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Article ; Online: Diagnosis and management of blunt cardiac injury: What you need to know.

Biffl, Walter L / Fawley, Jason A / Mohan, Rajeev C

The journal of trauma and acute care surgery

2023 Volume 96, Issue 5, Page(s) 685–693

Abstract: Abstract: Blunt cardiac injury (BCI) encompasses a wide spectrum, from occult and inconsequential contusion to rapidly fatal cardiac rupture. A small percentage of patients present with abnormal electrocardiogram or shock, but most are initially ... ...

Abstract	Abstract: Blunt cardiac injury (BCI) encompasses a wide spectrum, from occult and inconsequential contusion to rapidly fatal cardiac rupture. A small percentage of patients present with abnormal electrocardiogram or shock, but most are initially asymptomatic. The potential for sudden dysrhythmia or cardiac pump failure mandates consideration of the presence of BCI, including appropriate monitoring and management. In this review, we will present what you need to know to diagnose and manage BCI.
MeSH term(s)	Humans ; Wounds, Nonpenetrating/therapy ; Wounds, Nonpenetrating/diagnosis ; Wounds, Nonpenetrating/complications ; Heart Injuries/diagnosis ; Heart Injuries/therapy ; Myocardial Contusions/diagnosis ; Myocardial Contusions/therapy ; Myocardial Contusions/complications ; Electrocardiography
Language	English
Publishing date	2023-12-04
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004216
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Article ; Online: Update on Extracorporeal Membrane Oxygenation Coding.

Fawley, Jason / Napolitano, Lena M

ASAIO journal (American Society for Artificial Internal Organs : 1992)

2019 Volume 66, Issue 1, Page(s) e5–e7

Language	English
Publishing date	2019-01-04
Publishing country	United States
Document type	Journal Article
ZDB-ID	759982-1
ISSN	1538-943X ; 0162-1432 ; 1058-2916
ISSN (online)	1538-943X
ISSN	0162-1432 ; 1058-2916
DOI	10.1097/MAT.0000000000000940
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Article ; Online: Vancomycin Enema in the Treatment of

Fawley, Jason / Napolitano, Lena M

Surgical infections

2019 Volume 20, Issue 4, Page(s) 311–316

Abstract: Background: ...

Abstract	Background:
MeSH term(s)	Administration, Rectal ; Aged ; Anti-Bacterial Agents/administration & dosage ; Clostridium Infections/drug therapy ; Clostridium difficile/drug effects ; Enema/methods ; Female ; Humans ; Male ; Practice Guidelines as Topic ; Treatment Outcome ; United States ; Vancomycin/administration & dosage
Chemical Substances	Anti-Bacterial Agents ; Vancomycin (6Q205EH1VU)
Language	English
Publishing date	2019-02-04
Publishing country	United States
Document type	Journal Article ; Systematic Review
ZDB-ID	1440120-4
ISSN	1557-8674 ; 1096-2964
ISSN (online)	1557-8674
ISSN	1096-2964
DOI	10.1089/sur.2018.238
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Article ; Online: Intestinal alkaline phosphatase: a summary of its role in clinical disease.

Fawley, Jason / Gourlay, David M

The Journal of surgical research

2016 Volume 202, Issue 1, Page(s) 225–234

Abstract: Over the past few years, there is increasing evidence implicating a novel role for Intestinal Alkaline Phosphatase (IAP) in mitigating inflammatory mediated disorders. IAP is an endogenous protein expressed by the intestinal epithelium that is believed ... ...

Abstract	Over the past few years, there is increasing evidence implicating a novel role for Intestinal Alkaline Phosphatase (IAP) in mitigating inflammatory mediated disorders. IAP is an endogenous protein expressed by the intestinal epithelium that is believed to play a vital role in maintaining gut homeostasis. Loss of IAP expression or function is associated with increased intestinal inflammation, dysbiosis, bacterial translocation and subsequently systemic inflammation. As these events are a cornerstone of the pathophysiology of many diseases relevant to surgeons, we sought to review recent research in both animal and humans on IAP's physiologic function, mechanisms of action and current research in specific surgical diseases.
MeSH term(s)	Alkaline Phosphatase/metabolism ; Bacterial Translocation ; Biomarkers/metabolism ; Dysbiosis/etiology ; Dysbiosis/metabolism ; Enterocolitis, Necrotizing/etiology ; Enterocolitis, Necrotizing/metabolism ; Enterocolitis, Necrotizing/microbiology ; GPI-Linked Proteins/metabolism ; Gastrointestinal Microbiome ; Homeostasis/physiology ; Humans ; Inflammation/etiology ; Inflammation/metabolism ; Inflammatory Bowel Diseases/etiology ; Inflammatory Bowel Diseases/metabolism ; Inflammatory Bowel Diseases/microbiology ; Intestinal Mucosa/metabolism ; Intestinal Mucosa/microbiology ; Intestines/metabolism ; Intestines/microbiology ; Metabolic Syndrome/etiology ; Metabolic Syndrome/metabolism ; Metabolic Syndrome/microbiology ; Sepsis/etiology ; Sepsis/metabolism ; Sepsis/microbiology
Chemical Substances	Biomarkers ; GPI-Linked Proteins ; ALPI protein, human (EC 3.1.3.1) ; Alkaline Phosphatase (EC 3.1.3.1)
Language	English
Publishing date	2016-05-01
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2015.12.008
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Article ; Online: Relationship between perioperative blood transfusion and surgical site infections in pediatric general and thoracic surgical patients.

Fawley, Jason / Chelius, Thomas H / Arca, Marjorie J

Journal of pediatric surgery

2018 Volume 53, Issue 6, Page(s) 1105–1110

Abstract: Background: Recently, perioperative transfusions were demonstrated to be associated with higher rate of surgical site infections (SSIs) in neonates. We sought to examine whether a similar relationship exists between perioperative blood transfusions and ... ...

Abstract	Background: Recently, perioperative transfusions were demonstrated to be associated with higher rate of surgical site infections (SSIs) in neonates. We sought to examine whether a similar relationship exists between perioperative blood transfusions and SSI among non-neonatal pediatric general surgical patients. Methods: We conducted an IRB-approved retrospective study reviewing non-neonatal patients (age greater than 28days and less than 18years) who underwent a general or thoracic surgical procedure in 2012, 2013, 2014, in the American College of Surgeons National Safety and Quality Improvement Project-Pediatric (ACS-NSQIP-P) Participant User Files. We used Chi-square analyses to perform a bivariate analysis comparing proportions of SSI's between patients who received blood transfusion to those who did not. Multiple logistic regression analyses compared the odds of SSIs in transfused versus nontransfused patients controlling for organ failure, steroid use, nutritional status, current infection, American Society of Anesthesiologists (ASA) Physical Status classification, and wound classification. Results: There were 55,133 patients with 1779 patients who received blood transfusion (≥25ml/kg body weight) during or within 72h of surgery. Bivariate analysis showed at least twice the rate of infection in transfused patients compared to nontransfused patients (p<0.01): superficial SSI 3.5% vs 1.5%; deep SSI 0.8% vs 0.2%, organ space SSI 3.8% vs 1.6%; deep dehiscence 2% vs 0.3%. Total wound infections and dehiscence for transfused patients were 10.5% vs 3.8% in nontransfused patients (p<0.01). Multiple regression analysis showed that nutritional issue, current infection, and wounds not classified as "clean" have statistically significant correlation with SSI. Although there was significant interaction between ASA and transfusion (p<0.0001), we found statistically significant associations between transfusions and SSI for ASA class 1-2 (OR=5.51, 95% CI 3.47-7.52), ASA class 3 (OR=2.06, 95% CI 1.63-2.61), and ASA class 4-5 (OR=1.67, 95% CI 1.15-2.42). Conclusion: In non-newborn pediatric general and thoracic surgery patients, transfusions were associated with higher risk of SSI or wound dehiscence. Although there was a significant interaction between ASA and transfusion, OR for SSI was stronger for lower ASA classes. Type of study: Retrospective Review. Level of evidence: II.
MeSH term(s)	Adolescent ; Blood Transfusion ; Child ; Child, Preschool ; Female ; Humans ; Infant ; Infant, Newborn ; Logistic Models ; Male ; Multivariate Analysis ; Perioperative Care/adverse effects ; Perioperative Care/methods ; Retrospective Studies ; Risk Factors ; Surgical Wound Dehiscence/diagnosis ; Surgical Wound Dehiscence/epidemiology ; Surgical Wound Dehiscence/etiology ; Surgical Wound Infection/diagnosis ; Surgical Wound Infection/epidemiology ; Surgical Wound Infection/etiology ; Thoracic Surgical Procedures ; Transfusion Reaction/diagnosis ; Transfusion Reaction/epidemiology
Language	English
Publishing date	2018-03-04
Publishing country	United States
Document type	Journal Article ; Observational Study
ZDB-ID	80165-3
ISSN	1531-5037 ; 0022-3468
ISSN (online)	1531-5037
ISSN	0022-3468
DOI	10.1016/j.jpedsurg.2018.02.062
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Article ; Online: Enteral nutrition is associated with high rates of pneumonia in intensive care unit (ICU) patients with acute pancreatitis.

Gaitanidis, Apostolos / Breen, Kerry / Mendoza, April / Fawley, Jason / Lee, Jarone / Parks, Jonathan / Kaafarani, Haytham M A / Velmahos, George / Fagenholz, Peter J

Journal of critical care

2022 Volume 69, Page(s) 154012

Abstract: Purpose: Enteral nutrition is associated with improved outcomes in acute pancreatitis (AP), but previous studies have not focused on critically-ill patients. Our purpose was to determine the association between nutritional support and infectious ... ...

Abstract	Purpose: Enteral nutrition is associated with improved outcomes in acute pancreatitis (AP), but previous studies have not focused on critically-ill patients. Our purpose was to determine the association between nutritional support and infectious complications in ICU-admitted patients with AP. Methods: A retrospective analysis of patients with AP admitted in ICUs of 127 US hospitals from the eICU Collaborative were included. Patients were classified by type (initial and any use) of nutritional support they received: none (NN); oral (ON); enteral (EN); and parenteral nutrition (PN). Results: 925 patients were identified. Length of stay was longer in the initial PN group (PN 21.3 ± 15.4 d, EN 19.1 ± 20.1 d, ON 8 ± 7.1 d, NN 6.6 ± 6.3 d, p < 0.001) and mortality was more common in the initial EN group (EN 16.7%, PN 8.9%, ON 2.7%, NN 10.9%, p < 0.001). Multivariate analysis found any EN use to be associated with infections (OR 2.12, 95% CI: 1.13-3.98, p = 0.019) and pneumonias (OR 2.04, 95% CI: 1.04-4.03, p = 0.039). Conclusion: EN was associated with an increased risk for pneumonias and overall infections in critically-ill patients with AP. More studies are needed to assess optimal nutritional approaches in critically-ill AP patients and patients who do not tolerate EN.
MeSH term(s)	Acute Disease ; Critical Illness ; Enteral Nutrition ; Humans ; Intensive Care Units ; Length of Stay ; Pancreatitis/therapy ; Pneumonia/epidemiology ; Pneumonia/therapy ; Retrospective Studies
Language	English
Publishing date	2022-02-23
Publishing country	United States
Document type	Journal Article
ZDB-ID	632818-0
ISSN	1557-8615 ; 0883-9441
ISSN (online)	1557-8615
ISSN	0883-9441
DOI	10.1016/j.jcrc.2022.154012
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Article ; Online: American Association for the Surgery of Trauma/American College of Surgeons Committee on Trauma clinical protocol for management of acute respiratory distress syndrome and severe hypoxemia.

Fawley, Jason A / Tignanelli, Christopher J / Werner, Nicole L / Kasotakis, George / Mandell, Samuel P / Glass, Nina E / Dries, David J / Costantini, Todd W / Napolitano, Lena M

The journal of trauma and acute care surgery

2023 Volume 95, Issue 4, Page(s) 592–602

Abstract: Level of evidence: Therapeutic/Care Management: Level V. ...

Abstract	Level of evidence: Therapeutic/Care Management: Level V.
MeSH term(s)	Humans ; United States ; Respiratory Distress Syndrome/etiology ; Respiratory Distress Syndrome/therapy ; Hypoxia/etiology ; Hypoxia/therapy ; Surgeons ; Clinical Protocols
Language	English
Publishing date	2023-06-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000004046
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Article ; Online: Central Venous Access in the Pediatric Population With Emphasis on Complications and Prevention Strategies.

Duesing, Lori A / Fawley, Jason A / Wagner, Amy J

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition

2016 Volume 31, Issue 4, Page(s) 490–501

Abstract: Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid ... ...

Abstract	Central venous catheters are often necessary in the pediatric population. Access may be challenging, and each vessel presents its own unique set of risks and complications. Central venous catheterization is useful for hemodynamic monitoring, rapid fluid infusion, and administration of hyperosmolar medications, including vasopressors, antibiotics, chemotherapy, and parenteral nutrition. Recent advances have improved the catheters used as well as techniques for insertion. A serious complication of central access is infection, which is associated with morbidity, mortality, and significant financial costs. Reduction of catheter-related bloodstream infections is realized with use of ethanol locks, single lumens when appropriate, and prudent adherence to insertion and maintenance bundles. Ultrasound guidance used for central venous catheter placement improves accuracy of placement, reducing time and unsuccessful insertion and complication rates. Patients with central venous catheters are best served by multidisciplinary team involvement.
MeSH term(s)	Catheter-Related Infections/prevention & control ; Catheterization, Central Venous/adverse effects ; Catheterization, Central Venous/methods ; Central Venous Catheters/adverse effects ; Child, Preschool ; Humans ; Infant ; Ultrasonography, Interventional
Language	English
Publishing date	2016-08
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	645074-x
ISSN	1941-2452 ; 0884-5336
ISSN (online)	1941-2452
ISSN	0884-5336
DOI	10.1177/0884533616640454
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Article ; Online: Expanded utilization of nonoperative management for complicated appendicitis in children.

Fawley, Jason / Gollin, Gerald

Langenbeck's archives of surgery

2012 Volume 398, Issue 3, Page(s) 463–466

Abstract: Purpose: The initial approach to complicated appendicitis in children has become increasingly nonoperative, particularly when there is presumed perforation and a localized abscess. We extended the indications for nonoperative management to include most ... ...

Abstract	Purpose: The initial approach to complicated appendicitis in children has become increasingly nonoperative, particularly when there is presumed perforation and a localized abscess. We extended the indications for nonoperative management to include most cases other than simple appendicitis, including those with diffuse peritoneal involvement. We evaluated outcomes and sought to identify factors at the time of hospital admission that predicted an extended length of stay (LOS) with this strategy. Methods: The records of 223 consecutive children who were managed nonoperatively for complicated appendicitis were reviewed. A conservative approach was typically pursued in those with an abscess, phlegmon, or free fluid on initial imaging studies, and diffuse tenderness, diarrhea, or significant leukocytosis after 2 days of symptoms. Interval appendectomies were performed selectively. Results: The average LOS was 5.6 days (1-38), but nine subjects had a LOS of greater than 14 days. Eleven (4.9 %) required appendectomy during the initial admission. Free fluid on admission imaging studies, present in 78 % of those with an extended LOS, [odds ratio (OR) 5.5], in addition to a requirement for early nasogastric drainage (OR 24.2) and a higher band count (19 vs 15 %), was significantly associated with an extended LOS. Conclusions: An expansion of the indications for nonoperative management of complicated appendicitis yielded an acceptable average LOS and a low incidence of early appendectomy. However, a small subset of subjects had an extended LOS, and most of those had free peritoneal fluid on admission.
MeSH term(s)	Adolescent ; Age Factors ; Anti-Bacterial Agents/therapeutic use ; Appendicitis/diagnosis ; Appendicitis/therapy ; Blood Chemical Analysis ; Child ; Child, Preschool ; Cohort Studies ; Combined Modality Therapy ; Confidence Intervals ; Drainage/methods ; Female ; Follow-Up Studies ; Hospitalization ; Humans ; Length of Stay ; Leukocyte Count ; Male ; Odds Ratio ; Retrospective Studies ; Risk Assessment ; Severity of Illness Index ; Sex Factors ; Therapeutic Irrigation/methods ; Tomography, X-Ray Computed/methods ; Treatment Outcome
Chemical Substances	Anti-Bacterial Agents
Language	English
Publishing date	2012-12-27
Publishing country	Germany
Document type	Comparative Study ; Journal Article
ZDB-ID	1423681-3
ISSN	1435-2451 ; 1435-2443
ISSN (online)	1435-2451
ISSN	1435-2443
DOI	10.1007/s00423-012-1042-5
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Article ; Online: Do not forget the platelets: The independent impact of red blood cell to platelet ratio on mortality in massively transfused trauma patients.

Dorken Gallastegi, Ander / Naar, Leon / Gaitanidis, Apostolos / Gebran, Anthony / Nederpelt, Charlie J / Parks, Jonathan J / Hwabejire, John O / Fawley, Jason / Mendoza, April E / Saillant, Noelle N / Fagenholz, Peter J / Velmahos, George C / Kaafarani, Haytham M A

The journal of trauma and acute care surgery

2022 Volume 93, Issue 1, Page(s) 21–29

Abstract: Background: Balanced blood component administration during massive transfusion is standard of care. Most literature focuses on the impact of red blood cell (RBC)/fresh frozen plasma (FFP) ratio, while the value of balanced RBC:platelet (PLT) ... ...

Abstract	Background: Balanced blood component administration during massive transfusion is standard of care. Most literature focuses on the impact of red blood cell (RBC)/fresh frozen plasma (FFP) ratio, while the value of balanced RBC:platelet (PLT) administration is less established. The aim of this study was to evaluate and quantify the independent impact of RBC:PLT on 24-hour mortality in trauma patients receiving massive transfusion. Methods: Using the 2013 to 2018 American College of Surgeons Trauma Quality Improvement Program database, adult patients who received massive transfusion (≥10 U of RBC/24 hours) and ≥1 U of RBC, FFP, and PLT within 4 hours of arrival were retrospectively included. To mitigate survival bias, only patients with consistent RBC:PLT and RBC:FFP ratios between 4 and 24 hours were analyzed. Balanced FFP or PLT transfusions were defined as having RBC:PLT and RBC:FFP of ≤2, respectively. Multivariable logistic regression was used to compare the independent relationship between RBC:FFP, RBC:PLT, balanced transfusion, and 24-hour mortality. Results: A total of 9,215 massive transfusion patients were included. The number of patients who received transfusion with RBC:PLT >2 (1,942 [21.1%]) was significantly higher than those with RBC:FFP >2 (1,160 [12.6%]) (p < 0.001). Compared with an RBC:PLT ratio of 1:1, a gradual and consistent risk increase was observed for 24-hour mortality as the RBC:PLT ratio increased (p < 0.001). Patients with both FFP and PLT balanced transfusion had the lowest adjusted risk for 24-hour mortality. Mortality increased as resuscitation became more unbalanced, with higher odds of death for unbalanced PLT (odds ratio, 2.48 [2.18-2.83]) than unbalanced FFP (odds ratio, 1.66 [1.37-1.98]), while patients who received both FFP and PLT unbalanced transfusion had the highest risk of 24-hour mortality (odds ratio, 3.41 [2.74-4.24]). Conclusion: Trauma patients receiving massive transfusion significantly more often have unbalanced PLT rather than unbalanced FFP transfusion. The impact of unbalanced PLT transfusion on 24-hour mortality is independent and potentially more pronounced than unbalanced FFP transfusion, warranting serious system-level efforts for improvement. Level of evidence: Therapeutic/Care Management; Level IV.
MeSH term(s)	Adult ; Blood Component Transfusion ; Blood Platelets ; Erythrocyte Transfusion ; Erythrocytes ; Humans ; Retrospective Studies
Language	English
Publishing date	2022-03-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000003598
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