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Article ; Online: Invited Commentary to "Performance Improvement Program Review of Institutional Massive Transfusion Protocol Adherence: An Opportunity for Improvement".

Kalkwarf, Kyle J / Cotton, Bryan A

2024 Volume 90, Issue 5, Page(s) 1108–1109

MeSH term(s)	Humans ; Blood Transfusion/methods ; Guideline Adherence ; Retrospective Studies
Language	English
Publishing date	2024-02-01
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221103655
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Article ; Online: Commentary on "A Dose-Response Analysis of Crystalloid Administration during Esophageal Resection".

Kalkwarf, Kyle J

Southern medical journal

2019 Volume 112, Issue 7, Page(s) 419

MeSH term(s)	Crystalloid Solutions ; Fluid Therapy ; Humans ; Hypotension
Chemical Substances	Crystalloid Solutions
Language	English
Publishing date	2019-07-08
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	185329-6
ISSN	1541-8243 ; 0038-4348
ISSN (online)	1541-8243
ISSN	0038-4348
DOI	10.14423/SMJ.0000000000000992
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Article ; Online: Opioid Prescribing Behaviors Among Surgical Intensive Care Unit Attending Physicians.

Goodman, Emily M / Wells, Allison / Jensen, Hanna K / Kalkwarf, Kyle J

The American surgeon

2022 Volume 88, Issue 7, Page(s) 1479–1483

Abstract: Background: More than 5 million Americans misuse opioids. Six percent of patients who receive opioids for acute pain progress to chronic use; this increases with higher doses and longer prescriptions. Prescribing variation exists within trauma centers ... ...

Abstract	Background: More than 5 million Americans misuse opioids. Six percent of patients who receive opioids for acute pain progress to chronic use; this increases with higher doses and longer prescriptions. Prescribing variation exists within trauma centers and after emergency surgery but has not been demonstrated among intensivists. Methods: Milligram morphine equivalents (MME) per patient-ICU-day provided by eleven surgical intensivists were analyzed. The patients were separated into 2 groups based on their percentage of time intubated in the surgical ICU. Both study groups were compared using demographics and comorbidity scores. The attendings were divided into high- and low-prescribing groups based on their MME/pt-ICU-day for intubated patients, and bivariate statistical analyses were performed. A similar analysis compared surgery vs anesthesia intensivists. Results: The analysis included 257 patients in the "long-vent group" (LVG) and 668 patients in the "short-vent group" (SVG). The average MME/pt-ICU-day for the LVG was 222. Despite no significant differences in age, sex, or Elixhauser Comorbidity Index, there was a 45% difference between the high- and low-prescribing physicians in the LVG (253.7 vs 175.4 MME/pt-ICU-day;
MeSH term(s)	Analgesics, Opioid ; Critical Care ; Humans ; Intensive Care Units ; Pain, Postoperative/drug therapy ; Physicians ; Practice Patterns, Physicians' ; Retrospective Studies ; United States
Chemical Substances	Analgesics, Opioid
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221082280
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Article ; Online: Green Plasma Has a Superior Hemostatic Profile Compared With Standard Color Plasma.

Kalkwarf, Kyle J / Cardenas, Jessica C / Wade, Charles E / Cotton, Bryan A

The American surgeon

2022 Volume 88, Issue 8, Page(s) 1970–1975

Abstract: Background: Limitations in available donors have dramatically reduced plasma availability over the past several decades, concurrent with increasing demand for some types of plasma. Plasma from female donors who are pregnant or taking oral contraceptives ...

Abstract	Background: Limitations in available donors have dramatically reduced plasma availability over the past several decades, concurrent with increasing demand for some types of plasma. Plasma from female donors who are pregnant or taking oral contraceptives often has a green appearance, which frequently results in these units being discarded. This pilot study aimed to evaluate the hemostatic potential of green compared to standard-color plasma. Materials and methods: Plasma from twelve blood group-matched female and twelve male donors was obtained from the local blood center. Six of the female and all of the male units of plasma had a normal appearance (STANDARD), while six of the female units were grossly green (GREEN). The hemostatic potential was evaluated by thrombelastography (TEG), calibrated automated thrombogram (CAT), and coagulation factor level measurements. Univariate analysis was performed using Wilcoxon Rank-Sum. Results: GREEN plasma was more procoagulant for all TEG values ( Discussion: This pilot study demonstrates that female donors with green plasma have a superior hemostatic profile than standard plasma. GREEN plasma should be further investigated for its safety profile and hemostatic potential, so if it is found to be a safe and functionally non-inferior product, it should be actively re-introduced for transfusion in bleeding patients.
MeSH term(s)	Blood Coagulation Factors ; Female ; Hemostasis ; Hemostatics ; Humans ; Male ; Pilot Projects ; Pregnancy ; Thrombelastography/methods
Chemical Substances	Blood Coagulation Factors ; Hemostatics
Language	English
Publishing date	2022-04-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221096571
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Article: A closed surgical intensive care unit organization improves cardiac surgical patient outcomes.

Johnson, Lauren A / Klucher, Brianna / Jensen, Hanna / Reif, Rebecca / Kalkwarf, Kyle J / Sexton, Kevin / Kimbrough, Mary Katherine

Journal of thoracic disease

2024 Volume 16, Issue 2, Page(s) 1262–1269

Abstract: Background: Intensive care unit (ICU) organization is a critical factor in optimizing patient outcomes. ICU organization can be divided into "OPEN" (O) and "CLOSED" (C) models, where the specialist or intensivist, respectively, assumes the role of ... ...

Abstract	Background: Intensive care unit (ICU) organization is a critical factor in optimizing patient outcomes. ICU organization can be divided into "OPEN" (O) and "CLOSED" (C) models, where the specialist or intensivist, respectively, assumes the role of primary physician. Recent studies support improved outcomes in closed ICUs, however, most of the available data is centered on ICUs generally or on subspecialty surgical patients in the setting of a subspecialized surgical intensive care unit (SICU). We examined the impact of closing a general SICU on patient outcomes following cardiac and ascending aortic surgery. Methods: A retrospective cohort of patients following cardiac or ascending aortic surgery by median sternotomy was examined at a single academic medical center one year prior and one year after implementation of a closed SICU model. Patients were divided into "OPEN" (O; n=53) and "CLOSED" (C; n=73) cohorts. Results: Cohorts were comparable in terms of age, race, and number of comorbid conditions. A significant difference in male gender (O: 60.4% Conclusions: Our study identified a decreased ICU LOS and hospital readmission in cardiac and ascending aortic patients in a closed general SICU despite increased procedure complexity. Further study is needed to clarify the effects on surgical complications and hospital charges.
Language	English
Publishing date	2024-02-27
Publishing country	China
Document type	Journal Article
ZDB-ID	2573571-8
ISSN	2077-6624 ; 2072-1439
ISSN (online)	2077-6624
ISSN	2072-1439
DOI	10.21037/jtd-22-1471
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Article ; Online: Weight-Based Dosing for Low-Molecular-Weight Heparin (Enoxaparin) Administration to Achieve Optimal VTE Prophylaxis in Trauma Patients.

Thind, Tarendeep / Heye, Thomas / Henson, Curran / Reif, Rebecca / Jensen, Hanna K / Kalkwarf, Kyle J / Bhavaraju, Avi / Robertson, Ronald / Jenkins, Allison

The American surgeon

2024 , Page(s) 31348241241620

Abstract: Introduction: Patients admitted after traumatic injuries are at high risk for developing venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) is commonly used to prevent VTE in this patient population; however, the optimal dosing strategy ... ...

Abstract	Introduction: Patients admitted after traumatic injuries are at high risk for developing venous thromboembolism (VTE). Low-molecular-weight heparin (LMWH) is commonly used to prevent VTE in this patient population; however, the optimal dosing strategy has yet to be determined. To address this question, a fixed-dosing strategy of LMWH was compared to a weight-based dosing strategy of LMWH for VTE prophylaxis. Methods: A retrospective, pre-post implementation cohort study compared a fixed vs a weight-based dosing strategy of LMWH for VTE prophylaxis. Patients admitted to our level 1 trauma center were included if they had an estimated glomerular filtration rate >30 mL/min/1.73 m Results: There were 817 patients in the fixed-dosing group (FDG) and 874 patients in the weight-based dosing group (WBDG). In the FDG, 42.8% of the patients achieved the goal initial anti-Xa level, with 54.1% and 3.1% reaching sub- and supratherapeutic doses, respectively. In the WBDG, 66.5% of patients reached goal initial anti-Xa levels, with 23.5% and 10.1% at sub- and supratherapeutic levels. The distribution of dose ranges was significantly different between the dosing strategies ( Conclusions: In our study, weight-based dosing of LMWH yielded a significantly higher proportion of patients who achieved goal prophylactic anti-Xa levels than fixed-dosing of LMWH. Larger-scale studies are needed to assess the risk of VTE events and bleeding with these dosing strategies.
Language	English
Publishing date	2024-03-22
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348241241620
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Article ; Online: Increased Lengths of Stay, ICU, and Ventilator Days in Trauma Patients with Asymptomatic COVID-19 Infection.

Klutts, Garrett N / Squires, Austin / Bowman, Stephen M / Bhavaraju, Avi / Kalkwarf, Kyle J

The American surgeon

2022 Volume 88, Issue 7, Page(s) 1522–1525

Abstract: Background: The SARS-Cov-2 coronavirus has varying clinical effects-from asymptomatic patients to life-threatening illness and death. At the only Level 1 Trauma Center in a rural state, outcomes appeared worse in trauma patients who tested positive for ... ...

Abstract	Background: The SARS-Cov-2 coronavirus has varying clinical effects-from asymptomatic patients to life-threatening illness and death. At the only Level 1 Trauma Center in a rural state, outcomes appeared worse in trauma patients who tested positive for COVID despite these patients presumably being asymptomatic or only mildly affected before their traumatic event. This study compares all trauma admissions that were COVID-positive to those who were not. Methods: The institutional database was queried for all level 1 and 2 trauma activations from March 2020-July 2021. The analysis consisted of a multivariate regression between COVID-negative and the COVID-positive group controlling for age, injury severity score (ISS), and Glasgow Coma Score (GCS). Outcomes compared were hospital length-of-stay (LOS), ICU LOS, ventilator days, days to discharge to a facility, and in-hospital mortality. Results: Hospital LOS was 2.7 days longer in the COVID-positive group ( Conclusion: Trauma patients presenting positive for COVID-19 are presumed to be asymptomatic before their traumatic event. Despite this, the physiologic toll of trauma combined with the COVID infection causes significantly worse clinical outcomes, including increasing hospital days in this patient population, which continues to tax the already burdened healthcare system.
MeSH term(s)	COVID-19/therapy ; Humans ; Intensive Care Units ; Length of Stay ; Retrospective Studies ; SARS-CoV-2 ; Trauma Centers ; Ventilators, Mechanical
Language	English
Publishing date	2022-04-13
Publishing country	United States
Document type	Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221082290
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Article ; Online: Recognition of Laceration of an Aberrant Superficial Ulnar Artery With Intraoperative Allen Test and Primary Repair.

Pilkington, Collin W / Simmons, Christian D / Klutts, Garrett / Jensen, Hanna K / Kalkwarf, Kyle J

The American surgeon

2022 Volume 88, Issue 7, Page(s) 1570–1572

Abstract: There are variations in anatomy that may alter the vasculature of an individual. This case report demonstrates an abnormal branching pattern of a lacerated ulnar artery and its successful surgical repair. Without proper identification, anatomical ... ...

Abstract	There are variations in anatomy that may alter the vasculature of an individual. This case report demonstrates an abnormal branching pattern of a lacerated ulnar artery and its successful surgical repair. Without proper identification, anatomical variations can negatively impact a trauma patient.
MeSH term(s)	Humans ; Lacerations/diagnosis ; Lacerations/surgery ; Radial Artery/anatomy & histology ; Ulnar Artery/anatomy & histology ; Ulnar Artery/injuries ; Ulnar Artery/surgery
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
DOI	10.1177/00031348221084942
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Article ; Online: The silent killer: Previously undetected pulmonary emboli that result in death after discharge.

Kalkwarf, Kyle J / Yang, Yijiong / Mora, Stephen / Wolf, Dwayne A / Robertson, Ronald D / Holcomb, John B / Drake, Stacy A

Injury

2023 Volume 54, Issue 11, Page(s) 111016

Abstract: Introduction: Pulmonary embolism (PE) is a recognized cause of death in hospitalized trauma patients, yet less is known about PE after discharge.: Patients & methods: All post-discharge, autopsy-demonstrated, fatal PE resulting from trauma within a ... ...

Abstract	Introduction: Pulmonary embolism (PE) is a recognized cause of death in hospitalized trauma patients, yet less is known about PE after discharge. Patients & methods: All post-discharge, autopsy-demonstrated, fatal PE resulting from trauma within a large US county over six years were analyzed. Counts, percentages, mean values, SD, and IQR were calculated for all variables. Results: 1848 trauma deaths were reviewed, of which 85% had an autopsy. Eighty-five patients died from PE after discharge from their initial injury. 53% were initially treated at non-trauma centers, and 9% did not seek medical assistance. 75% were injured by falling, and most injuries occurred in the lower extremities. 86% had an ISS <16, but 87% needed assistance or were bed-bound after injury, despite 75% having no mobility limitations before the injury. 53% died within one month of injury, and 91% within the first year. Before death, only 11% were prescribed chemical thromboprophylaxis or an antiplatelet agent, and only 8% were diagnosed with venous thromboembolism before death. Conclusions: Fatal PE after discharge typically occurred following activity-limiting lower extremity injuries with an ISS<16.
MeSH term(s)	Humans ; Anticoagulants/therapeutic use ; Venous Thromboembolism/prevention & control ; Patient Discharge ; Aftercare ; Pulmonary Embolism/prevention & control ; Risk Factors
Chemical Substances	Anticoagulants
Language	English
Publishing date	2023-09-06
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	218778-4
ISSN	1879-0267 ; 0020-1383
ISSN (online)	1879-0267
ISSN	0020-1383
DOI	10.1016/j.injury.2023.111016
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Article ; Online: Resuscitation for Hypovolemic Shock.

Kalkwarf, Kyle J / Cotton, Bryan A

The Surgical clinics of North America

2017 Volume 97, Issue 6, Page(s) 1307–1321

Abstract: Hemorrhage is the leading cause of preventable deaths in trauma patients. After presenting a brief history of hemorrhagic shock resuscitation, this article discusses damage control resuscitation and its adjuncts. Massively bleeding patients in ... ...

Abstract	Hemorrhage is the leading cause of preventable deaths in trauma patients. After presenting a brief history of hemorrhagic shock resuscitation, this article discusses damage control resuscitation and its adjuncts. Massively bleeding patients in hypovolemic shock should be treated with damage control resuscitation principles including limited crystalloid, whole blood or balance blood component transfusion to permissive hypotension, preventing hypothermia, and stopping bleeding as quickly as possible.
Language	English
Publishing date	2017-12
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	215713-5
ISSN	1558-3171 ; 0039-6109
ISSN (online)	1558-3171
ISSN	0039-6109
DOI	10.1016/j.suc.2017.07.011
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