Early Restrictive vs Liberal Oxygen for Trauma Patients: The TRAUMOX2 Randomized Clinical Trial.

Importance: Early administration of supplemental oxygen for all severely injured trauma patients is recommended, but liberal oxygen treatment has been associated with increased risk of death and respiratory complications.

Objective: To determine whether an early 8-hour restrictive oxygen strategy compared with a liberal oxygen strategy in adult trauma patients would reduce death and/or major respiratory complications.

Design, Setting, And Participants: This randomized controlled trial enrolled adult trauma patients transferred directly to hospitals, triggering a full trauma team activation with an anticipated hospital stay of a minimum of 24 hours from December 7, 2021, to September 12, 2023.

Management of Acute Right Ventricular Failure.

Purpose Of Review: Acute right ventricular failure (RVF) is a frequent condition associated with high morbidity and mortality. This review aims to provide a current overview of the pathophysiology, presentation, and comprehensive management of acute RVF.

Recent Findings: Acute RVF is a common disease with a pathophysiology that is not completely understood.

Comparison of a short versus long-course antibiotic therapy for ventilator-associated pneumonia: a systematic review and meta-analysis of randomized controlled trials.

Background: For ventilator-associated pneumonia (VAP), the safety of short-course versus long-course antibiotic therapy is still debated, especially regarding documented VAP due to non-fermenting Gram-negative bacilli (NF-GNB). The aim of this meta-analysis was to assess the rates of recurrence and relapse of VAP in patients receiving short-course (≤8 days) and long-course (≥10-15 days) of antibiotic therapy.

Methods: The protocol for this study was registered in the PROSPERO database (ID: CRD42022365138).

Comparing restrictive versus liberal oxygen strategies for trauma patients: The TRAUMOX2 trial-Statistical analysis plan.

Background: The international advanced trauma life support guidelines recommend that all severely injured trauma patients receive supplemental oxygen based on very limited evidence. The TRAUMOX2 trial randomises adult trauma patients to a restrictive or liberal oxygen strategy for 8 h. The primary composite outcome consists of 30-day mortality and/or development of major respiratory complications (pneumonia and/or acute respiratory distress syndrome).

Comparing restrictive versus liberal oxygen strategies for trauma patients - the TRAUMOX2 trial: protocol for a randomised clinical trial.

Introduction: Supplemental oxygen is commonly used in trauma patients, although it may lead to hyperoxaemia that has been associated with pulmonary complications and increased mortality. The primary objective of this trial, TRAUMOX2, is to compare a restrictive versus liberal oxygen strategy the first 8 hours following trauma.

Methods And Analysis: TRAUMOX2 is an investigator-initiated, international, parallel-grouped, superiority, outcome assessor-blinded and analyst-blinded, randomised, controlled, clinical trial.

Supplemental oxygen for traumatic brain injury: A systematic review.

Background: Oxygen supplementation is recommended after traumatic brain injury (TBI) but excessive oxygen may be harmful. The aim of this study was to investigate the effect of supplemental oxygen or high/low inspiratory oxygen fraction (FiO ) for TBI patients on in-hospital mortality.

Methods: We searched Medline (Pubmed), EMBASE and the Cochrane Library for interventional and observational studies fulfilling the following criteria: TBI patients >17 years (population); initial use of supplemental oxygen/high (≥0.

A high fraction of inspired oxygen may increase mortality in intubated trauma patients - A retrospective cohort study.

Background: Mechanical ventilation of trauma patients is common, and many will require a higher than normal fraction of inspired oxygen (FiO) to avoid hypoxaemia. The primary objective of this study was to assess the association between FiO and all-cause, one-year mortality in intubated trauma patients.

Methods: Adult trauma patients intubated in the initial phase post-trauma between 2015 and 2017 were retrospectively identified.

Ketamine versus propofol for rapid sequence induction in trauma patients: a retrospective study.

Background: Rapid Sequence Induction (RSI) is used for emergency tracheal intubation to minimise the risk of pulmonary aspiration of stomach contents. Ketamine and propofol are two commonly used induction agents for RSI in trauma patients. Yet, no consensus exists on the optimal induction agent for RSI in the trauma population.

Determining a safe upper limit of oxygen supplementation for adult patients: a systematic review.

Objective: This systematic review aimed to describe the connection between the inspired oxygen fraction and pulmonary complications in adult patients, with the objective of determining a safe upper limit of oxygen supplementation.

Methods: MEDLINE and Embase were systematically searched in August 2019 (updated July 2020) for studies fulfilling the following criteria: intubated adult patients (opulation); high fractions of oxygen (ntervention) versus low fractions of (omparison); atelectasis, acute respiratory distress syndrome (ARDS), pneumonia and/or duration of mechanical ventilation (utcome); original studies both observational and interventional (tudies). Screening, data extraction and risk of bias assessment was done by two independent reviewers.

Early-onset pneumonia following bag-mask ventilation versus endotracheal intubation during cardiopulmonary resuscitation: A substudy of the CAAM trial.

Aim: Early-onset pneumonia (EOP) is a common in-hospital complication in survivors of out-of-hospital cardiac arrest. In this substudy of the CAAM trial, we aimed to compare whether bag mask ventilation (BMV) compared to endotracheal intubation (ETI) performed during cardiopulmonary resuscitation increases the risk of developing EOP.

Methods: Adult patients from the CAAM trial that survived beyond 12 h of hospitalization were included.

Ketamine for rapid sequence intubation in adult trauma patients: A retrospective observational study.

Background: In the trauma population, ketamine is commonly used during rapid sequence induction. However, as ketamine has been associated with important side effects, this study sought to compare in-hospital mortality in trauma patients after induction with ketamine versus other induction agents.

Methods: We retrospectively identified adult trauma patients intubated in the pre-hospital phase or initially in the trauma bay at two urban level-1 trauma centers during a 2-year period using local trauma registries and medical records.

Impact of Physician-staffed Helicopters on Pre-hospital Patient Outcomes: A systematic review.

Background: Management of pre-hospital patients remains a challenge. In developed countries a physician-staffed helicopter emergency medical service (PS-HEMS) is used in addition to ground emergency medical service (GEMS), but the effect is debated. This systematic review aimed to evaluate the effect of PS-HEMS compared with GEMS on patient outcomes based on the published scientific literature.

Cervical Spine Clearance in Trauma Patients with an Unreliable Physical Examination.

Background: The objective of this study was to describe and compare the timing of cervical spine clearance in trauma patients with an unreliable physical examination.

Methods: We prospectively included adult trauma patients admitted with a cervical collar and an unreliable clinical examination (as defined by the NEXUS criteria) at two level 1 trauma centers: one in the USA (US) and one in Denmark (DK). We excluded patients with cervical spine injuries requiring a collar or surgery as treatment and patients with a collar placed after hospital arrival.

Patient experience of spinal immobilisation after trauma.

Background: Spinal immobilisation of blunt trauma victims with potential spinal cord injury is considered standard of care. The traditional management has, however, been increasingly questioned and concerns about harm have been raised. Few studies have described the perspective of the trauma patient regarding the spinal immobilisation.

Dental injuries in relation to general anaesthesia-A retrospective study.

Background: Dental injuries may occur during general anaesthesia, especially during airway management. The aim of this study was to describe cases of dental injury related to general anaesthesia, focusing on the type and extent of the injuries as well as the timing of recognition.

Method: We reviewed the nationwide electronic database available at the Danish Patient Compensation Association and scrutinized all claims classified as possible dental injuries in relation to general anaesthesia between 2007 and 2017.

Spontaneous Retroperitoneal and Rectus Sheath Hemorrhage-Management, Risk Factors and Outcomes.

Background: Spontaneous retroperitoneal and rectus sheath hemorrhage (SRRSH) is associated with high mortality in the literature, but studies on the subject are lacking. The objective of this study was to identify early predictors of the need for angiographic or surgical intervention (ASI) in patients with SRRSH and define risk factors for mortality.

Methods: We conducted a retrospective cohort study at a tertiary academic hospital.

Restrictive vs liberal oxygen for trauma patients-the TRAUMOX1 pilot randomised clinical trial.

Introduction: Hyperoxaemia is commonly observed in trauma patients but has been associated with pulmonary complications and mortality in some patient populations. The objectives of this study were to evaluate whether maintenance of normoxia is feasible using a restrictive oxygen strategy in the initial phase after trauma and to evaluate the incidence of 30-day mortality and/or major pulmonary complications.

Methods: Forty-one adult trauma patients admitted to our trauma centre were randomised to 24 hours of restrictive oxygen therapy (no supplemental oxygen if the arterial oxyhaemoglobin saturation (SpO ) was at least 94%, n = 21) or liberal oxygen therapy (intubated patients: FiO 1.

Cervical spinal cord injury after blunt assault: Just a pain in the neck?

Background: We aimed to determine the incidence, risk factors, and outcomes of cervical spinal cord injury (CSCI) after blunt assault.

Methods: The ACS National Trauma Data Bank (NTDB) 2012 Research Data Set was used to identify victims of blunt assault using the ICD-9 E-codes 960.0, 968.

Pre-hospital management of acute stroke patients eligible for thrombolysis - an evaluation of ambulance on-scene time.

Background: Stroke is a leading cause of death and disability with effective treatment, including thrombolysis or thrombectomy, being time-critical for favourable outcomes. While door-to-needle time in hospital has been optimized for many years, little is known about the ambulance on-scene time (OST). OST has been reported to account for 44% of total alarm-to-door time, thereby being a major time component.

Supplemental oxygen and hyperoxemia in trauma patients: A prospective, observational study.

Background: Supplemental oxygen is recommended during the initial treatment of trauma patients according to several guidelines, but the supporting evidence is sparse. We aimed to describe the use of supplemental oxygen and occurrence of hyperoxemia in the initial phase of trauma management at two level 1 trauma centers, TC1 and TC2.

Methods: In this prospective, observational study we included trauma patients ≥16 years of age.

Initial use of supplementary oxygen for trauma patients: a systematic review.

Objective: This systematic review aimed to identify and describe the evidence for supplementary oxygen for spontaneously breathing trauma patients, and for high (0.60-0.90) versus low (0.