The Journal of surgical research
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Percutaneous stabilization using three-dimensional (3D) navigation system is a promising treatment for pelvic and acetabular fractures. However, there are still some controversies regarding the use of 3D navigation to treat pelvic and acetabular fractures. The purpose of this study was to compare the Iso-C(3D) fluoroscopic navigation, standard fluoroscopy, and two-dimensional (2D) fluoroscopic navigation in placing percutaneous lag screws in pelvic specimens to better understand the merits of 3D navigation techniques. ⋯ In the present study, we compared Iso-C(3D) fluoroscopic navigation, 2D fluoroscopic navigation, and standard fluoroscopy. Iso-C(3D) fluoroscopic navigation showed a higher accuracy rate in positioning and a shorter instrumentation operating time. The fluoroscopic time was longer in Iso-C(3D) fluoroscopic navigation than that in standard fluoroscopy, indicating that radiation exposure can be moderately reduced in Iso-C(3D) fluoroscopic navigation operation, although the fluoroscopic time was the shortest in 2D fluoroscopic navigation.
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Randomized Controlled Trial Comparative Study
Long-term patient perception of pain control experience after participating in a trial between patient-controlled analgesia and epidural after pectus excavatum repair with bar placement.
Pain control is the dominant management issue after bar placement for pectus excavatum. We previously conducted a prospective, randomized trial comparing patient-controlled analgesia (PCA) to thoracic epidural (EPI) documenting similar objective outcomes. Our impression is that the subjective cognitive experience differs between the groups, which impacts trial results interpretation. Therefore, we conducted a survey to ascertain patient recollection and impression of their experience. ⋯ Long-term recall after repair of pectus excavatum with bar placement does not substantially differ between those managed with an epidural or PCA.
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Randomized Controlled Trial
Pulmonary acute respiratory distress syndrome: positive end-expiratory pressure titration needs stress index.
The heterogeneity of lung injury in pulmonary acute respiratory distress syndrome (ARDS) may have contributed to the greater response of hyperinflated area with positive end-expiratory pressure (PEEP). PEEP titrated by stress index can reduce the risk of alveolar hyperinflation in patients with pulmonary ARDS. The authors sought to investigate the effects of PEEP titrated by stress index on lung recruitment and protection after recruitment maneuver (RM) in pulmonary ARDS patients. ⋯ PEEP titration by stress index might be more beneficial for pulmonary ARDS patients after RM.
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We evaluated the effect of incomplete revascularization (IR) on the long-term outcomes after off-pump coronary artery bypass grafting. ⋯ CR in off-pump coronary artery bypass grafting was related to superior cardiac survival after 5 years of follow-up compared with IR. The benefit of CR was more distinct in those with a low LVEF. CR should be achieved whenever possible, especially in patients with a low LVEF.
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Comparative Study
Initial assessment on the impact of crystalloids versus colloids during damage control resuscitation.
High ratios of fresh frozen plasma:packed red blood cells in damage control resuscitation (DCR) are associated with increased survival. The impact of volume and type of resuscitative fluid used during high ratio transfusion has not been analyzed. We hypothesize a difference in outcomes based on the type and quantity of resuscitative fluid used in patients that received high ratio DCR. ⋯ During high ratio DCR, resuscitation with higher volumes of crystalloids was associated with an overall decreased survival, whereas low volumes of colloid use were associated with increased survival. In order to improve outcomes without diluting the survival benefit of hemostatic resuscitation, guidelines should focus on effective low volume resuscitation when high ratio DCR is used. A multi-institutional analysis is needed in order to validate these results.