The use of lyophilized plasma in a severe multi-injury pig model.

Background: Shock and severe tissue injury lead to an endogenous coagulopathy mediated by activation of Protein C and hyperfibrinolysis known as acute traumatic coagulopathy. Together, hemodilution, acidosis, inflammation, and hypothermia result in a global trauma-induced coagulopathy. Coagulopathy in trauma is associated with mortality.

Crystalloid resuscitation improves survival in trauma patients receiving low ratios of fresh frozen plasma to packed red blood cells.

Background: Current trauma resuscitation guidelines recommend giving an initial crystalloid bolus as first line for resuscitation. Recent studies have shown a survival benefit for trauma patients resuscitated with high ratios of fresh frozen plasma (FFP) to packed red blood cells (PRBC). Our aim was to determine whether the volume of crystalloid given during resuscitation correlated with differences in morbidity or mortality based on the ratio of FFP:PRBC given.

Lyophilized plasma with ascorbic acid decreases inflammation in hemorrhagic shock.

Background: Delivery of a high ratio of plasma to packed red blood cells to patients who require massive transfusion is associated with improved survival. Hemorrhagic shock causes increased production of pro-inflammatory cytokines. These are associated with late morbidity and mortality.

Lyophilized plasma reconstituted with ascorbic acid suppresses inflammation and oxidative DNA damage.

Background: Lyophilized plasma (LP) has been shown to be as effective as fresh frozen plasma (FFP) for resuscitation in polytrauma and hemorrhagic shock. LP reconstituted with ascorbic acid is associated with suppression of cytokines when compared with fresh frozen plasma. We aimed to determine the effect of using alternate LP reconstitution acids on physiologic parameters, blood loss, coagulation, oxidative DNA damage, and proinflammatory cytokines in a polytrauma and hemorrhagic shock model.

Trauma induces a hypercoagulable state that is resistant to hypothermia as measured by thrombelastogram.

Background: The aim of this study was to test the hypothesis that severely injured trauma patients would be hypercoagulable compared with controls measured by thromboelastography and that this hypercoagulability would persist over a broad range of temperatures.

Methods: A prospective study evaluating the effects of temperature on coagulation in trauma patients with Injury Severity Scores ≥ 15 and controls was completed. Thromboelastography was performed 24 hours after admission at 4 temperatures ranging from 32°C to 38°C.

Red blood cells accelerate the onset of clot formation in polytrauma and hemorrhagic shock.

Background: Hemorrhage and coagulopathy are major contributors to death after trauma. The contribution of red blood cells (RBCs) in correcting coagulopathy is poorly understood. Current methods of measuring coagulopathy may fail to accurately characterize in vivo clotting.

Effects of ethanol intoxication and gender on blood coagulation.

Background: Ethanol intoxication is a common contributor to traumatic injury. It is unknown whether ethanol consumption contributes to the coagulation differences seen between men and women after trauma. Our aim was to examine the combined effect of ethanol intoxication and gender on coagulation.

Lyophilized plasma for resuscitation in a swine model of severe injury.

Hypothesis: Lyophilized plasma (LP) is as safe and effective as fresh frozen plasma (FFP) for resuscitation after severe trauma.

Design: Multicenter animal study.

Setting: Animal laboratories, 2 level I trauma centers.

Should the principle of "pay for performance" be applied to nutrition support?

Americans spent 2.4 trillion dollars on health care in 2008. The massive size of this expenditure has led to perpetual efforts to improve health care quality while attempting to reduce overall cost.

Reconstruction of complex abdominal wall hernias using acellular human dermal matrix: a single institution experience.

Background: Acellular human dermal matrix (AHDM) has mechanical properties suitable for complex abdominal wall reconstructions and physiologic properties that allow more resistance to infection in contaminated fields. The purpose of this study was to determine which patient and technical factors lead to optimal surgical outcomes.

Methods: A retrospective review was conducted of 144 abdominal wall reconstructions using AHDM over a 33-month period.