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  1. Article ; Online: Ultrasound-guided tracheostomy--not for the many, but perhaps the few... or the one.

    Tremblay, Lorraine N / Scales, Damon C

    Critical care (London, England)

    2011  Volume 15, Issue 2, Page(s) 147

    Abstract: Percutaneous tracheostomy has become a routine procedure in most intensive care units, and point of care ultrasound is becoming used with greater frequency to augment diagnosis and therapy for critically ill patients. The case series from Rajajee and ... ...

    Abstract Percutaneous tracheostomy has become a routine procedure in most intensive care units, and point of care ultrasound is becoming used with greater frequency to augment diagnosis and therapy for critically ill patients. The case series from Rajajee and colleagues incorporates 'real-time' ultrasound in an effort to improve the safety of percutaneous tracheostomy. While their report does not prove that ultrasound should be used prior to or during all percutaneous tracheostomies, it does reinforce several important safety considerations concerning the anatomy of the neck, and in particular the potential to encounter bleeding complications during these procedures.
    MeSH term(s) Female ; Humans ; Male ; Trachea/diagnostic imaging ; Tracheostomy/methods ; Ultrasonography, Interventional/methods
    Language English
    Publishing date 2011-04-06
    Publishing country England
    Document type Journal Article ; Research Support, Non-U.S. Gov't ; Comment
    ZDB-ID 2041406-7
    ISSN 1466-609X ; 1364-8535
    ISSN (online) 1466-609X
    ISSN 1364-8535
    DOI 10.1186/cc10106
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  2. Article: Defining the Safe Entry Point in Deep Plane Facelifting with Novel Landmark for the Buccal Branch of the Facial Nerve.

    Medhurst, Ryan / Tremblay, Cory / Marrelli, Kristina / Best, Corliss / Jadeski, Lorraine / Brace, Matthew

    Plastic and reconstructive surgery. Global open

    2024  Volume 12, Issue 4, Page(s) e5749

    Abstract: ... the intercept in 12.12% of specimens (0 mm from intercept, n = 4). Buccal rami passed superiorly in 66.67 ... of specimens (3.71 ± 3.28 mm from intercept, n = 7) and inferiorly in 21.21% of specimens (2.44 ± 0.92 mm ... from intercept, n = 7). Noteworthy, buccal rami were located within 1 cm of the intercept landmark with 96.97 ...

    Abstract Background: In deep facial surgery, accurate preoperative landmarking of branches of the facial nerve is helpful in avoiding inadvertent facial nerve injury. The objective of our study was to determine the accuracy at which the intersection point of two bisecting lines that join facial surface landmarks can be used to accurately locate the buccal branch(es) of the facial nerve, specifically at the deep plane entry point (ie, intercept landmark).
    Methods: Thirty-three cadavers were dissected to determine the position of the buccal rami relative to the intercept.
    Results: Buccal rami crossed the intercept in 12.12% of specimens (0 mm from intercept, n = 4). Buccal rami passed superiorly in 66.67% of specimens (3.71 ± 3.28 mm from intercept, n = 7) and inferiorly in 21.21% of specimens (2.44 ± 0.92 mm from intercept, n = 7). Noteworthy, buccal rami were located within 1 cm of the intercept landmark with 96.97% accuracy (32/33 cadavers).
    Conclusions: These data suggest that this novel intercept (1) reliably locates the buccal branch of the facial nerve as it courses distal to the parotid gland, and (2) helps define a "safe zone" for entry into the deep plane where the likelihood of encountering the facial nerve is extremely low.
    Language English
    Publishing date 2024-04-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2851682-5
    ISSN 2169-7574 ; 2169-7574
    ISSN (online) 2169-7574
    ISSN 2169-7574
    DOI 10.1097/GOX.0000000000005749
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  3. Article: Ventilator-induced lung injury: from the bench to the bedside.

    Tremblay, Lorraine N / Slutsky, Arthur S

    Intensive care medicine

    2006  Volume 32, Issue 1, Page(s) 24–33

    MeSH term(s) Biomedical Research ; Critical Illness ; Humans ; Respiration, Artificial/adverse effects ; Respiration, Artificial/methods ; Respiratory Distress Syndrome, Adult/etiology ; Respiratory Distress Syndrome, Adult/physiopathology ; Respiratory Distress Syndrome, Adult/prevention & control
    Language English
    Publishing date 2006-01
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 80387-x
    ISSN 1432-1238 ; 0342-4642 ; 0340-0964 ; 0935-1701
    ISSN (online) 1432-1238
    ISSN 0342-4642 ; 0340-0964 ; 0935-1701
    DOI 10.1007/s00134-005-2817-8
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  4. Article: Pathogenesis of ventilator-induced lung injury: trials and tribulations.

    Tremblay, Lorraine N / Slutsky, Arthur S

    American journal of physiology. Lung cellular and molecular physiology

    2005  Volume 288, Issue 4, Page(s) L596–8

    MeSH term(s) Animals ; Chemokines/metabolism ; Humans ; Lung/metabolism ; Lung Injury ; Receptors, Tumor Necrosis Factor/deficiency ; Respiration, Artificial/adverse effects ; Respiratory Distress Syndrome, Adult/etiology ; Respiratory Distress Syndrome, Adult/metabolism ; Signal Transduction ; Tumor Necrosis Factor-alpha/antagonists & inhibitors ; Tumor Necrosis Factor-alpha/metabolism
    Chemical Substances Chemokines ; Receptors, Tumor Necrosis Factor ; Tumor Necrosis Factor-alpha
    Language English
    Publishing date 2005-03-08
    Publishing country United States
    Document type Comment ; Editorial
    ZDB-ID 1013184-x
    ISSN 1522-1504 ; 1040-0605
    ISSN (online) 1522-1504
    ISSN 1040-0605
    DOI 10.1152/ajplung.00438.2004
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    Zs.A 2749: Show issues Location:
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  5. Article ; Online: Retrospective Evaluation of Splenic Artery Embolization Outcomes in the Management of Blunt Splenic Trauma: A Single Centre Experience at a Large Level 1 Trauma Centre.

    O'Rourke, Colin / McKee, Hayley / Wijeyaratnam, Darrin O / Bajwa, Jaspreet / Tremblay, Lorraine / David, Elizabeth

    Canadian Association of Radiologists journal = Journal l'Association canadienne des radiologistes

    2023  Volume 74, Issue 4, Page(s) 745–754

    Abstract: ... Patients were treated with proximal SAE (n = 97), distal SAE (n = 23) or combined SAE (n = 18), and 68 ...

    Abstract Purpose: Retrospective review of splenic artery embolization (SAE) outcomes performed for blunt abdominal trauma.
    Materials and methods: 11-year retrospective review at a large level-1 Canadian trauma centre. All patients who underwent SAE after blunt trauma were included. Technical success was defined as angiographic occlusion of the target vessel and clinical success was defined as successful non-operative management and splenic salvage on follow-up.
    Results: 138 patients were included of which 68.1% were male. The median age was 47 years (interquartile range (IQR) = 32.5 years). The most common mechanisms of injury were motor vehicle accidents (37.0%), mechanical falls (25.4%), and pedestrians hit by motor vehicles (10.9%). 70.3% of patients had American Association for the Surgery of Trauma (AAST) grade 4 injuries. Patients were treated with proximal SAE (n = 97), distal SAE (n = 23) or combined SAE (n = 18), and 68% were embolized with an Amplatzer plug. No significant differences were observed across all measures of hospitalization (Length of hospital stay: x
    Conclusion: We report that SAE as an adjunct to non-operative management of blunt splenic trauma can be performed safely and effectively with a high rate of clinical success.
    MeSH term(s) Humans ; Male ; Adult ; Female ; Retrospective Studies ; Treatment Outcome ; Trauma Centers ; Splenic Artery/diagnostic imaging ; Canada ; Abdominal Injuries/diagnostic imaging ; Abdominal Injuries/therapy ; Embolization, Therapeutic ; Wounds, Nonpenetrating/diagnostic imaging ; Wounds, Nonpenetrating/therapy
    Language English
    Publishing date 2023-04-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 418190-6
    ISSN 1488-2361 ; 0846-5371 ; 0008-2902
    ISSN (online) 1488-2361
    ISSN 0846-5371 ; 0008-2902
    DOI 10.1177/08465371231166946
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  6. Article: Are resuscitation and operation justified in injured patients with extreme base deficits (less than -20)?

    Tremblay, Lorraine N / Feliciano, David V / Rozycki, Grace S

    American journal of surgery

    2003  Volume 186, Issue 6, Page(s) 597–600; discussion 600–1

    Abstract: Background: This study assessed the outcome of injured patients in shock with an admission base deficit of -20 or less (approximate pH <7.0) at a level 1 trauma center.: Methods: A retrospective review was made of the trauma registry, supplemented by ...

    Abstract Background: This study assessed the outcome of injured patients in shock with an admission base deficit of -20 or less (approximate pH <7.0) at a level 1 trauma center.
    Methods: A retrospective review was made of the trauma registry, supplemented by chart review, of all trauma patients admitted with a base deficit -20 or less from 1995 to 2002. Data collected included mechanism of injury, base deficit, Injury Severity Score(ISS), operative procedures, and outcome. Data are presented as mean +/- SD.
    Results: Over the study period, 110 trauma patients (88% male; 31 +/- 13 years; 34% blunt trauma; ISS 26 +/- 15) were admitted with base deficit of -20 or less. Overall survival was 38%, with the majority of deaths occurring within hours of admission.
    Conclusions: An admission base deficit of -20 or less is associated with high mortality in patients with gunshot wounds (64%) or blunt trauma (70%). The majority of patients who die will do so within hours of admission. Beyond 24 hours, the survival rates of 73% for patients with blunt trauma, 79% for those with gunshot wounds, and 90% for those with stab wounds justify continuing resuscitation and reoperations.
    MeSH term(s) Acid-Base Imbalance/complications ; Adult ; Female ; Glasgow Coma Scale ; Humans ; Hydrogen-Ion Concentration ; Injury Severity Score ; Length of Stay ; Male ; Resuscitation ; Retrospective Studies ; Shock, Traumatic/blood ; Shock, Traumatic/therapy ; Survival Rate ; Treatment Outcome ; Wounds, Gunshot/blood ; Wounds, Gunshot/mortality ; Wounds, Gunshot/surgery ; Wounds, Nonpenetrating/blood ; Wounds, Nonpenetrating/mortality ; Wounds, Nonpenetrating/surgery ; Wounds, Stab/blood ; Wounds, Stab/mortality ; Wounds, Stab/surgery
    Language English
    Publishing date 2003-10-02
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2953-1
    ISSN 1879-1883 ; 0002-9610
    ISSN (online) 1879-1883
    ISSN 0002-9610
    DOI 10.1016/j.amjsurg.2003.09.003
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  7. Article: Secondary extremity compartment syndrome.

    Tremblay, Lorraine N / Feliciano, David V / Rozycki, Grace S

    The Journal of trauma

    2002  Volume 53, Issue 5, Page(s) 833–837

    Abstract: Background: Abdominal compartment syndrome has been reported to occur after fluid resuscitation in injured patients, even in the absence of intra-abdominal injuries. This report describes a set of patients who developed the secondary extremity ... ...

    Abstract Background: Abdominal compartment syndrome has been reported to occur after fluid resuscitation in injured patients, even in the absence of intra-abdominal injuries. This report describes a set of patients who developed the secondary extremity compartment syndrome (SECS) in uninjured extremities after resuscitation for other injuries.
    Methods: This study was a retrospective chart review of all trauma patients developing SECS at a Level I trauma center. Data are mean +/- SD.
    Results: From 1996 to 2001, 10 patients (8 men, age 31 +/- 13 years, Injury Severity Score of 29 +/- 17, and 3 with penetrating trauma) from a series of 11,996 trauma admissions developed SECS after resuscitation for other injuries. The mean number of extremities developing the SECS per patient was 3.1. This included compartment syndromes in 10 upper extremities and in 12 lower extremities that did not have any apparent injuries (i.e., contusions, fractures, or vascular injuries). After evaluation by the trauma team, abdominal silos were needed in 7 of the 10 patients also, and the mortality in patients with the SECS was 70%.
    Conclusion: SECS is a rare complication of the postresuscitation systemic inflammatory response syndrome, is associated with significant morbidity, and may be a marker for mortality. SECS should be ruled out by measurement of compartment pressures in uninjured and injured extremities in patients with severe diffuse edema after resuscitation for injury.
    MeSH term(s) Adolescent ; Adult ; Chi-Square Distribution ; Compartment Syndromes/diagnosis ; Compartment Syndromes/etiology ; Compartment Syndromes/physiopathology ; Extremities ; Female ; Humans ; Injury Severity Score ; Male ; Middle Aged ; Multiple Trauma/complications ; Multiple Trauma/therapy ; Resuscitation/adverse effects ; Retrospective Studies ; Treatment Outcome
    Language English
    Publishing date 2002-11
    Publishing country United States
    Document type Journal Article
    ZDB-ID 219302-4
    ISSN 1529-8809 ; 0022-5282 ; 1079-6061
    ISSN (online) 1529-8809
    ISSN 0022-5282 ; 1079-6061
    DOI 10.1097/00005373-200211000-00005
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  8. Article: Assessment of initial base deficit as a predictor of outcome: mechanism of injury does make a difference.

    Tremblay, Lorraine N / Feliciano, David V / Rozycki, Grace S

    The American surgeon

    2002  Volume 68, Issue 8, Page(s) 689–93; discussion 693–4

    Abstract: Initial base deficit in injured patients has been shown to predict the adequacy of resuscitation and outcome. The usefulness of base deficit as a predictor of outcome, however, may be dependent on the mechanism of injury. We conducted a retrospective ... ...

    Abstract Initial base deficit in injured patients has been shown to predict the adequacy of resuscitation and outcome. The usefulness of base deficit as a predictor of outcome, however, may be dependent on the mechanism of injury. We conducted a retrospective review of the trauma registry, supplemented by chart review, of all trauma patients treated at a Level I trauma center from January 1995 through July 2001. Data collected included mechanism of injury, base deficit, Injury Severity Score, and outcome. From 1995 through 2001 a total of 3275 patients (23% of trauma admissions) at a mean age of 34 +/- 15 years had a base deficit recorded at the time of admission. The patients were 78 per cent male, and the mechanism of injury was blunt trauma in 58.2 per cent. Mortality increased with successive increases in base deficit but was markedly lower for a given base deficit in those patients having sustained stab wounds and/or severe lacerations as compared with those with gunshot wounds or blunt trauma. The value of the base deficit as a predictor of outcome depends upon the mechanism of injury and appears most useful for patients sustaining gunshot wounds or blunt trauma. Future studies in patients with penetrating trauma using base deficit as a predictor of outcome should separate patients with gunshot wounds from those with stab wounds or lacerations.
    MeSH term(s) Acid-Base Imbalance/physiopathology ; Adult ; Female ; Glasgow Coma Scale ; Humans ; Injury Severity Score ; Logistic Models ; Male ; Middle Aged ; Prognosis ; Retrospective Studies ; Shock, Hemorrhagic/etiology ; Shock, Hemorrhagic/mortality ; Wounds, Gunshot/mortality ; Wounds, Gunshot/physiopathology ; Wounds, Gunshot/therapy ; Wounds, Nonpenetrating/mortality ; Wounds, Nonpenetrating/physiopathology ; Wounds, Nonpenetrating/therapy ; Wounds, Penetrating/mortality ; Wounds, Penetrating/physiopathology ; Wounds, Penetrating/therapy
    Language English
    Publishing date 2002-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 202465-2
    ISSN 1555-9823 ; 0003-1348
    ISSN (online) 1555-9823
    ISSN 0003-1348
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  9. Article: Perioperative vasopressors are associated with an increased risk of gastrointestinal anastomotic leakage.

    Zakrison, Tanya / Nascimento, Bartolomeu A / Tremblay, Lorraine N / Kiss, Alex / Rizoli, Sandro B

    World journal of surgery

    2007  Volume 31, Issue 8, Page(s) 1627–1634

    Abstract: Background: The purpose of this study was to investigate the effect of vasopressors on gastrointestinal (GI) anastomotic leaks. Vasopressors are commonly used in surgical patients admitted to the intensive care unit (ICU) and their effects on GI ... ...

    Abstract Background: The purpose of this study was to investigate the effect of vasopressors on gastrointestinal (GI) anastomotic leaks. Vasopressors are commonly used in surgical patients admitted to the intensive care unit (ICU) and their effects on GI anastomotic integrity are unknown.
    Patients and methods: Surgical patients admitted to the ICU in our tertiary university hospital following the creation of a GI anastomosis were studied by a retrospective chart analysis for anastomotic leaks and complications
    Results: A total of 223 patients with 259 GI anastomoses, mostly for cancer, were admitted to the ICU immediately after surgery. Twenty-two patients developed anastomotic leaks (9.9%). The two groups (leak versus no-leak) had similar demographics, surgery type and indication, type of anastomosis, co-morbidities, cancer, steroid use, blood transfusion, drains, and epidural catheters. Vasopressor use was associated with increased anastomotic leakage (p = 0.02, OR 3.25). Multiple vasopressors and prolonged exposure caused even higher leaking rates. This effect was independent of the medical status and operative morbidity (APACHE II, POSSUM). Blood pressure preceding vasopressor use was similar in both groups. Vasopressors might have been occasionally used to treat hypovolemia. Patients with leaks had higher reoperation rates (41% versus 1%, p < 0.0001) and mortality (21% versus 4%, p = 0.002).
    Conclusions: Vasopressors appear to increase anastomotic leaks threefold, independent of clinical/surgical status or hypotension. Evidence-based guidelines are warranted for the optimal use of vasopressors in postoperative patients admitted to the ICU.
    MeSH term(s) APACHE ; Adult ; Aged ; Anastomosis, Surgical ; Critical Care ; Female ; Gastrointestinal Diseases/surgery ; Humans ; Male ; Middle Aged ; Regression Analysis ; Reoperation ; Retrospective Studies ; Risk Factors ; Surgical Wound Dehiscence/chemically induced ; Treatment Outcome ; Vasoconstrictor Agents/adverse effects
    Chemical Substances Vasoconstrictor Agents
    Language English
    Publishing date 2007-08
    Publishing country United States
    Document type Journal Article
    ZDB-ID 224043-9
    ISSN 1432-2323 ; 0364-2313
    ISSN (online) 1432-2323
    ISSN 0364-2313
    DOI 10.1007/s00268-007-9113-4
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  10. Article: Preventable deaths from hemorrhage at a level I Canadian trauma center.

    Tien, Homer C / Spencer, Fernando / Tremblay, Lorraine N / Rizoli, Sandro B / Brenneman, Frederick D

    The Journal of trauma

    2007  Volume 62, Issue 1, Page(s) 142–146

    Abstract: ... were from other causes. Of hemorrhagic deaths, 48% (n = 41) were from blunt injury, and 52% (n = 45 ...

    Abstract Background: Studies of trauma deaths have had a tremendous impact on the quality of contemporary trauma care. We studied causes of trauma death at a Level I Canadian trauma center, and tabulated preventable deaths from hemorrhage using explicit criteria.
    Methods: Trauma registry data were used to identify all trauma deaths at our institution from January 1, 1999 to December 31, 2003. Demographics, mechanism, and time or location of death were recorded. Registry data analysis and selective chart or autopsy review were then performed to assign causes of death.
    Results: A total of 558 consecutive trauma deaths were reviewed. Mean age was 48.7 (46.7-50.6), and mean Injury Severity Score was 38.8 (37.6-40.0); 29% were females. Blunt trauma represented 87% of all cases; penetrating injuries were only 13%. Central nervous system (CNS) injuries were the most frequent cause of death (60%), followed by hemorrhage (15%), and then combination CNS and hemorrhagic injuries (11%). Multiple organ failure caused 5% of deaths and 9% of deaths were from other causes. Of hemorrhagic deaths, 48% (n = 41) were from blunt injury, and 52% (n = 45) were from a penetrating mechanism. Of these hemorrhagic deaths, 16% were judged to be preventable because of significant delays in identifying the major source of hemorrhage. Hemorrhage from blunt pelvic injury was the major cause of exsanguination in 12 of 14 of these preventable deaths.
    Conclusions: Blunt injury is the major mechanism leading to trauma deaths. Massive bleeding from blunt pelvic injury is the major cause of preventable hemorrhagic deaths in our study.
    MeSH term(s) Adult ; Aged ; Aged, 80 and over ; Cause of Death ; Cohort Studies ; Female ; Hemorrhage/etiology ; Hemorrhage/mortality ; Hospital Mortality ; Humans ; Male ; Middle Aged ; Ontario/epidemiology ; Quality of Health Care ; Retrospective Studies ; Trauma Centers/statistics & numerical data ; Wounds, Nonpenetrating/complications ; Wounds, Nonpenetrating/mortality
    Language English
    Publishing date 2007-01
    Publishing country United States
    Document type Journal Article
    ZDB-ID 219302-4
    ISSN 1529-8809 ; 0022-5282 ; 1079-6061
    ISSN (online) 1529-8809
    ISSN 0022-5282 ; 1079-6061
    DOI 10.1097/01.ta.0000251558.38388.47
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