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Skip to Main Content. General Surgery, Trauma and Surgical Critical Care The Section of General Surgery, Trauma and Surgical Critical Care combines cutting edge clinical care, education and training of future surgeons, with the most advanced research to improve the management of critically ill or injured patients. Trauma cares for all trauma patients admitted to Yale-New Haven Hospital, which is the regional Level 1 Trauma Center for Southern Connecticut and the only trauma center in the state to be verified by the American College of Surgeons for both adult and pediatric patients.

Emergency General Surgery treats patients with surgical emergencies both in the Emergency Department and in the hospital. These clinical missions are performed by a dedicated group of surgeons who provide around the clock, in-house coverage days a year. Although relatively few citations, these recent recommendations update the guidelines. This study found no difference in mortality between patients transfused fresh mean Early onset VAP was an independent risk factor for poor neurologic outcome at 1 year.

Rationale for inclusion: This is a narrative review of several current controversies regarding stress ulcer prophylaxis. Rationale for inclusion: Although no definitive study exists in the broadly accepted practice, this study adequately describes the practice with positive results. Rationale for inclusion: Demonstrated superiority of TIPS in prevention of repeat bleeding after treatment of variceal bleeds. Rationale for inclusion: Most contemporary but highly referenced paper on 5 year outcomes following critical illness.

While their findings were not significant, this study highlights the importance of treating both patient and family members in a new field of chronic critical care. Rationale for inclusion: This is in a new and less-notable journal. This is a systematic review and meta-analysis of RCTs.

Overall the data favors PPI. Rationale for inclusion: A constellation of well-known researchers used an interesting statistical alternative to meta-analysis to evaluate articles out of 23, between and They found distinct indications for DCL, but the most common were the lethal triad and inability to close the abdomen.

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Rationale for inclusion: 8 RCT were included, none of which were considered high quality by the authors. The suggestion was that minimally invasive procedures with step-up to more invasive ones e. Patients were studied for the first week of their ICU stay randomized within 36 hours of admission to a 5-day trial of early nutritional support via either parenteral or enteral routes.

It's a long read with excellent discussion and references. Rationale for inclusion: Good summary of the most important nutrition trials since the ASPEN guidelines which stopped including studies in December GRADE methodology was used. Many recommendations are unchanged, with the notable exception of long term therapy. Specifically, dabigatran, rivaroxaban, apixaban, or edoxaban are recommended for long-term VTE treatment over vitamin K antagonists.

Rationale for inclusion: Use of MAPs to optimize spinal cord perfusion and optimize recovery from injury is studied in this paper. Rationale for inclusion: Good summary of current treatment modalities the usual standbys of terlipressin and albumin. Rationale for inclusion: Most up-to-date guidelines available for nonvariceal upper GI bleeding - same author as the lower GI bleed.

Rationale for inclusion: A large multi center trial on the ABC approach to vent liberation. Rationale for inclusion: This is one of many but a more definitive articles on value of dexmedetomidine use in the severely aggitated. Rationale for inclusion: Excellent discussion of critical care surge capacity during disasters. Rationale for inclusion: AB imbalances associated with immunologic activation. Rationale for inclusion: Balanced fluids e. LR was associated with improved mortality compared to normal saline - retrospective, propensity-matched. LR was associated with improved mortlity compared to normal saline - retrospective, propensity-matched.

Rationale for inclusion: Contemporary guidelines for the prevention of SSIs: a highly-sited article. Rationale for inclusion: This is a really comprehensive survey of the latest therapies for cirrhotic patients presenting with sepsis, variceal bleeds, hepatorenal syndrome, as well as scoring systems. Rationale for inclusion: Similar to cerebral perfusion pressure, spinal cord perfusion pressure is evaluated in this study, supporting its use. Rationale for inclusion: A well referenced paper helping to dial in the perfect temperature goal.

Its findings suggested perhaps the real goals of targeted temperature management are to simply prevent hyperthermia. Rationale for inclusion: This is a very large population study based on reimbursement data 24, cirrhotics with a control group of 97, which shows the expected outcomes increased mortality, increased complications including sepsis, and renal failure. Rationale for inclusion: Solid article on length of treatment following bacteremia. Rationale for inclusion: Important follow up study of the "wake up and breath" campaign to show efficacy.

Rationale for inclusion: Good general overview, covering resuscitation, imaging, post-ERCP care, timing and appropriateness of interventions on fluid collections. Rationale for inclusion: The last word on prone positioning - in favor of early prone positioning for ARDS. Rationale for inclusion: Contemporary comprehensive sepsis guidelines by the socitey of critical care medicine.

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Classification mild, moderate, severe, and critical is based on the presence or absence of infected pancreatic necrosis and organ failure. Rationale for inclusion: EAST guideline on geriatric trauma which discusses the induced coagulopathies of pharmacy. Rationale for inclusion: Association between hypoglycemia seen in intensive glycemic control and mortality. Rationale for inclusion: Landmark article describing the use of Procalcitonin and determination for need of antibiotics in the critical care setting. Rationale for inclusion: HES associated with increased mortality and renal failure.

Rationale for inclusion: Position article for the use of extracorporeal life support in adult patients.

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Rationale for inclusion: Organizes patient outcomes by weaning classification patients in multicenter trial. Rationale for inclusion: 5-year prospective follow up of 88 patients 63 survivors, 58 who had mesh. Notable also for many historic references. Rationale for inclusion: Positive fluid balance associated with increased mortality. Rationale for inclusion: Very large patient cohort of perc trachs. The last word. Rationale for inclusion: Early randomized trial on TIPS, showing decreased treatment failure and decreased mortality. Rationale for inclusion: "Elderly" was defined as age 55 or older.

This was actually encouraging to the study group, who had expected far higher mortality. Rationale for inclusion: Diaphragmatic pacing following SCI is at its infancy in terms of use but this paper describes its use. Rationale for inclusion: A patient safety approach to IVC filter manegment to ensure timely removal when no longer indicated.

Rationale for inclusion: Highly referenced article on the use of Factor VII in traumatic hemmorrhage. Rationale for inclusion: Standard lovenox dosing may not be adaquate; this paper describes the use of tracking Xa levels. Rationale for inclusion: Strong association of glucose variability and mortality.

Rationale for inclusion: Well-referenced paper on thrombocytopenia and the management thereof. Rationale for inclusion: Similar to LA County's nearly simultaneous review but slightly larger 2, patients who had survived 96 hours. Rationale for inclusion: Early mobilization in the ICU improves functional recovery after critical illness. Rationale for inclusion: Trauma specific paper on long-term outcomes following prolonged ICU stays. Rationale for inclusion: Excellent description on discerning hypercoagulable states using TEG.

Rationale for inclusion: Convential and physiochemical approach to acid base balance assessment in critically ill trauma patients. Rationale for inclusion: One of the better head-to-head trials of dexmedetomidine vs versed in a RCT.

Traumatology, Surgical Critical Care and Emergency Surgery

Rationale for inclusion: Strong early study on measurement of transpulmonary pressures to guide PEEP. Rationale for inclusion: Variation in glucose levels is independent factor of mortality in ICU. Rationale for inclusion: Single dose Etomidate associated with adrenal inhibition, ICU stay, and vent days in trauma patients. Rationale for inclusion: Meta analysis showing effect of tight glycemic control on episodes of hypoglycemia and no decreased mortality. Rationale for inclusion: This paper supported the major change in practice away from giving steroids to all SCI patients.

Rationale for inclusion: A concensus statement on the diagnosis and management of adrenal insufficiency. Rationale for inclusion: Trauma -specific paper on end-of-life care in the ICU. Rationale for inclusion: Single dose Etomidate associated with adrenal inhibition for 48 hours. Rationale for inclusion: The study which sums up the open lung approach to date. Rationale for inclusion: Sedation cessation paired with spontaneous breathing trials - the backbone of today's ICU liberation protocols.

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Rationale for inclusion: Excellent results of fresh whole blood for hemmorrhage resuscitation in the military. Rationale for inclusion: This article is the basis for today's broadly accepted Isolation Precautions.

Heather Evans, MD, MS, Critical Care - Tramua Surgery MUSC Health

Rationale for inclusion: Patients with cirrhosis have an AB equillibrium which is lost in critical illness - the resulting acidosis disturbance is associated with increased mortality. No difference in mortality. Rationale for inclusion: Steroid treatment did not change outcome in relative adrenal insufficiency in nonseptic ICU patients. A large multi-institutional trail suggesting a role for progesterone in TBI.

Surgical Critical Care > Educational Opportunities | Atrium Health > NC & SC

Rationale for inclusion: On of the original yet contemporary prognositication papers in critical care. Rationale for inclusion: Goals for family involvement in goals of care conversations. Rationale for inclusion: Pinnicle article on civilian ratios of red cells to FFP; calling for resuscitations. Rationale for inclusion: Ad hoc analysis of the SAFE trial - effect of type and volume of resuscitation fluid on acid base and electrolytes. Rationale for inclusion: Conservative fluid management decreased duration of mechanical ventilation in acute lung injury without increase in other organs' dysfunction- though no difference in mortality at 60 days.

Rationale for inclusion: Contributing paper to the current practice patterns of MRI in clearing the cervical spine. Rationale for inclusion: Although the numerical pain scale is most common, in sedated or non-communicative patients, the BPS is the current gold standard. Rationale for inclusion: Conservative fluid management decreased duration of mechanical ventilation in acute lung injury without increase in other organs' dysfunction - though no difference in mortality at 60 days.