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Article ; Online: Focused and Extended Focused Assessment With Sonography for Trauma.

Blank-Reid, Cynthia / Zappile, Denise M / Santora, Thomas A

2023 Volume 34, Issue 2, Page(s) 129–138

Abstract: Timing is crucial when caring for an injured patient, and the evaluation requires a systematic, rapid, and thorough assessment to identify and treat immediate life-threatening injuries. An integral component of this assessment is the Focused Assessment ... ...

Abstract	Timing is crucial when caring for an injured patient, and the evaluation requires a systematic, rapid, and thorough assessment to identify and treat immediate life-threatening injuries. An integral component of this assessment is the Focused Assessment with Sonography for Trauma (FAST) and the extended FAST (eFAST). These assessments allow for a rapid, noninvasive, portable, accurate, repeatable, and inexpensive means of diagnosing internal injury to the abdomen, chest, and pelvis. Understanding the basic principles of ultrasonography, having a thorough familiarity with the equipment, and being knowledgeable in anatomy allow the bedside practitioner to use this tool to rapidly assess injured patients. This article reviews the basic tenets that underpin the FAST and eFAST evaluations. Practical interventions and tips are provided to assist novice operators-all with the goal of decreasing the learning curve.
MeSH term(s)	Humans ; Focused Assessment with Sonography for Trauma ; Thoracic Injuries ; Sensitivity and Specificity ; Ultrasonography
Language	English
Publishing date	2023-06-08
Publishing country	United States
Document type	Review ; Journal Article
ZDB-ID	2239949-5
ISSN	1559-7776 ; 1559-7768
ISSN (online)	1559-7776
ISSN	1559-7768
DOI	10.4037/aacnacc2023597
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Article ; Online: Talk and Die: A Descriptive Analysis of Penetrating Trauma Patients.

Dauer, Elizabeth / Beard, Jessica H / Maher, Zoë / Sjoholm, Lars / Santora, Thomas / Pathak, Abhijit / Anderson, Jeffrey / Goldberg, Amy

The Journal of surgical research

2022 Volume 278, Page(s) 1–6

Abstract: Introduction: "Talk and die" traditionally described occult presentations of fatal intracranial injuries, but we broaden its definition to victims of penetrating trauma.: Methods: We conducted a descriptive analysis of patients with penetrating torso ...

Abstract	Introduction: "Talk and die" traditionally described occult presentations of fatal intracranial injuries, but we broaden its definition to victims of penetrating trauma. Methods: We conducted a descriptive analysis of patients with penetrating torso trauma who presented with a Glasgow Coma Scale verbal score ≥3 and died within 48 h of arrival from 2008 to 2018. Results: Sixty patients were identified. Eighteen (30.0%) required resuscitative thoracotomy with 7 (11.7%) dying in the trauma bay. Fifty-three (86.9%) patients went to the operating room, and 35 (66.0%) required multicavitary exploration. The most common injuries were hollow viscous (58.5%), intra-abdominal vascular (49.0%), liver (28.3%), pulmonary (26.4%), intrathoracic vascular (18.9%), and cardiac (15.75) injuries. Twenty-three (43.4%) patients survived their initial operation, but died in the first 48 h postoperatively. Conclusions: Patients who "talk and die" most frequently have intra-abdominal vascular injures and require multicavitary exploration.
MeSH term(s)	Glasgow Coma Scale ; Humans ; Resuscitation ; Retrospective Studies ; Thoracotomy ; Wounds, Penetrating/complications ; Wounds, Penetrating/surgery
Language	English
Publishing date	2022-05-16
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2022.04.037
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Article ; Online: Syncope workup: Greater yield in select trauma population.

Harfouche, Melike / Cline, Michael / Mazzei, Michael / Santora, Thomas

International journal of surgery (London, England)

2017 Volume 44, Page(s) 210–214

Abstract: Background: There is great variation in practice regarding the assessment of trauma patients who present with syncope. The purpose of this study was to determine the yield of screening studies (electrocardiogram, echocardiogram, and carotid duplex) and ... ...

Abstract	Background: There is great variation in practice regarding the assessment of trauma patients who present with syncope. The purpose of this study was to determine the yield of screening studies (electrocardiogram, echocardiogram, and carotid duplex) and define characteristics to identify groups that may benefit from these investigations. Methods: We conducted a retrospective cohort study of all trauma patients from 2003 to 2015 who received a carotid duplex as part of a syncope evaluation at our urban Level 1 Trauma Center. Demographics, clinical findings as well as interventions undertaken (ie: placement of defibrillators/pacemakers) as a result of the syncope evaluation were collected. Data analysis was performed with STATA 14 and relationships between comorbidities, positive findings and interventions were assessed. Significance was assumed for p < 0.05. Results: 736 trauma patients were included in the study. The most common mechanism of injury was fall (592, 82%). A history of congestive heart failure (CHF) and/or coronary artery disease (CAD) and age ≥ 65 were significantly associated with abnormal ECG and ECHO findings, but not with severe carotid stenosis. Elevated Injury Severity Scale (ISS) was significantly associated with an abnormal ECHO on both univariate and multivariate analysis. An abnormal ECG was predictive of an abnormal ECHO (p = 0.02). Ten patients (1.4%) underwent placement of a defibrillator and/or pacemaker, all of whom reported having CHF. Only 11 patients (1.7%) had severe carotid stenosis (>70%) requiring intervention. Conclusion: The screening studies used in a syncope evaluation have low yield in the general trauma population. Carotid duplex should not be routinely performed. Cardiac evaluation should be tailored to individuals with cardiac comorbidities, older age and elevated ISS. An ECG should be used as initial screening in this patient cohort.
Language	English
Publishing date	2017-08
Publishing country	England
Document type	Journal Article
ZDB-ID	2212038-5
ISSN	1743-9159 ; 1743-9191
ISSN (online)	1743-9159
ISSN	1743-9191
DOI	10.1016/j.ijsu.2017.06.080
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Article ; Online: The changing epidemiology of interpersonal firearm violence during the COVID-19 pandemic in Philadelphia, PA.

Afif, Iman N / Gobaud, Ariana N / Morrison, Christopher N / Jacoby, Sara F / Maher, Zoë / Dauer, Elizabeth D / Kaufman, Elinore J / Santora, Thomas A / Anderson, Jeffrey H / Pathak, Abhijit / Sjoholm, Lars Ola / Goldberg, Amy J / Beard, Jessica H

Preventive medicine

2022 Volume 158, Page(s) 107020

Abstract: Recent increases in firearm violence in U.S. cities are well-documented, however dynamic changes in the people, places and intensity of this public health threat during the COVID-19 pandemic are relatively unexplored. This descriptive epidemiologic study ...

Abstract	Recent increases in firearm violence in U.S. cities are well-documented, however dynamic changes in the people, places and intensity of this public health threat during the COVID-19 pandemic are relatively unexplored. This descriptive epidemiologic study spanning from January 1, 2015 - March 31, 2021 utilizes the Philadelphia Police Department's registry of shooting victims, a database which includes all individuals shot and/or killed due to interpersonal firearm violence in the city of Philadelphia. We compared victim and event characteristics prior to the pandemic with those following implementation of pandemic containment measures. In this study, containment began on March 16, 2020, when non-essential businesses were ordered to close in Philadelphia. There were 331 (SE = 13.9) individuals shot/quarter pre-containment vs. 545 (SE = 66.4) individuals shot/quarter post-containment (p = 0.031). Post-containment, the proportion of women shot increased by 39% (95% CI: 1.21, 1.59), and the proportion of children shot increased by 17% (95% CI: 1.00, 1.35). Black women and children were more likely to be shot post-containment (RR 1.11, 95% CI: 1.02, 1.20 and RR 1.08, 95% CI: 1.03, 1.14, respectively). The proportion of mass shootings (≥4 individuals shot within 100 m within 1 h) increased by 53% post-containment (95% CI: 1.25, 1.88). Geographic analysis revealed relative increases in all shootings and mass shootings in specific city locations post-containment. The observed changes in firearm injury epidemiology following COVID-19 containment in Philadelphia demonstrate an intensification in firearm violence, which is increasingly impacting people who are likely made more vulnerable by existing social and structural disadvantage. These findings support existing knowledge about structural causes of interpersonal firearm violence and suggest structural solutions are required to address this public health threat.
MeSH term(s)	COVID-19/epidemiology ; Child ; Female ; Firearms ; Humans ; Pandemics ; Philadelphia/epidemiology ; Violence ; Wounds, Gunshot/epidemiology
Language	English
Publishing date	2022-03-14
Publishing country	United States
Document type	Journal Article ; Research Support, Non-U.S. Gov't
ZDB-ID	184600-0
ISSN	1096-0260 ; 0091-7435
ISSN (online)	1096-0260
ISSN	0091-7435
DOI	10.1016/j.ypmed.2022.107020
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Article ; Online: Outcomes in Trauma Patients With Behavioral Health Disorders.

Harfouche, Melike / Beard, Jessica / Mason, Leonard / Maher, Zoe / Dauer, Elizabeth / Santora, Thomas / Goldberg, Amy / Pathak, Abhijit

The Journal of surgical research

2019 Volume 244, Page(s) 425–429

Abstract: Background: The relationship between behavioral health disorders (BHDs) and outcomes after traumatic injury is not well understood. The objective of this study was to evaluate the association between BHDs and outcomes in the trauma patient population.!## ...

Abstract	Background: The relationship between behavioral health disorders (BHDs) and outcomes after traumatic injury is not well understood. The objective of this study was to evaluate the association between BHDs and outcomes in the trauma patient population. Materials and methods: We performed a review of the Trauma Quality Improvement Program database from 2013 to 2016 comparing patients with and without a BHD, which was defined as a psychiatric disorder, alcohol or drug use disorders, dementia, or attention deficit hyperactivity disorder. Outcomes of interest were mortality, length of stay (LOS), and inpatient complications. Results: In the study population, 254,882 patients (25%) had a BHD. Of these, psychiatric disorders comprised 38.3% (n = 97,668) followed by alcohol (33.3%, n = 84,845) and drug (26.4%, n = 67,199) use disorders, dementia (20.2%, n = 51,553), and attention deficit hyperactivity disorder (1.7%, n = 4301). On multivariable analysis, overall mortality was lower in the BHD group (odds ratio [OR] 0.83, confidence interval [CI] 0.79-0.83; P < 0.001). Patients with dementia had higher mortality when controlling for other risk factors (OR 1.62, CI 1.56-1.69; P < 0.001). LOS was 8.5 d (s = 0.02) for patients with a BHD versus 7.4 d (s = 0.01) for patients without a BHD (P < 0.001). Comorbid BHD was associated with any inpatient complication (OR 1.19, CI 1.18-1.20; P < 0.001). Conclusions: Trauma patients with a BHD had lower overall mortality compared with those without a BHD. However, on subgroup analysis, those with dementia had increased mortality. BHDs increased risk for any inpatient complication and prolonged LOS. Trauma patients with BHDs represent a vulnerable population and warrant special attention to minimize harm and improve outcomes.
MeSH term(s)	Female ; Humans ; Length of Stay ; Male ; Mental Disorders/complications ; Middle Aged ; Wounds and Injuries/complications ; Wounds and Injuries/mortality
Language	English
Publishing date	2019-07-18
Publishing country	United States
Document type	Journal Article
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2019.06.061
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Article ; Online: Police transport of firearm-injured patients-more often and more injured.

Maher, Zoё / Beard, Jessica H / Dauer, Elizabeth / Carroll, Madeleine / Forman, Steven / Topper, Gena V / Pathak, Abhijit / Santora, Thomas A / Sjoholm, Lars Ola / Zhao, Huaqing / Goldberg, Amy J

The journal of trauma and acute care surgery

2021 Volume 91, Issue 1, Page(s) 164–170

Abstract: Background: Police transport (PT) of penetrating trauma patients decreases the time between injury and trauma center arrival. Our study objective was to characterize trends in the rate of PT and its impact on mortality. We hypothesized that PT is ... ...

Abstract	Background: Police transport (PT) of penetrating trauma patients decreases the time between injury and trauma center arrival. Our study objective was to characterize trends in the rate of PT and its impact on mortality. We hypothesized that PT is increasing and that these patients are more injured. Methods: We conducted a single-center, retrospective cohort study of adult (≥18 years) patients presenting with gunshot wounds (GSWs) to a level 1 center from 2012 to 2018. Patients transported by police or ambulance (emergency medical service [EMS]) were included. The association between mode of transport (PT vs. EMS) and mortality was evaluated using χ2, t tests, Mann-Whitney U tests, and logistic regression. Results: Of 2,007 patients, there were 1,357 PT patients and 650 EMS patients. Overall in-hospital mortality was 23.7%. The rate of GSW patients arriving by PT increased from 48.9% to 78.5% over the study period (p < 0.001). Compared with EMS patients, PT patients were sicker on presentation with lower initial systolic blood pressure (98 vs. 110, p < 0.001), higher Injury Severity Score (median [interquartile range], 10 [2-75] vs. 9 [1-17]; p < 0.001) and more bullet wounds (3.5 vs. 2.9, p < 0.001). Police-transported patients more frequently underwent resuscitative thoracotomy (19.2% vs. 10.0%, p < 0.001) and immediate surgical exploration (31.3% vs. 22.6%, p < 0.001). There was no difference in adjusted in-hospital mortality between transport groups. Of patients surviving to discharge, PT patients had higher Injury Severity Score (9.6 vs. 8.3, p = 0.004) and lower systolic blood pressure on arrival (126 vs. 130, p = 0.013) than EMS patients. Conclusion: Police transport of GSW patients is increasing at our urban level 1 center. Compared with EMS patients, PT patients are more severely injured but have similar in-hospital mortality. Further study is necessary to understand the impact of PT on outcomes in specific subsets in penetrating trauma patients. Level of evidence: Epidemiological, level III.
MeSH term(s)	Adult ; Emergency Medical Services ; Female ; Hospital Mortality ; Humans ; Injury Severity Score ; Logistic Models ; Male ; Pennsylvania ; Police ; Retrospective Studies ; Transportation of Patients ; Trauma Centers ; Wounds, Gunshot/mortality ; Young Adult
Language	English
Publishing date	2021-06-07
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.0000000000003225
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Article ; Online: Life after near death: long-term outcomes of emergency department thoracotomy survivors.

Keller, Deborah / Kulp, Heather / Maher, Zoe / Santora, Thomas A / Goldberg, Amy J / Seamon, Mark J

The journal of trauma and acute care surgery

2013 Volume 74, Issue 5, Page(s) 1315–1320

Abstract: Background: Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, ...

Abstract	Background: Predictors of hospital survival after emergency department thoracotomy (EDT) are well established, but little is known of long-term outcomes after hospital survival. Our primary study objective was to analyze the long-term social, cognitive, functional, and psychological outcomes in EDT survivors. Methods: Review of our Level I trauma center registry (2000-2010) revealed that 37 of 448 patients survived hospitalization after EDT. Demographics and clinical characteristics were analyzed. After attempts to contact survivors, 21 patients or caretakers were invited to an outpatient study evaluation; 16 were unreachable (none of whom were present in the Social Security Death Index). Study evaluation included demographic and social data and an outpatient multidisciplinary assessment with validated scoring instruments (Mini-Mental Status Exam, Glasgow Outcome Scores, Timed Get-Up and Go Test, Functional Independence Measure Scoring, SF-36 Health Survey, and civilian posttraumatic stress disorder checklist). Results: After extended hospitalization (43 ± 41 days), disposition varied (home, 62%; rehabilitation, 32%; skilled nursing facility, 6%), but readmission was common (33%) in the 37 EDT hospital survivors. Of the 21 contacted, 16 completed the study evaluation, 2 had died, 1 remained in a comatose state, and 2 were available by telephone only. While unemployment (75%), daily alcohol (50%), and drug use (38%) were common, of the 16 patients who underwent the comprehensive, multidisciplinary outpatient assessment after a median of 59 months following EDT, 75% had normal cognition and returned to normal activities, 81% were freely mobile and functional, and 75% had no evidence of posttraumatic stress disorder upon outpatient screening. Conclusion: Despite the common belief that EDT survivors often live with severe neurologic or functional impairment, we have found that most of our sampled EDT survivors had no evidence of long-term impairment. It is our hope that these results are considered by physicians making life or death decisions regarding the "futility" of EDT in our most severely injured patients.
MeSH term(s)	Activities of Daily Living/psychology ; Adult ; Female ; Glasgow Outcome Scale ; Health Status ; Humans ; Male ; Neuropsychological Tests ; Registries ; Survivors/psychology ; Survivors/statistics & numerical data ; Thoracotomy/adverse effects ; Thoracotomy/psychology ; Thoracotomy/statistics & numerical data ; Trauma Centers/statistics & numerical data ; Treatment Outcome ; Wounds and Injuries/psychology ; Wounds and Injuries/surgery
Language	English
Publishing date	2013-05
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.0b013e31828c3db4
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Article ; Online: The evil of good is better: Making the case for basic life support transport for penetrating trauma victims in an urban environment.

Rappold, Joseph F / Hollenbach, Kathryn A / Santora, Thomas A / Beadle, Dania / Dauer, Elizabeth D / Sjoholm, Lars O / Pathak, Abhijit / Goldberg, Amy J

The journal of trauma and acute care surgery

2015 Volume 79, Issue 3, Page(s) 343–348

Abstract: Background: Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers.: Methods: A retrospective ... ...

Abstract	Background: Controversy remains over the ideal way to transport penetrating trauma victims in an urban environment. Both advance life support (ALS) and basic life support (BLS) transports are used in most urban centers. Methods: A retrospective cohort study was conducted at an urban Level I trauma center. Victims of penetrating trauma transported by ALS, BLS, or police from January 1, 2008, to November 31, 2013, were identified. Patient survival by mode of transport and by level of care received was analyzed using logistic regression. Results: During the study period, 1,490 penetrating trauma patients were transported by ALS (44.8%), BLS (15.6%), or police (39.6%) personnel. The majority of injuries were gunshot wounds (72.9% for ALS, 66.8% for BLS, 90% for police). Median transport minutes were significantly longer for ALS (16 minutes) than for BLS (14.5 minutes) transports (p = 0.012). After adjusting for transport time and Injury Severity Score (ISS), among victims with an ISS of 0 to 30, there was a 2.4-fold increased odds of death (95% confidence interval [CI], 1.3-4.4) if transported by ALS as compared with BLS. With an ISS of greater than 30, this relationship did not exist (odds ratio, 0.9; 95% CI, 0.3-2.7). When examined by type of care provided, patients with an ISS of 0 to 30 given ALS support were 3.7 times more likely to die than those who received BLS support (95% CI, 2.0-6.8). Among those with an ISS of greater than 30, no relationship was evident (odds ratio, 0.9; 95% CI, 0.3-2.7). Conclusion: Among penetrating trauma victims with an ISS of 30 or lower, an increased odds of death was identified for those treated and/or transported by ALS personnel. For those with an ISS of greater than 30, no survival advantage was identified with ALS transport or care. Results suggest that rapid transport may be more important than increased interventions. Level of evidence: Therapeutic study, level IV.
MeSH term(s)	Adult ; Emergency Medical Services ; Female ; Humans ; Injury Severity Score ; Life Support Care ; Male ; Philadelphia ; Police ; Registries ; Retrospective Studies ; Risk Factors ; Survival Analysis ; Time Factors ; Transportation of Patients ; Trauma Centers ; Urban Population ; Wounds, Penetrating/mortality ; Wounds, Penetrating/therapy
Language	English
Publishing date	2015-09
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.0000000000000783
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Article ; Online: Prehospital intubation does not decrease complications in the penetrating trauma patient.

Taghavi, Sharven / Vora, Halley P / Jayarajan, Senthil N / Gaughan, John P / Pathak, Abhijit S / Santora, Thomas A / Goldberg, Amy J

The American surgeon

2014 Volume 80, Issue 1, Page(s) 9–14

Abstract: Intubation in the prehospital setting does not result in a survival benefit in penetrating trauma. However, the effect of prehospital intubation (PHI) on the development of in-hospital complications has yet to be determined. The goal of this study was to ...

Abstract	Intubation in the prehospital setting does not result in a survival benefit in penetrating trauma. However, the effect of prehospital intubation (PHI) on the development of in-hospital complications has yet to be determined. The goal of this study was to determine if PHI in patients with penetrating trauma results in reduced mortality and in-hospital complications. Patient records for all Category 1 trauma activations as a result of penetrating injury admitted to our institution from 2006 to 2010 were reviewed. There were 1615 Category 1 trauma activations with 152 (9.8%) intubated in the field. A total of 1311 survived initial resuscitative efforts to permit hospital admission with 55 (4.2%) being intubated in the field. For patients surviving to admission, prehospital intubation was associated with increased mortality (hazard ratio, 8.266; 95% confidence interval [CI, 4.336 to 15.758; P < 0.001). After correcting for Injury Severity Score, PHI was not protective against pulmonary complications (odds ratio [OR], 0.724; 95% CI, 0.229 to 2.289; P = 0.582), deep vein thrombosis/pulmonary embolus (OR, 0.838; 95% CI, 0.281 to 2.494; P = 0.750), sepsis (OR, 0.572; 95% CI, 0.201 to 1.633; P = 0.297), wound infections (OR, 1.739; 95% CI, 0.630 to 4.782; P = 0.286), or complications of any kind (OR, 1.020; 95% CI, 0.480 to 2.166; P = 0.959). For victims of penetrating trauma, immediate transportation by emergency medical personnel may result in improved outcomes.
MeSH term(s)	Adult ; Aged ; Aged, 80 and over ; Emergency Medical Services/methods ; Emergency Treatment/methods ; Female ; Humans ; Injury Severity Score ; Intubation, Intratracheal ; Length of Stay/statistics & numerical data ; Logistic Models ; Male ; Middle Aged ; Propensity Score ; Registries ; Retrospective Studies ; Treatment Outcome ; Wounds, Gunshot/complications ; Wounds, Gunshot/mortality ; Wounds, Gunshot/therapy ; Wounds, Stab/complications ; Wounds, Stab/mortality ; Wounds, Stab/therapy
Language	English
Publishing date	2014-01
Publishing country	United States
Document type	Evaluation Studies ; Journal Article
ZDB-ID	202465-2
ISSN	1555-9823 ; 0003-1348
ISSN (online)	1555-9823
ISSN	0003-1348
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Article ; Online: Acute right heart failure after hemorrhagic shock and trauma pneumonectomy-a management approach: A blinded randomized controlled animal trial using inhaled nitric oxide.

Lubitz, Andrea L / Sjoholm, Lars O / Goldberg, Amy / Pathak, Abhijit / Santora, Thomas / Sharp, Thomas E / Wallner, Markus / Berretta, Remus M / Poole, Lauren A / Wu, Jichuan / Wolfson, Marla R

The journal of trauma and acute care surgery

2017 Volume 82, Issue 2, Page(s) 243–251

Abstract: Background: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. ... ...

Abstract	Background: Hemorrhagic shock and pneumonectomy causes an acute increase in pulmonary vascular resistance (PVR). The increase in PVR and right ventricular (RV) afterload leads to acute RV failure, thus reducing left ventricular (LV) preload and output. Inhaled nitric oxide (iNO) lowers PVR by relaxing pulmonary arterial smooth muscle without remarkable systemic vascular effects. We hypothesized that with hemorrhagic shock and pneumonectomy, iNO can be used to decrease PVR and mitigate right heart failure. Methods: A hemorrhagic shock and pneumonectomy model was developed using sheep. Sheep received lung protective ventilatory support and were instrumented to serially obtain measurements of hemodynamics, gas exchange, and blood chemistry. Heart function was assessed with echocardiography. After randomization to study gas of iNO 20 ppm (n = 9) or nitrogen as placebo (n = 9), baseline measurements were obtained. Hemorrhagic shock was initiated by exsanguination to a target of 50% of the baseline mean arterial pressure. The resuscitation phase was initiated, consisting of simultaneous left pulmonary hilum ligation, via median sternotomy, infusion of autologous blood and initiation of study gas. Animals were monitored for 4 hours. Results: All animals had an initial increase in PVR. PVR remained elevated with placebo; with iNO, PVR decreased to baseline. Echo showed improved RV function in the iNO group while it remained impaired in the placebo group. After an initial increase in shunt and lactate and decrease in SvO2, all returned toward baseline in the iNO group but remained abnormal in the placebo group. Conclusion: These data indicate that by decreasing PVR, iNO decreased RV afterload, preserved RV and LV function, and tissue oxygenation in this hemorrhagic shock and pneumonectomy model. This suggests that iNO may be a useful clinical adjunct to mitigate right heart failure and improve survival when trauma pneumonectomy is required.
MeSH term(s)	Administration, Inhalation ; Animals ; Blood Chemical Analysis ; Blood Transfusion, Autologous ; Disease Models, Animal ; Echocardiography ; Heart Failure/prevention & control ; Hemodynamics ; Nitric Oxide/administration & dosage ; Nitric Oxide/pharmacology ; Pneumonectomy ; Pulmonary Artery/drug effects ; Pulmonary Gas Exchange ; Sheep ; Shock, Hemorrhagic/physiopathology ; Sternotomy ; Vascular Resistance/drug effects ; Ventricular Dysfunction, Right/prevention & control
Chemical Substances	Nitric Oxide (31C4KY9ESH)
Language	English
Publishing date	2017
Publishing country	United States
Document type	Journal Article ; Randomized Controlled Trial ; Research Support, U.S. Gov't, Non-P.H.S. ; Research Support, Non-U.S. Gov't
ZDB-ID	2651070-4
ISSN	2163-0763 ; 2163-0755
ISSN (online)	2163-0763
ISSN	2163-0755
DOI	10.1097/TA.0000000000001325
Database	MEDical Literature Analysis and Retrieval System OnLINE

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