Trauma care today, what′s new?

Ramaiah, Ramesh; Grabinsky, Andreas; Williamson, Kelvin; Bhanankar, Sanjay M

doi:10.4103/2229-5151.79278

Cited by 3 publications

(2 citation statements)

References 38 publications

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“…Trauma is the leading cause of death in the under-45 age group and the third-leading cause of death in all populations 1 . Nosocomial pneumonia is a common cause of morbidity and death in trauma patients 2–5 .…”

Section: Introductionmentioning

confidence: 99%

Intratracheal instillation of neutrophils rescues bacterial overgrowth initiated by trauma damage-associated molecular patterns

Itagaki

Riça

Zhang

et al. 2017

Journal of Trauma and Acute Care Surgery

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Background Nosocomial pneumonias are common in trauma patients and so interventions to prevent and treat nosocomial pneumonia may improve outcomes. Our prior work strongly suggests that tissue injury predisposes to infections like nosocomial pneumonia because mitochondrial debris (MTD) originating from injured cells contains damage-associated molecular patterns (DAMPs) that can reduce neutrophil (PMN) migration into the airway and diminish PMN function in response to bacterial inoculation of the airway. This suggested that putting exogenous “normal” PMN into the airway might be beneficial. Methods Post-injury pneumonia (PNA) commonly arises in two groups, early, community-acquired PNA (CAP) and later hospital-acquired PNA (HAP). Post-traumatic Early onset CAP and Late onset HAP were modeled in CD-1 mice using S. aureus (SA) or P. aeruginosa (PA) instilled intra-tracheal (i.t.) at clinically relevant times with or without extrapulmonary injuries mimicked by an intraperitoneal application of mitochondrial DAMPs. We applied bone-marrow derived PMN intratracheally to access bacterial clearance in the lung. Results BM-PMN instillation i.t. had no untoward clinical effects on recipient animals. In both the Early/CAP and Late/HAP models, clearance of the inoculum from the lung was suppressed by MTD and restored to uninjured levels by i.t. instillation of exogenous BM-PMN. Furthermore PMN instillation cleared the inoculum of P. aeruginosa that could not be cleared by uninjured mice. The instillation of PMN into the lung, even across strains (CD-1 vs. C57BL/6) had no injurious effect. Conclusion These initial studies suggest PMN instillation (i.t.) is worthy of further study as a potential adjunctive therapy aimed at decreasing the morbidity of lung infections in trauma patients. Moreover, PMN instillation (i.t.) may represent a unique means of preventing or treating pneumonia after serious injury that is completely independent of the need for antibiotic use.

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Section: Introductionmentioning

confidence: 99%

Intratracheal instillation of neutrophils rescues bacterial overgrowth initiated by trauma damage-associated molecular patterns

Itagaki

Riça

Zhang

et al. 2017

Journal of Trauma and Acute Care Surgery

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“…Traumatic injury is the fourth leading cause of death in western countries and the leading cause of death in younger age (1). Furthermore, more years of productive life are lost due to traumatic injury than to any other illnesses (2).…”

Section: Introductionmentioning

confidence: 99%

Effect of Physician-Staffed Emergency Medical Services (P-EMS) on the Outcome of Patients with Severe Traumatic Brain Injury: A Review of the Literature

Popal

Bossers²,

Terra³

et al. 2019

Prehospital Emergency Care

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Introduction: Traumatic injury is the fourth leading cause of death in western countries and the leading cause of death in younger age. However, it is still unclear which groups of patients benefit most from advanced prehospital trauma care. A minimal amount is known about the effect of prehospital physician-based care on patients with specifically traumatic brain injury (TBI). The aim of this review is to assess the effect of physician-staffed Emergency Medical Services (EMS) on the outcome of patients with severe TBI. Methods: Literature searches have been performed in the bibliographic databases of PubMed, EMBASE and The Cochrane Library. Data concerning (physician-staffed) prehospital care for patients with severe TBI were only included if the control group was based on non-physician-staffed EMS. Primarily the mortality rate and secondarily the neurological outcome were examined. Additionally, data concerning hypotension, hypoxia, length of stay (hospital and intensive care unit) and the number of required early neurosurgical interventions were taken into account. Results: The overall mortality was decreased in three of the fourteen included studies after the implementation of a physician in the prehospital setting. One study found also a decrease in mortality only for patients with a Glasgow Coma Scale of 6-8. Strikingly, two other studies reported higher mortality, one for all the included patients and one for patients with GCS 10-12 only. Neurological outcome was improved in five studies after prehospital deployment of a physician. One study reported that more patients had a poor neurological outcome in the P-EMS group. Results of the remaining outcome measures differed widely. Conclusion: The included literature did not show a clear beneficial effect of P-EMS in the prehospital management of patients with severe TBI. The available evidence showed contradictory results, suggesting more research should be performed in this field with focus on decreasing heterogeneity in the compared groups.

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Military Trauma

Houston¹,

Ryan²

2012

Disaster Medicine

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Trauma care today, what′s new?

Cited by 3 publications

References 38 publications

Intratracheal instillation of neutrophils rescues bacterial overgrowth initiated by trauma damage-associated molecular patterns

Intratracheal instillation of neutrophils rescues bacterial overgrowth initiated by trauma damage-associated molecular patterns

Effect of Physician-Staffed Emergency Medical Services (P-EMS) on the Outcome of Patients with Severe Traumatic Brain Injury: A Review of the Literature

Military Trauma

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