar head, choosing the proximal 1 of 2 forearm as the donor site of the skin paddle to increase its distal reach is reliable.