The institution of massive transfusion protocols (MTPs) has improved the timely delivery of large quantities of blood products and improves patient outcomes. In recent years, the cost of blood products has increased, compounded by significant blood product shortages. There is practical need for identification of a transfusion volume in trauma patients that is associated with increased mortality, or a threshold after which additional transfusion is futile and associated with nonsurvivability. This transfusion threshold is often described in the setting of an ultramassive transfusion (UMT). There are few studies defining what constitutes amount or outcomes associated with such large volume transfusion. The purpose of this narrative review is to provide an analysis of existing literature examining the effects of UMT on outcomes including survival in adult trauma patients and to determine whether there is a threshold transfusion limit after which mortality is inevitable. Fourteen studies were included in this review. The data examining the utility of UMT in trauma are of poor quality, and with the variability inherent in trauma patients, and the surgeons caring for them, no universally accepted cutoff for transfusion exists. Not surprisingly, there is a trend toward increasing mortality with increasing transfusions. The decision to continue transfusing is multifactorial and must be individualized, taking into consideration patient characteristics, institution factors, blood bank supply, and most importantly, constant reevaluation of the need for ongoing transfusion rather than blind continuous transfusion until the heart stops.
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http://dx.doi.org/10.1213/ANE.0000000000006504 | DOI Listing |
Distal tibial fractures are common lower-limb injuries and are generally associated with a high risk of postoperative complications, especially in patients with multiple medical comorbidities. This study sought to ascertain the efficacy of retrograde intramedullary tibial nails (RTN) for treating extra-articular distal tibial fractures in high-risk patients. Between January 2019 and December 2021, 13 patients considered at high risk for postoperative complications underwent RTN fixation.
View Article and Find Full Text PDFThis study was performed according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta- Analyses) guidelines. PubMed and Medline databases were searched in October 2023 for studies reporting outcomes of arthroscopic anterior cruciate ligament (ACL) reconstruction and stable medial meniscal ramp lesion treatment. Studies focused on diagnostic approaches, biomechanical properties, unstable ramp lesions, isolated ramp lesions, and concomitant intraarticular/extraarticular pathologies other than ACL rupture are excluded.
View Article and Find Full Text PDFThe aim of the study was to compare the outcomes of bone transport in treating upper- middle vs. lower- middle tibial bone defects. Sixty-two patients with tibial infected large segmental defects treated by bone transport were analyzed retrospectively and divided into distal group (lower- middle tibial bone defects and proximal transport, n=38) and proximal group (upper- middle tibial bone defects and distal transport, n=24).
View Article and Find Full Text PDFThe aim of this study was to investigate the effect of the presence of the "cortex sign" (corticalization) in femoral diaphysis fractures determined by the dynamization of nails because of delayed union. The study included 12 patients with a closed transverse femoral fracture (AO 32a3) treated with dynamization (all the screws distal of the nail were removed) because of delayed healing and followed up for at least 2 years. These patients were evaluated for the presence of bone union, cortex-like sclerosis (corticalization) distal to the nail, and the distance of the corticalization from the joint during follow- up after dynamization.
View Article and Find Full Text PDFThere is a lack in understanding the reasons for different lengths of sick leave in patients who sustain ankle fractures. The aim of this study is to examine variations in the length of sick leave in ankle fracture patients and how treatment, type of ankle fracture and the patient-reported outcome are associated with the length of sick leave. In this study were data from the Swedish Social Insurance Agency (SSIA) and the Swedish Fracture Register (SFR), combined.
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