Three-Dimensional Electrical Impedance Imaging During Spontaneous Breathing Trials in Patients With Acute Hypoxic Respiratory Failure: A Pilot Study.

The purpose of this work is to evaluate the feasibility of lung imaging using 3D electrical impedance tomography (EIT) during spontaneous breathing trials (SBTs) in patients with acute hypoxic respiratory failure. EIT is a noninvasive, nonionizing, real-time functional imaging technique, suitable for bedside monitoring in critically ill patients. EIT data were collected in 24 mechanically ventilated patients immediately preceding and during a SBT on two rows of 16 electrodes using a simultaneous multicurrent source EIT system for 3D imaging.

An Exploratory Analysis of Sociodemographic Factors Associated With Physical Functional Impairment in ICU Survivors.

Importance: Physical functional impairment is one of three components of postintensive care syndrome (PICS) that affects up to 60% of ICU survivors.

Objectives: To explore the prevalence of objective physical functional impairment among a diverse cohort of ICU survivors, both at discharge and longitudinally, and to highlight sociodemographic factors that might be associated with the presence of objective physical functional impairment.

Design, Setting, And Participants: This was a secondary analysis of 37 patients admitted to the ICU in New Orleans, Louisiana, and Denver, Colorado between 2016 and 2019 who survived with longitudinal follow-up data.

Prevalence of Alcohol Use Characterized by Phosphatidylethanol in Patients With Respiratory Failure Before and During the COVID-19 Pandemic.

Background: Alcohol misuse is overlooked frequently in hospitalized patients, but is common among patients with pneumonia and acute hypoxic respiratory failure. Investigations in hospitalized patients rely heavily on self-report surveys or chart abstraction, which lack sensitivity. Therefore, our understanding of the prevalence of alcohol misuse before and during the COVID-19 pandemic is limited.

Findings on Repeat Posttraumatic Brain Computed Tomography Scans in Older Patients With Minimal Head Trauma and the Impact of Existing Antithrombotic Use.

Study Objective: Evaluate the utility of routine rescanning of older, mild head trauma patients with an initial negative brain computed tomography (CT), who is on a preinjury antithrombotic (AT) agent by assessing the rate of delayed intracranial hemorrhage (dICH), need for surgery, and attributable mortality.

Methods: Participating centers were trained and provided data collection instruments per institutional review board-approved protocols. Data were obtained from manual chart review and electronic medical record download.

The epidemiology of do-not-resuscitate orders in patients with trauma: a community level one trauma center observational experience.

Background: Do-Not-Resuscitate (DNR) orders in patients with traumatic injury are insufficiently described. The objective is to describe the epidemiology and outcomes of DNR orders in trauma patients.

Methods: We included all adults with trauma to a community Level I Trauma Center over 6 years (2008-2013).

Association between a geriatric trauma resuscitation protocol using venous lactate measurements and early trauma surgeon involvement and mortality risk.

Objectives: To investigate whether implementing a geriatric resuscitation protocol that uses lactate-guided therapy with early trauma surgeon involvement is associated with lower mortality through the early recognition of occult hypoperfusion (OH).

Design: Prospective cohort study.

Setting: Level I trauma center.

Unintentional discontinuation of statins may increase mortality after traumatic brain injury in elderly patients: a preliminary observation.

Background: The abrupt discontinuation of statin therapy has been suggested as being deleterious to patient outcomes. Although pre-injury statin (PIS) therapy has been shown to have a protective effect in elderly trauma patients, no study has examined how this population is affected by its abrupt discontinuation. This study examined the effects of in-hospital statin discontinuation on patient outcomes in elderly traumatic brain injury (TBI) patients.

A retrospective analysis of geriatric trauma patients: venous lactate is a better predictor of mortality than traditional vital signs.

Background: Traditional vital signs (TVS), including systolic blood pressure (SBP), heart rate (HR) and their composite, the shock index, may be poor prognostic indicators in geriatric trauma patients. The purpose of this study is to determine whether lactate predicts mortality better than TVS.

Methods: We studied a large cohort of trauma patients age ≥ 65 years admitted to a level 1 trauma center from 2009-01-01 - 2011-12-31.

Injury severity and serum amyloid A correlate with plasma oxidation-reduction potential in multi-trauma patients: a retrospective analysis.

Background: In critical injury, the occurrence of increased oxidative stress or a reduced antioxidant status has been observed. The purpose of this study was to correlate the degree of oxidative stress, by measuring the oxidation-reduction potential (ORP) of plasma in the critically injured, with injury severity and serum amyloid A (SAA) levels.

Methods: A total of 140 subjects were included in this retrospective study comprising 3 groups: healthy volunteers (N = 21), mild to moderate trauma (ISS < 16, N = 41), and severe trauma (ISS >or= 16, N = 78).

Implementation of a rapid response team decreases cardiac arrest outside of the intensive care unit.

Background: Patient safety and preventable inhospital mortality remain crucial aspects of optimum medical care and continue to receive public scrutiny. Signs of physiologic instability often precede overt clinical deterioration in many patients. The purpose of this study was to evaluate our early experience with implementation of a rapid response team (RRT) which would evaluate and treat nonintensive care unit (nonICU) patients with early signs of physiologic instability.

Nonoperative management of acute epidural hematomas: a "no-brainer".

Background: Acute epidural hematomas are generally considered to require urgent operation for clot evacuation and bleeding control. It has become increasingly apparent, however, that many epidural hematomas will resolve with nonoperative management. The purpose of the current study was to review our experience with nonoperative management of acute epidural hematomas.

Age of blood: does it make a difference?

During the past 20 years, the perceived value of blood transfusions has changed as it has become appreciated that transfusions are not without risk. Red blood cell transfusion has been associated with disease transmission and immunosuppression for some time. More recently, proinflammatory consequences of red blood cell transfusion have also been documented.

Lung injury severity scoring in the era of lung protective mechanical ventilation: the PaO2/FIO2 ratio.

Background: Lung protective ventilatory strategies using low tidal volume and high positive end-expiratory pressure (PEEP) have become standard practice. Such strategies, however, may invalidate measurement of lung injury severity by traditional methods that are based on plain chest radiograph findings, oxygenation, minute ventilation, lung compliance, and PEEP level, such as the Murray lung injury score (LIS). Many of these criteria are potentially therapy dependent and may change with different ventilatory strategies.

General surgery residents improve efficiency but not outcome of trauma care.

Background: Current American College of Surgeons Level I trauma center verification requires the presence of a residency program in which trauma care is an integral part of the training. The rationale for this requirement remains unclear, with no scientific evidence that resident participation improves the quality of trauma care. The purpose of this study was to determine whether quality or efficiency of trauma care is influenced by general surgery residents.

The role of temporary inferior vena cava filters in critically ill surgical patients.

Hypothesis: Prophylactic temporary inferior vena cava (IVC) filters are safe and effective in critically ill patients at high risk for venous thromboembolism.

Design: Prospective cohort study.

Setting: Urban level I trauma center.

The adrenal response after severe trauma.

Background: The integrity of the hypothalamic-pituitary-adrenal axis is a major determinant of the host response to stress. Relative adrenal insufficiency has been implicated in poor outcome from systemic inflammatory states; however, whether low endogenous glucocorticoid levels are adaptive or pathologic remains controversial. The purpose of this study was to prospectively evaluate the cortisol response and determine the incidence of occult adrenal insufficiency after severe trauma.

The injured child is resistant to multiple organ failure: a different inflammatory response?

Background: Although postinjury multiple organ failure (MOF) is a well-described phenomenon in adults, the incidence of this syndrome in children is unknown. The purpose of this study was to describe the incidence, course, and severity of pediatric postinjury MOF. We hypothesized that the incidence and severity of postinjury MOF in children would be less when compared with adults.

Lung-sparing techniques are associated with improved outcome compared with anatomic resection for severe lung injuries.

Background: Pulmonary tractotomy was introduced in 1994 as a novel concept for lung salvage after penetrating wounds. Recently, tractotomy has been suggested to increase morbidity and, thus, its practice has been challenged. The purpose of this study was to compare the morbidity and mortality associated with nonanatomic and anatomic lung resection in the management of severe pulmonary injuries.

Increased rate of infection associated with transfusion of old blood after severe injury.

Hypothesis: Blood components undergo changes during storage that may affect the recipient, including the release of bioactive agents, with significant immune consequences. We hypothesized that transfusion of old blood increases infection risk in severely injured patients.

Design: Prospective cohort study.

The Outreach Trauma Program: a model for survival of the academic trauma center.

Background: In the current health care climate, trauma centers face particular economic challenges. Statewide trauma systems provide a network for referral of critically injured patients to academic Level I trauma centers, but favorable reimbursement in states such as Colorado results in intense competition for patients. We hypothesized that a comprehensive Outreach Trauma Program would facilitate our mission as a key resource facility in our trauma system, and would increase referrals of critically injured patients to our center from outside our metropolitan area.

Acute hypoxemia in humans enhances the neutrophil inflammatory response.

The neutrophil (PMN) is regarded as a key component in the hyperinflammatory response known as the systemic inflammatory response syndrome. Acute respiratory distress syndrome (ARDS) and subsequent multiple organ failure (MOF) are related to the severity of this hyperinflammation. ICU patients who are at highest risk of developing MOF may have acute hypoxic events that complicate their hospital course.

Evaluation of a new technique for bedside percutaneous tracheostomy.

Background: Percutaneous tracheostomy as described by Ciaglia is accepted as a safe technique with minimal associated morbidity. Recent modification of the technique to a single-step dilator prompted us to evaluate this in the critically injured patient.

Methods: A comparison of patients undergoing percutaneous tracheostomy was performed.

Helmet availability at skiing and snowboarding rental shops. a survey of Colorado ski resort rental practices.

Background: Many studies have determined that head injuries are serious and potentially life threatening in skiers and snowboarders. Helmets have proven to be effective in reducing the risk of head and brain injury in blunt trauma from bicycling, climbing, skiing, and snowboarding. The objective of this study was to evaluate the availability, cost, and prevelance of helmet rental to skiers and snowboarders at Colorado ski resorts.