The Sequential Clinical Assessment of Respiratory Function (SCARF) score: A dynamic pulmonary physiologic score that predicts adverse outcomes in critically ill rib fracture patients.

Background: Rib fracture scoring systems are limited by a lack of serial pulmonary physiologic variables. We created the Sequential Clinical Assessment of Respiratory Function (SCARF) score and hypothesized that admission, maximum, and rising scores predict adverse outcomes among critically ill rib fracture patients.

Methods: Prospective cohort study of rib fracture patients admitted to the surgical intensive care unit (ICU) at a Level I trauma center from August 2017 to June 2018.

Screening for Ventilator-Associated Pneumonia in the Surgical Intensive Care Unit: A Single-Institution Analysis of 1,013 Lower Respiratory Tract Cultures.

Background: Refinement of criteria for both screening and initiation of empiric therapy in ventilator-associated pneumonia (VAP) will minimize antibiotic overuse. We hypothesized that variables within the commonly used Clinical Pulmonary Infection Score (CPIS) have unfavorable test performance characteristics.

Methods: Consecutive bronchoalveolar lavage (BAL) cultures obtained from surgical intensive care unit patients were abstracted (2009-2012).

Early tracheostomy improves outcomes in severely injured children and adolescents.

Background: Early tracheostomy has been advocated for adult trauma patients to improve outcomes and resource utilization. We hypothesized that timing of tracheostomy for severely injured children would similarly impact outcomes.

Methods: Injured children undergoing tracheostomy over a 10-year period (2002-2012) were reviewed.

Nebulized hypertonic saline attenuates acute lung injury following trauma and hemorrhagic shock via inhibition of matrix metalloproteinase-13.

Objective: We hypothesized that aerosolized inhaled hypertonic saline given at the onset of resuscitation will decrease acute lung injury following hemorrhagic shock, by inhibiting the release of epithelial derived proinflammatory mediators.

Design: Animal study.

Setting: Animal-care facility procedure room in a medical center.

Selective Intrabronchial Air Insufflation for Acute Lobar Collapse in the Surgical Intensive Care Unit.

OVERVIEW: The horseshoe kidney is more prone to blunt abdominal trauma because of its low position and the presence of the isthmus across the midline. This is a rare case of complete transection of a horseshoe kidney at the isthmus due to blunt abdominal trauma with two sites of active extravasation on initial CT imaging. This extravasation was successfully treated by embolization with coils.

One thousand bedside percutaneous tracheostomies in the surgical intensive care unit: time to change the gold standard.

Background: Bedside percutaneous tracheostomy (BPT) is a cost-effective alternative to open tracheostomy. Small series have consistently documented minimal morbidity, but BPT has yet to be embraced as the standard of care. Because this has been our preferred technique in the surgical ICU for more than 20 years, we reviewed our experience to ascertain its safety.

Patterns of early and late ventilator-associated pneumonia due to methicillin-resistant Staphylococcus aureus in a trauma population.

Background: Community-acquired methicillin-resistant Staphylococcal aureus (CA-MRSA) infection is approaching endemic proportions nationally, and it is a potential cause for early ventilator-associated pneumonia (VAP) in the acutely injured patient. We sought to determine the prevalence of early (≤4 days) and late (>4 days) MRSA pneumonia in ventilated multisystem trauma patients and to correlate findings with admission nasal swabs.

Methods: We performed a review of our prospective trauma and infectious disease data bases for all patients admitted to our surgical intensive care unit with early (≤4 days) and late (>4 days) VAP during a 4-year period.

Rapid thrombelastography (r-TEG) identifies hypercoagulability and predicts thromboembolic events in surgical patients.

Background: Despite routine prophylaxis, thromboembolic events (TEs) in surgical patients remain a substantial problem. Furthermore, the timing and incidence of hypercoagulability, which predisposes to these events is unknown, with institutional screening programs serving primarily to establish a diagnosis after an event has occurred. Emerging evidence suggests that point of care (POC) rapid thrombelastography (r-TEG) provides a real-time analysis of comprehensive thrombostatic function, which represents an analysis of both enzymatic and platelet components of thrombus formation.

Postinjury life threatening coagulopathy: is 1:1 fresh frozen plasma:packed red blood cells the answer?

Background: Recent military experience suggests that immediate 1:1 fresh frozen plasma (FFP); red blood cells (RBC) for casualties requiring >10 units packed red blood cells (RBC) per 24 hours reduces mortality, but no clinical trials exist to address this issue. Consequently, we reviewed our massive transfusion practices during a 5-year period to test the hypothesis that 1:1 FFP:RBC within the first 6 hours reduces life threatening coagulopathy.

Methods: We queried our level I trauma center's prospective registry from 2001 to 2006 for patients undergoing massive transfusion.

Streptococcus milleri infections of the pleural space: operative management predominates.

Background: Management of patients with thoracic empyema ranges from tube thoracostomy drainage, with or without fibrinolytics, to operative intervention, with the optimal intervention remaining uncertain. Streptococcus milleri, typically a benign bacterium colonizing the oropharynx, has recently been reported as a potential pathogen in pneumonia and pleural space disease. Our initial experience indicated this infection, when in the pleural space, was particularly tenacious and often required major operative intervention to eradicate.

Postinjury abdominal compartment syndrome does not preclude early enteral feeding after definitive closure.

Background: Critically injured patients are susceptible to the abdominal compartment syndrome (ACS), which requires decompressive laparotomy with delayed abdominal closure. Previous work by the University of Texas Houston group showed impaired gut function after resuscitation-associated gut edema. The purpose of this study was to determine if enteral nutrition was precluded by the intra-abdominal hypertension and bowel edema of the ACS.

Nutrition support of the trauma patient.

Hypercatabolism after trauma may lead to acute protein malnutrition, ultimately resulting in multiple organ failure. Nutrition support may prevent this sequence. This review addresses the need for early nutrition support, the preferred route of substrate delivery, and the potential advantages of "immune-enhancing" diets.

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.