J Trauma
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The diagnosis of acute lung injury (ALI) is based on a consensus clinical definition. Despite the simplicity of this definition, ALI remains underdiagnosed and undertreated. Severe trauma is a well-described cause of ALI that represents a relatively homogeneous subset of patients with ALI. The aims of this study were to develop a panel of plasma biomarkers to facilitate diagnosis of trauma-induced ALI and to enhance our understanding of the pathogenesis of human ALI. ⋯ A model using seven plasma biomarkers had a high diagnostic accuracy in differentiating patients with trauma-induced ALI from trauma patients without ALI. In addition, use of a panel of biomarkers provides insight into the likely importance of alveolar epithelial injury in the pathogenesis of early ALI.
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Published experience of hypertonic saline (HTS) use in resuscitation has described the use of commercially unavailable 7.5% solutions. The purpose of this study was to compare our experience with the administration of commercially available 5% HTS solution with that of well-matched controls who did not receive HTS. ⋯ Although serum sodium remained increased for several days after HTS administration, no adverse sequelae as a result of hypernatremia resulted. Commercially available 5% HTS solution is safe for use in the resuscitation of trauma patients and may improve outcomes in a selected subset of patients with head injury.
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Traumatic brain injury (TBI) causes gastrointestinal dysfunction and increased intestinal permeability. Regulation of the gut barrier may involve the central nervous system. We hypothesize that vagal nerve stimulation prevents an increase in intestinal permeability after TBI. ⋯ In a mouse model of TBI, vagal stimulation prevented TBI-induced intestinal permeability. Furthermore, vagal stimulation increased enteric glial activity and may represent the pathway for central nervous system regulation of intestinal permeability.