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Outcomes of traumatically injured patients after nighttime transfer from the intensive care unit. 夜间从重症监护室转移的创伤性受伤患者的预后。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-11-26 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001451
Amy Howk, Devin John Clegg, Jacob C Balmer, Natalie G Foster, Justin Gerard, Anthony S Rowe, Brian Daley

Background: Prior studies have associated nighttime transfer of patients from the intensive care unit (ICU) with increased morbidity. This study sought to examine this relationship in traumatically injured patients, as this has not been previously performed.

Methods: A retrospective review of traumatically injured patients admitted to a Level I Trauma Center's ICU from January 2021 to September 2022 was performed. "Day shift" (DS) was defined as 07:00 to 19:00 and "night shift" (NS) as 19:01 to 06:59. The time of transfer completion was based on the time of the patient arrival at the destination unit. The univariate analysis compared patients with completed transfers during DS and NS. Multivariate logistic regression was performed to predict readmission to the ICU.

Results: A total of 1,800 patients were included in the analysis, with 608 patients that had completed transfers during NS, and 1,192 during DS. Both groups were similar, with no significant differences in age, sex, Injury Severity Score (ISS), mechanism of injury, or median total comorbidities. The NS group had a longer median time to transfer completion (10.1 (IQR 5.5-13.6) hours vs 5.1 (IQR 2.9-8.4) hours; p<0.001). A significantly higher proportion of the NS group had a readmission to the ICU (60 (10.0%) vs 86 (7.0%); p=0.03) or a major complication (72 (11.9%) vs 107 (9.0%); p=0.048). When controlling for age, comorbidities, ISS, time to bed assignment and to transfer completed, and ICU length of stay, transfer completion during NS was associated with 1.56 times higher odds of having an ICU readmission (OR 1.56 (95% CI 1.05, 2.33); p=0.03).

Conclusions: Trauma patients transferred from the ICU during NS experienced longer delays, readmission to the ICU, and major complications significantly more often. With increasing hospital bed shortages, patient transfers must be analyzed to minimize worsened outcomes, especially in traumatically injured patients.

Level of evidence: Level III, therapeutic/care management.

背景:先前的研究表明夜间从重症监护病房(ICU)转移患者与发病率增加有关。这项研究试图检查创伤性损伤患者的这种关系,因为这之前没有进行过。方法:回顾性分析2021年1月至2022年9月在某一级创伤中心ICU收治的创伤性损伤患者。“白班”定义为07:00至19:00,“夜班”定义为19:01至06:59。转移完成的时间以患者到达目的单位的时间为基础。单变量分析比较了DS和NS期间完成转移的患者。采用多变量logistic回归预测再入院情况。结果:共有1800名患者被纳入分析,其中608名患者在NS期间完成了转移,1192名患者在DS期间完成了转移。两组相似,在年龄、性别、损伤严重程度评分(ISS)、损伤机制或中位总合并症方面无显著差异。NS组转移完成的中位时间更长(10.1 (IQR 5.5-13.6)小时vs 5.1 (IQR 2.9-8.4)小时;结论:在NS期间从ICU转移的创伤患者经历了更长的延迟、再入院和更频繁的主要并发症。随着医院床位短缺的增加,必须对患者转移进行分析,以尽量减少恶化的结果,特别是在创伤性受伤患者中。证据等级:III级,治疗/护理管理。
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引用次数: 0
Potential new treatment for inferior vena cava injury using extracorporeal membrane oxygenation applying flow diversion effect. 利用体外膜氧合技术的血流分流效应治疗下腔静脉损伤的潜在新疗法。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-11-18 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001618
Takaaki Maruhashi, Keita Saku, Hideo Maruki, Marina Oi, Yasushi Asari

Background: Retrohepatic inferior vena cava (IVC) injuries remain among the most lethal and serious liver injuries. Gauze packing is currently the first choice for IVC injuries; however, laparotomy itself poses the risk of circulatory collapse. Thus, less invasive treatment strategies are needed.

Methods: In this study, we conducted an animal experiment to replicate and validate successful treatments for an actual case of retrohepatic IVC injury that we had encountered.

Results: A woman in her 80s presented to our hospital due to cardiac arrest caused by a pulmonary artery embolism. Venoarterial extracorporeal membrane oxygenation (ECMO) was introduced, and the patient was resuscitated. After resuscitation, contrast-enhanced CT revealed liver and retrohepatic IVC injuries, possibly caused by chest compressions. Liver injury was treated using transarterial embolization of the left hepatic artery. To treat the retrohepatic IVC injury, ECMO flow was increased to enhance the negative drainage pressure. The extravasation of the contrast medium had resolved in IVC angiography, and we opted for nonoperative management. The patient's hemodynamic status gradually stabilized, and ECMO was withdrawn on day 6. We confirmed these findings in a dog model of retrohepatic IVC injury.

Conclusions: Our findings from the patient and the animal model suggest that the flow diversion effect of ECMO can effectively manage active bleeding from the IVC by inserting a drainage cannula across the injured lesion. We think this procedure represents a novel treatment option for retrohepatic IVC injuries.

背景:肝后下腔静脉(IVC)损伤仍是最致命、最严重的肝损伤之一。目前,纱布填塞是治疗 IVC 损伤的首选方法;然而,开腹手术本身就存在循环衰竭的风险。因此,我们需要创伤更小的治疗策略:在本研究中,我们进行了一项动物实验,以复制和验证我们遇到的一例肝后 IVC 损伤的成功治疗方法:结果:一名 80 多岁的妇女因肺动脉栓塞导致心脏骤停而来到我院。我们引入了静脉体外膜肺氧合(ECMO),并对患者进行了抢救。复苏后,对比增强 CT 显示肝脏和肝后 IVC 损伤,可能是胸外按压造成的。经动脉栓塞左肝动脉治疗了肝损伤。为了治疗肝后 IVC 损伤,增加了 ECMO 流量以提高负引流压。造影剂外渗在 IVC 血管造影中已经消失,我们选择了非手术治疗。患者的血液动力学状态逐渐稳定,ECMO 于第 6 天撤出。我们在狗肝后静脉损伤模型中证实了这些发现:我们在患者和动物模型上的研究结果表明,ECMO 的血流分流作用可通过在损伤病灶处插入引流插管,有效控制 IVC 的活动性出血。我们认为,这种方法是治疗肝后 IVC 损伤的一种新选择。
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引用次数: 0
We do it the same way every time! Eliminating disparities in trauma care. 我们每次都用同样的方法!消除创伤护理中的差异。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-11-14 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001639
Laura N Haines, Brandon M Harris
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引用次数: 0
Endovascular control of ongoing pelvic hemorrhage after intraoperative arterial shunting and venous ligation in peripheral vascular trauma. 外周血管创伤术中动脉分流和静脉结扎术后盆腔持续出血的血管内控制。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-11-14 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001595
Terry R Schaid, William Aaron Marshall, Clay Cothren Burlew, Kristy Lynn Hawley
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引用次数: 0
Vape grenade: a patient with maxillofacial injuries with C1-C2 fracture secondary to electronic cigarette blast injury. Vape grenade:一名因电子香烟爆炸伤继发 C1-C2 骨折的颌面部损伤患者。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-11-05 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001652
Arden Aron L Asuncion, Aireen Patricia M Madrid, Joseph T Juico, Ivan Burke M Tan, Ernest Stephen F Co, Charles Arthur M Sydiongco
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引用次数: 0
Early identification of respiratory decompensation among older adults with rib fractures: a sound solution for fragile ribs. 肋骨骨折老年人呼吸衰竭的早期识别:脆弱肋骨的合理解决方案。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-10-26 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001632
W Preston Hewgley, Adam Lucy, Rondi Gelbard
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引用次数: 0
Damage control surgery in a patient with cardiac arrest from necrotizing soft tissue infection. 对一名因软组织坏死性感染而心跳骤停的患者实施损伤控制手术。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-10-24 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001428
Jianshe Shi, Jialong Zheng, Yong Zhang, Yijie Chen, Chenghua Zhang
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引用次数: 0
Do not fear the open abdomen. 不要害怕开腹。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-10-23 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001647
Hector Mejia Morales, David A Hampton
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引用次数: 0
Bridging the gap: a robotic approach to the repair of a traumatic diaphragmatic intercostal hernia. 缩小差距:用机器人修复外伤性膈肋间疝。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001604
Caitlin Anne Fitzgerald, Sejul Chaudhary, Mary Noory
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引用次数: 0
Documentation and coding for trauma and surgical critical care: updates and tips. 创伤和外科重症护理的文档和编码:更新和提示。
IF 2.1 Q3 CRITICAL CARE MEDICINE Pub Date : 2024-10-16 eCollection Date: 2024-01-01 DOI: 10.1136/tsaco-2024-001532
Jordan Michael Kirsch, Samir M Fakhry, Andrew Bernard, Gail T Tominaga

Clinical documentation is an essential part of medical practice. Medical records serve as a durable testament of care provided and are fundamental to communication among providers. Medical records provide justification and support for healthcare coding and billing for providers and hospitals and also provide evidence in regulatory and legal proceedings. Here, the authors emphasize the importance of clinical documentation in support of both professional and hospital billing and address two areas of recent regulatory changes: Operative coding for hernia operation and professional coding for critical care. The important role of provider documentation in supporting organizational revenue and quality is also discussed.

临床记录是医疗实践的重要组成部分。医疗记录是医疗服务的持久见证,也是医疗服务提供者之间沟通的基础。医疗记录为医疗服务提供者和医院的医疗编码和计费提供理由和支持,也为监管和法律程序提供证据。在此,作者强调了临床文件在支持专业和医院计费方面的重要性,并讨论了近期监管变化的两个领域:疝气手术的手术编码和重症监护的专业编码。作者还讨论了医疗服务提供者的文档在支持组织收入和质量方面的重要作用。
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引用次数: 0
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Trauma Surgery & Acute Care Open
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