bluuebunny/crossref_metadata_2025_split huggingface dataset:
Ultrasound in trauma resuscitation and critical care with hemodynamic transesophageal echocardiography guidance
Authors: Nowack Timothy , Christie D. Benjamin 
Published: April 2019

BACKGROUND
Volume replacement strategies and resuscitation endpoints of therapy in the critical ill or injured patient continues to be a heavily debated topic despite decades of research and the ever evolving technologies that provide for alternate methods of monitoring. Hemodynamic transesophageal echocardiography (hTEE), refined for the use in the intensive care unit (ICU), allows for direct visualization of cardiac filling and function, enabling real-time guidance in the resuscitation of critically ill patients. The disposable, 17F hTEE probe can remain indwelling for up to 72 hours, providing continuous, unobstructed assessments of cardiac activity via the transgastric short axis, midesophageal four chamber, and superior vena cava views. With such, preload and contractility, ventricular size and function, and volume responsiveness can be accurately evaluated and trended for change over time. Hemodynamic transesophageal echocardiography as a monitoring modality is becoming more pervasive in ICUs on a worldwide scale, allowing for real-time visualization of resuscitation and its therapeutic effects, a better understanding of resuscitation effects on individual patients, a more rapid conclusion to patient's resuscitation needs and provides the physician more confidence and patience in guiding complex volume resuscitations.

RESULTS
This presentation will focus on discussing practical applications of the hTEE system and its benefits in critical care management. We will review four patients at our facility admitted to the ICU due to hemodynamic instability of varying etiologies that required volume resuscitation. With the videos, we will demonstrate how hTEE can guide patient therapy, often counter-intuitively, in the critically ill using the three basic cardiac views. Specific scenarios and hTEE videos include: (1) volume resuscitation in Acute Respiratory Distress Syndrome (ARDS), (2) volume resuscitation guided by hTEE, (3) underresuscitation in a “routine” trauma case, and (4) deescalation of therapy by weaning of high-dose vasopressors using hTEE monitoring.

CONCLUSION
Hemodynamic transesophageal echocardiography is an excellent hemodynamic monitoring modality for the intensivist and has many practical applications in the management of the critical ill or injured patients. Hemodynamic transesophageal echocardiography has demonstrated that patient's resuscitation needs are often underestimated and that a more tailored approach to volume delivery is achievable, a particular benefit in the older and more comorbid patient. Future applications of hTEE include CRRT volume management, organ donor hemodynamic optimization, and postresuscitation monitoring in trauma patient requiring massive transfusion protocol. These videos demonstrate examples of the benefits of real-time cardiac monitoring, which allowed for guided resuscitation and improved patient outcomes.

LEVEL OF EVIDENCE
Procedures and techniques, level IV.
Indices of muscle and liver dysfunction after surviving hemorrhage and prolonged hypotension
Authors: Hinojosa-Laborde Carmen , Shade Robert E. , Frost Patrice A. , Dutton John W. , Muniz Gary W. , Hudson Ian L. , Carter Robert , Ryan Kathy L. 
Published: April 2019

BACKGROUND
This study determined the long-term effects of prolonged hypotension (PH) on liver, muscle, and kidney dysfunction. The hypothesis was that longer duration of PH after hemorrhage will result in greater organ dysfunction.

METHODS
Baboons were sedated and hemorrhaged (30% blood volume). Systolic blood pressure greater than 80 mm Hg was maintained for 1 hour (1 hr-PH; n = 5), 2 hours (2 hr-PH; n = 5), or 3 hours (3 hr-PH; n = 5). After PH, hemorrhage volume was replaced. Animals were recovered and monitored for 21 days. Control animals were hemorrhaged and immediately resuscitated (0 hr-PH, n = 3). Data are Mean ± Standard Deviation, and analyzed by 2-way repeated measures ANOVA and Holm-Sidak test.

RESULTS
Hemorrhage resulted in mild hypotension. Minimal resuscitation was required during the hypotensive phase, and survival rate was 100%. Significant increases (p < 0.001) in alanine aminotransferase, aspartate aminotransferase, creatine phosphokinase, and lactate dehydrogenase occurred on Day 1 after PH, and were significantly greater (p < 0.001) in the 2 hr- and 3 hr-PH groups than the 0 hr-PH group. Maximum alanine aminotransferase levels (U/L) were 140 ± 56 (0 hr-PH), 170 ± 130 (1 hr-PH), 322 ± 241 (2 hr-PH), and 387 ± 167 (3 hr-PH). Maximum aspartate aminotransferase levels (U/L) were 218 ± 44 (0 hr-PH), 354 ± 219 (1 hr-PH), 515 ± 424 (2 hr-PH), and 711 ± 278 (3 hr-PH). Maximum creatine phosphokinase values (U/L) were 7834 ± 3681 (0 hr-PH), 24336 ± 22268 (1 hr-PH), 50494 ± 67653 (2 hr-PH), and 59857 ± 32408 (3 hr-PH). Maximum lactic acid dehydrogenase values (U/L) were 890 ± 396 (0 hr-PH), 2055 ± 1520 (1 hr-PH), 3992 ± 4895 (2 hr-PH), and 4771 ± 1884 (3 hr-PH). Plasma creatinine and blood urea nitrogen were unaffected by PH (p > 0.10).

CONCLUSION
These results indicate that PH up to 3 hours in duration results in transient liver and muscle dysfunction that was most severe after 2 hr-PH and 3 hr-PH. Prolonged hypotension produced minimal effects on the kidney.

LEVEL OF EVIDENCE
Basic science research, Level of evidence not required for basic science research.
Use of helicopters for retrieval of trauma patients: A geospatial analysis
Authors: Smedley W. Andrew , Stone K. Lorraine , Brown Allison , Farley Paige , Griffin Russell L. , Cox Daniel B. , Kerby Jeffrey D. , Jansen Jan O. 
Published: April 2019

BACKGROUND
Helicopters are widely used to facilitate the transport of trauma patients, from the scene of an incident to the hospital. However, the use of helicopters may not always be appropriate. The aim of this project was to conduct a geospatial analysis of helicopter transport to a Level I trauma center.

METHODS
Retrospective geospatial analysis of trauma registry data, 2013 to 2018. We included all adult (≥16) trauma patients brought to the trauma center directly from the scene. Data were geocoded and analyzed using arcGIS. Drive times and flight times were calculated using Google Maps. Flight times included the time required to reach the incident location.

RESULTS
Two thousand eight hundred ninety-three patients were identified, and 1,911 had incident locations recorded and were therefore included in the analysis. The median age was 41 years (interquartile range [IQR], 27–58 years). Twenty-four percent of the patients had suffered severe injuries (Injury Severity Score [ISS], 16–25), 17% very severe injuries (ISS > 25), 24% moderately severe injuries, and 36% minor injuries (ISS, 1–8). The overall geographical distribution was centroidal, although with a concentration of case volume in the vicinity, and to the northeast, of the trauma center. Median flight time was 60 minutes (IQR, 52–69 minutes), and median drive time 65 minutes (IQR, 54–86 minutes). In 33% of the patients, the calculated drive time to the trauma center was shorter than the calculated flight time when considering the time for the helicopter to reach the scene.

CONCLUSION
The majority of patients taken to our level I trauma center by helicopter are injured in relatively close proximity. One in four patients is severely or very severely injured, but one third of the patients have only minor injuries. Over a quarter of trauma patients might have reached hospital more quickly if they had been taken by road, rather than helicopter.

LEVEL OF EVIDENCE
Epidemiological/geographical study, level V.
Infection after penetrating brain injury—An Eastern Association for the Surgery of Trauma multicenter study oral presentation at the 32nd annual meeting of the Eastern Association for the Surgery of Trauma, January 15–19, 2019, in Austin, Texas
Authors: Harmon Laura A. , Haase Daniel J. , Kufera Joseph A. , Adnan Sakib , Cabral Donna , Lottenberg Lawrence , Cunningham Kyle W. , Bonne Stephanie , Burgess Jessica , Etheridge James , Rehbein Jennifer L. , Semon Gregory , Noorbakhsh Matthew R. , Cragun Benjamin N. , Agrawal Vaidehi , Truitt Michael , Marcotte Joseph , Goldenberg Anna , Behbahaninia Milad , Keric Natasha , Hammer Peter M. , Nahmias Jeffry , Grigorian Areg , Turay Dave , Chakravarthy Vikram , Lalchandani Priti , Kim Dennis , Chapin Trinette , Dunn Julie , Portillo Victor , Schroeppel Thomas , Stein Deborah M. 
Published: April 2019

BACKGROUND
Fatality rates following penetrating traumatic brain injury (pTBI) are extremely high and survivors are often left with significant disability. Infection following pTBI is associated with worse morbidity. The modern rates of central nervous system infections (INF) in civilian survivors are unknown. This study sought to determine the rate of and risk factors for INF following pTBI and to determine the impact of antibiotic prophylaxis.

METHODS
Seventeen institutions submitted adult patients with pTBI and survival of more than 72 hours from 2006 to 2016. Patients were stratified by the presence or absence of infection and the use or omission of prophylactic antibiotics. Study was powered at 85% to detect a difference in infection rate of 5%. Primary endpoint was the impact of prophylactic antibiotics on INF. Mantel-Haenszel χ2 and Wilcoxon's rank-sum tests were used to compare categorical and nonparametric variables. Significance greater than p = 0.2 was included in a logistic regression adjusted for center.

RESULTS
Seven hundred sixty-three patients with pTBI were identified over 11 years. 7% (n = 51) of patients developed an INF. Sixty-six percent of INF patients received prophylactic antibiotics. Sixty-two percent of all patients received one dose or greater of prophylactic antibiotics and 50% of patients received extended antibiotics. Degree of dural penetration did not appear to impact the incidence of INF (p = 0.8) nor did trajectory through the oropharynx (p = 0.18). Controlling for other variables, there was no statistically significant difference in INF with the use of prophylactic antibiotics (p = 0.5). Infection was higher in patients with intracerebral pressure monitors (4% vs. 12%; p = <0.001) and in patients with surgical intervention (10% vs. 3%; p < 0.001).

CONCLUSION
There is no reduction in INF with prophylactic antibiotics in pTBI. Surgical intervention and invasive intracerebral pressure monitoring appear to be risk factors for INF regardless of prophylactic use.

LEVEL OF EVIDENCE
Therapeutic, level IV.
Predictors of postinjury acute respiratory distress syndrome: Lung injury persists in the era of hemostatic resuscitation
Authors: Kornblith Lucy Z. , Robles Anamaria J. , Conroy Amanda S. , Redick Brittney J. , Howard Benjamin M. , Hendrickson Carolyn M. , Moore Sara , Nelson Mary F. , Moazed Farzad , Callcut Rachael A. , Calfee Carolyn S. , Cohen Mitchell Jay 
Published: April 2019

BACKGROUND
Acute respiratory distress syndrome (ARDS) following trauma is historically associated with crystalloid and blood product exposure. Advances in resuscitation have occurred over the last decade, but their impact on ARDS is unknown. We sought to investigate predictors of postinjury ARDS in the era of hemostatic resuscitation.

METHODS
Data were prospectively collected from arrival to 28 days for 914 highest-level trauma activations who required intubation and survived more than 6 hours from 2005 to 2016 at a Level I trauma center. Patients with ratio of partial pressure of oxygen to fraction of inspired oxygen of 300 mmHg or less during the first 8 days were identified. Two blinded expert clinicians adjudicated all chest radiographs for bilateral infiltrates in the first 8 days. Those with left-sided heart failure detected were excluded. Multivariate logistic regression was used to define predictors of ARDS.

RESULTS
Of the 914 intubated patients, 63% had a ratio of partial pressure of oxygen to fraction of inspired oxygen of 300 or less, and 22% developed ARDS; among the ARDS cases, 57% were diagnosed early (in the first 24 hours), and 43% later. Patients with ARDS diagnosed later were more severely injured (ISS 32 vs. 20, p = 0.001), with higher rates of blunt injury (84% vs. 72%, p = 0.008), chest injury (58% vs. 36%, p < 0.001), and traumatic brain injury (72% vs. 48%, p < 0.001) compared with the no ARDS group. In multivariate analysis, head/chest Abbreviated Injury Score scores, crystalloid from 0 to 6 hours, and platelet transfusion from 0 to 6 hours and 7 to 24 hours were independent predictors of ARDS developing after 24 hours.

CONCLUSIONS
Blood and plasma transfusion were not independently associated with ARDS. However, platelet transfusion was a significant independent risk factor. The role of platelets warrants further investigation but may be mechanistically explained by lung injury models of pulmonary platelet sequestration with peripheral thrombocytopenia.

LEVEL OF EVIDENCE
Prognostic study, level IV.
Acute resuscitation with polyethylene glycol-20k: A thromboelastographic analysis
Authors: Wickramaratne Niluka , Kenning Kristine , Reichstetter Heather , Blocher Charles , Li Ru , Aboutanos Michel , Mangino Martin J. 
Published: April 2019

BACKGROUND
Previous ex vivo studies have shown that polyethylene glycol-20,000 Da (PEG-20k), a novel synthetic polymer that is highly effective for resuscitation, has a hypocoagulable effect on human blood. This study's objective was to determine the in vivo effects of PEG-20k-based resuscitation solutions on coagulation and platelet function in a porcine model of hemorrhagic shock.

METHODS
Anesthetized pigs underwent controlled hemorrhage until the lactate reached 7 mmol/L or 50% to 55% of their estimated blood volume was removed. A laparotomy was performed to simulate tissue injury. Low volume resuscitation (LVR) was given with fluorescein isothiocyanate-labeled 10% PEG-20k solution (100 mg/mL) or Lactated Ringers, both delivered at volumes equal to 10% of the estimated blood volume (n = 5). Thromboelastography was performed after surgery (baseline), after hemorrhage, and 15 minutes, 120 minutes, and 240 minutes postresuscitation. Hemoglobin was measured to determine changes in plasma volume. Plasma PEG-20k concentration was measured by indicator dilution.

RESULTS
Pigs given PEG-20k survived 2.6-fold longer than controls (p < 0.001) and had a significant increase in plasma volume demonstrated by the sustained drop in hemoglobin, relative to controls. Pigs resuscitated with LR died from hypotension an average of 90 minutes after resuscitation compared to the PEG-20k pigs, which all survived 240 minutes and were then euthanized with normal blood pressure and lactate. Administration of PEG-20k primarily decreased the thromboelastograph maximum amplitude, however this began to return toward baseline by 240 minutes. Peak plasma concentration of PEG-20k after LVR were 40% lower than predicted, based on simple dilution (5.7 mg/mL vs. 10 mg/mL) and the half-life was 59.6 minutes.

CONCLUSION
These data demonstrate that acute resuscitation with PEG-20k significantly improves tolerance to hypovolemia but also decreases platelet function in the coagulation cascade, which was due, in part, to its volume expanding effects.
Quantifying geographic barriers to trauma care: Urban-rural variation in prehospital mortality
Authors: Jarman Molly P. , Hashmi Zain , Zerhouni Yasmin , Udyavar Rhea , Newgard Craig , Salim Ali , Haider Adil H. 
Published: April 2019

BACKGROUND
Few studies of trauma care access and quality account for prehospital injury mortality. Little is known about geographic variation in prehospital mortality or the impact of prehospital care on injury disparities.

METHODS
Using the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research database, we queried county-level incidence of prehospital injury mortality from 1999 to 2016. We linked mortality incidence with county-level urban-rural classifications from the National Center for Health Statistics and population data from the US Census Bureau. We used negative binomial regression to estimate the relationship between rurality and prehospital injury mortality, adjusting for county-level distribution of race, sex, age, income, and insurance coverage. Models were then stratified by injury mechanism (motor vehicle traffic [MVT] vs. penetrating) to determine if prehospital mortality rates varied by type of injury.

RESULTS
Prehospital injury mortality rates were elevated for all urban-rural county classes, relative to large central metro counties, with incidence rate ratios (IRR) ranging from 1.25 (95% confidence interval [CI], 1.16–1.35) for fringe metro counties to 1.69 (95% CI, 1.58–1.82) for noncore counties. For MVT injury, IRRs for urban-rural classes compared with large central metro counties ranged from 2.02 (95% CI, 1.85–2.21) for fringe metro counties to 3.02 (95% CI, 2.76–3.30) to noncore counties. Incidence of prehospital mortality from penetrating injury was 14% higher for noncore counties compared to large central metro counties (IRR, 1.14; 95% CI, 1.05–1.23).

CONCLUSION
There is substantial geographic variation in prehospital injury mortality in the United States, with risk of prehospital death increasing with rurality. Patterns of prehospital death associated with penetrating and MVT injuries suggest that improvements to both trauma center access, prehospital care, and primary injury prevention are essential to reduce preventable injury deaths.

LEVEL OF EVIDENCE
Retrospective ecological analysis, level III.
Hypobaria during aeromedical evacuation exacerbates histopathological injury and modifies inflammatory response in rats exposed to blast overpressure injury
Authors: Dayani Yaron , Stierwalt Joshua , White Andrea , Chen Ye , Arnaud Francoise , Jefferson Michelle A. , Goforth Carl , Malone Debra , Scultetus Anke H. 
Published: April 2019

BACKGROUND
Aeromedical evacuation (AE) is often used as a rapid and effective way to evacuate patients. However, little is known about the possible effects of AE on patients with blast and traumatic brain injury. In the current study, we used blast overpressure (BOP) as a method to introduce traumatic brain injury in rats and investigated the effects of hypobaria during AE on histology and inflammatory response.

METHODS
Animals were exposed to a 12-hour flight 2 days after BOP and euthanized 48 hours after flight. Control animals were kept at normobaria.

RESULTS
Overall, BOP animals exposed to flight demonstrated higher histopathologic injury scores as compared to control animals in lungs, brain, kidney, heart, and intestine. The BOP animals exposed to normobaria exhibited a proinflammatory response compared to those that were not blasted, an observation that was not seen in BOP animals exposed to hypobaria.

CONCLUSION
These data suggest that AE 48 hours post blast may lead to impairment in the inflammatory process and worsening of long-term outcomes.

LEVEL OF EVIDENCE
Animal research, level II.
Cold-stored whole blood platelet function is preserved in injured children with hemorrhagic shock
Authors: Leeper Christine M. , Yazer Mark H. , Cladis Franklyn P. , Saladino Richard , Triulzi Darrell J. , Gaines Barbara A. 
Published: April 2019

BACKGROUND
Recent data demonstrate the safety of uncrossmatched cold-stored whole blood (WB) transfusion in pediatric trauma patients. The hemostatic capabilities of platelets within the cold-stored WB unit have been demonstrated via in vitro studies and animal models. However, platelet function has not been evaluated in pediatric recipients of cold-stored WB transfusions.

METHODS
Injured children, 2 years or older and 10 kg or greater with hemorrhagic shock received up to 30 mL/kg of cold-stored, low titer (<50) anti-A and -B, leukoreduced, group O- WB during their initial resuscitation. Patients were included if (1) they received WB and no conventional platelets, and (2) platelet count and thromboelastography maximum amplitude were measured both before and after transfusion. These data and relevant clinical outcomes (mortality, intensive care unit length of stay [LOS], hospital LOS and ventilator days) were compared to a historical cohort of pediatric trauma patients who received uncrossmatched red blood cells (RBC) and conventional room temperature platelets.

RESULTS
Twenty-two children were included in the study; 14 in the component cohort versus 8 in the WB cohort. Neither posttransfusion platelet count (129 × 109/L vs. 135 × 109/L) nor function (thromboelastography maximum amplitude, 59.5 mm vs. 60.2 mm) differed significantly between children receiving cold-stored platelets within the WB unit versus children who received conventional warm platelets. Median (interquartile range) weight-adjusted platelet transfusion volume in the historical cohort was 4.6 (2.5–7.7) mL/kg vs. 2.4 (1.3–4.0) mL/kg in the WB cohort (p = 0.03). There was no difference between groups in age, race, mechanism of injury, Injury Severity Score, vital signs, and severe traumatic brain injury (TBI). Outcomes, including mortality, intensive care unit LOS, hospital LOS, and ventilator days, were not significantly different between groups.

CONCLUSION
No difference was seen in posttransfusion platelet number or function in severely injured children receiving cold-stored WB platelets as compared to those receiving conventional room temperature-stored platelets. Larger cohorts are required to confirm these findings.

LEVEL OF EVIDENCE
Therapeutic, level IV.
The Effect of Ceramic Painting on the Life Satisfaction and Cognitive Status of Older Adults Residing in a Nursing Home
Authors: Çetinkaya Funda , Duru Aşiret Güler , Direk Filiz , Özkanlı Nilüfer Nazende 
Published: April 2019

Objectives:
The aim of this experimental study was to assess the cognitive activity and satisfaction with life of older adults in nursing home before and after ceramic painting.

Methods:
The sample of the survey consisted of 15 older adults each in the intervention and control groups. Data for the study were collected using a questionnaire form developed to determine the sociodemographic characteristics of the older adults, the Mini-Mental State Examination, and the Life Satisfaction Scale.

Results:
There was a statistically significant increase in the mean Mini-Mental State Examination score of the intervention group compared with the control group at the end of ceramic painting (P < .05). The intervention group had increased average Life Satisfaction Scale scores in the posttest compared with the control group, although the difference was not statistically significant.

Conclusions:
The results showed that art therapy with ceramic painting was a positive effect on the cognitive levels and quality of life of older adults.
The Dual-Tasking Overload on Functional Mobility Is Related to Specific Cognitive Domains in Different Subtypes of Parkinson's Disease
Authors: Pereira Marcelo Pinto , Batistela Rosangela Alice , Rocha dos Santos Paulo Cezar , Simieli Lucas , Gobbi Lilian Teresa Bucken 
Published: April 2019

Objective:
To investigate the role of different cognitive domains on the dual-tasking overload during functional mobility in Parkinson's disease subtypes.

Methods:
Eleven tremor-dominant and 15 akinetic-rigid participants performed the Timed Up-and-Go (TUG) test with and without a secondary task; executive function and attention were assessed.

Results:
Dual tasking increased TUG time in both groups (tremor-dominant: 6.38 ± 1.19 seconds and 7.79 ± 1.48 seconds; akinetic-rigid: 8.80 ± 3.09 seconds and 10.38 ± 3.77 seconds). Dual-tasking overload was correlated with attention in akinetic-rigid and mental inflexibility in tremor-dominant participants. Cognitive scores were similar between groups.

Conclusion:
Distinguished cognitive domains are involved with dual-tasking overload in Parkinson's disease subgroups.