A5109085680- Trauma, Hemostasis, Coagulopathy, Resuscitation
- Neonatal Respiratory Health Research
- Immune Response and Inflammation
- Trauma and Emergency Care Studies
- Cardiac Arrest and Resuscitation
- Sepsis Diagnosis and Treatment
- Blood transfusion and management
- Nosocomial Infections in ICU
- Clostridium difficile and Clostridium perfringens research
- Traumatic Brain Injury and Neurovascular Disturbances
- Hemodynamic Monitoring and Therapy
- Hemoglobin structure and function
- Abdominal Trauma and Injuries
- Inhalation and Respiratory Drug Delivery
- Respiratory Support and Mechanisms
- Clinical Nutrition and Gastroenterology
- Abdominal Surgery and Complications
- Pneumonia and Respiratory Infections
- Neuroscience of respiration and sleep
- Alcohol Consumption and Health Effects
- Pediatric health and respiratory diseases
- Ultrasound in Clinical Applications
- Infant Nutrition and Health
- Cardiac, Anesthesia and Surgical Outcomes
- Fatty Acid Research and Health
Wayne State University
2014-2023
Detroit Medical Center
2008-2020
May Institute
2014-2020
American Association for the Surgery of Trauma
2002-2017
Detroit Receiving Hospital
1990-2016
Sinai Grace Hospital
2013
Detroit R&D (United States)
2012
Committee on Publication Ethics
2003-2011
Society of Critical Care Medicine
2009
Johnson Space Center
1999-2002
To develop a clinical practice guideline for red blood cell transfusion in adult trauma and critical care.Meetings, teleconferences electronic-based communication to achieve grading of the published evidence, discussion consensus among entire committee members.This management was developed by joint taskforce EAST (Eastern Association Surgery Trauma) American College Critical Care Medicine (ACCM) Society (SCCM). We performed comprehensive literature review topic graded evidence using...
The effects of increased intra-abdominal pressure (IAP) on hepatic perfusion were studied in five anesthetized pigs. Doppler flow probes used to measure artery blood (HABF) and portal venous (PVBF), laser flowmetry was assess changes microvascular (HMVBF). Hepatic responses 10, 20, 30 40 mm Hg increases IAP assessed while the mean arterial BP (MAP) maintained at baseline levels with IV crystalloid infusions. Although cardiac output MAP normal, HABF HMVBF fell significantly 10 IAP, 20 45%...
The effects of increased intra-abdominal pressure (IAP) on intestinal blood flow were studied in eight anesthetized pigs. Mesenteric artery (MABF), mucosal (IMBP), tonometric intramucosal pH (pH|), mean BP (MAP), cardiac output (CO), and pulmonary wedge (PAWP) measured as IAP was raised to 10, 20, 30, 40 mm Hg by infusing lactated Ringer's solution (LR) into the peritoneal cavity. MAP kept constant with IV LR. Cardiac fell slightly from 5.4 ± 1.1 at baseline 4.0 1.2 L/min an (p < 0.05). An...
Thoracic ultrasound may rapidly diagnose pneumothorax when radiographs are unobtainable; the accuracy is not known.We prospectively evaluated thoracic detection of in patients at high suspicion pneumothorax. The presence "lung sliding" or "comet tail" artifacts were determined by before radiologic verification residents instructed ultrasound. Results compared with standard radiography.There 382 enrolled; cause injury was blunt (281 382), gunshot wound (22 stab (61 and spontaneous (18 382)....
Major trauma or abdominal injury may lead to the development of increased intra-abdominal pressure (IAP) and onset compartment syndrome. Although effect raised IAP on systemic splanchnic hemodynamics have been described, consequences resultant gut hypoperfusion in this setting are unknown. Bacterial translocation (BT) occurs after a period ischemia contribute later organ failure. A rodent model was used examine ileal mucosal blood flow (MBF) BT. 25 mm Hg for 60 minutes mean arterial...
• The relative value of pulmonary artery wedge pressure (PAWP) and right ventricular end-diastolic volume index (RVEDVI) as a reflection the preload status critically ill was determined in 29 patients. Regression analysis 131 hemodynamic studies demonstrated that cardiac (CI) correlated better with RVEDVI (<i>r</i>=.61) than did PAWP (<i>r</i>=.42). Comparisons showed possible misleading information concerning filling provided by at some time 15 (52%) these In patients given 22 fluid...
STATEMENT OF THE PROBLEM Red blood cell (RBC) transfusion is common in critically ill and injured patients. Many studies1–6 have documented the widespread use of RBC patients data from these studies diverse locations Western Europe, Canada, United Kingdom, States reveal remarkably similar findings, with approximately 40% receiving transfusions, a mean five units transfused per patient, pretransfusion hemoglobin (Hb) 8.5 g/dL. transfusions are used for treatment hemorrhage anemia as well to...
Objective To evaluate the relative accuracy of right ventricular end-diastolic volume index (RVEDVI) and pulmonary artery wedge pressure (PAWP) for determining cardiac preload. Methods A modified catheter was used to determine RVEDVI, PAWP, Cl 238 times in 32 trauma patients. Results The initial mean values included (Cl) = 3.4 ± 1.3 L/min/m2, PAWP 14.8 6.6 mm Hg, RVEDVI 99 40 mL/m2. Cardiac correlated better with (r 0.6440; p < 0.001) than 0.1068) or CVP 0.1604). In 84 studies 19 patients,...
Ventilator-dependent spinal cord-injured (SCI) patients require significant resources related to ventilator dependence. Diaphragm pacing (DP) has been shown successfully replace mechanical ventilators for chronic ventilator-dependent tetraplegics. Early use of DP following SCI not described. Here, we report our multicenter review experience with the in initial hospitalization after SCI.Under institutional board approval humanitarian device, retrospectively reviewed nonrandomized...
BACKGROUND Systemic vascular endothelial injury is a consequence of trauma (T)/hemorrhagic shock (HS) which results in disturbances coagulation, inflammation, and barrier integrity. The effect T/HS on the endothelium (endotheliopathy [EoT]) intense research interest may lead to EoT-directed therapies. Administration tranexamic acid (TXA) patients associated with survival benefit fewer complications if given early after injury. Mechanisms for this protective include antifibrinolytic...
INTRODUCTION Trauma and hemorrhagic shock lead to microcirculatory disturbances related endothelial injury glycocalyx (EG) degradation. Improved outcomes following trauma have been linked protection of the EG layer, which is a topic increasing investigation. Early tranexamic acid (TXA) administration improves in clinic studies. Recent translational studies also shown that early TXA protects insults; impact on blood-endothelial cell interactions unknown. Platelet adherence vascular...
Ultrasound is of proven accuracy in abdominal and thoracic trauma may be useful for diagnosing extremity injury situations where radiography not available such as military space applications. We prospectively evaluated the utility ultrasound performed by trained, nonphysician personnel patients with to simulate remote aerospace or applications.Patients were identified history, physical examination, radiographic studies. examination was bilaterally personnel, blinded results, a portable...
BACKGROUND The endothelial glycocalyx (GCX) plays an important role in vascular barrier function. Damage to the GCX occurs due a variety of causes including hypoxia, ischemia-reperfusion, stress-related sympathoadrenal activation, and inflammation. Tranexamic acid (TXA) may prevent degradation. therapeutic window for TXA administration mechanism action has been under review. Membrane-anchored proteases (sheddases) are key components cell biology regulation permeability. effect on damage,...
Dulchavsky, Scott A. MD, PhD; Hamilton, Douglas R. Diebel, Lawrence N. MD; Sargsyan, Ashot E. Billica, Roger D. Williams, David MD Author Information
The intestinal epithelial barrier and the mucus layer may be protective against trauma/hemorrhage shock-induced injury in females. This effect is related to estradiol (E₂) concentrations varies with menstrual cycle. We examined ability of E₂ impact physiochemical properties protect oxidant-related underlying an vitro model.Non-mucus-producing (HT29) mucus-producing (HT29-MTX) cells (IECs) were exposed or no for 3 days then grown confluence on transwell plates. Nonadherent adherent content...
Early resuscitation after trauma-hemorrhagic shock with plasma rather than crystalloid may ameliorate systemic endothelial cell (EC) injury and dysfunction (endotheliopathy of trauma). We postulated that endothelial-lined microfluidic networks would be a useful platform to study the EC activation/injury under flow conditions mimic shock. then used system further characterize protective effects optimal timing infusion on development "endotheliopathy trauma" in our model.Human umbilical vein...
Plasma is an important component of resuscitation after trauma and hemorrhagic shock (T/HS). The specific plasma proteins the impact storage conditions are uncertain. Utilizing a microfluidic device system, we studied effect various types on endothelial barrier function following T/HS.Human umbilical vein cells (HUVEC) were cultured in plates. plates subjected to control or (hypoxia/reoxygenation + epinephrine, 10 μM). Fresh plasma, 1 day thawed 5-day lyophilized then added. Supplementation...
Background Cardiac preload is most commonly assessed by pulmonary artery wedge pressure. It was postulated that the right ventricular end-diastolic volume index (RVEDVI) derived thermodilution would be a better predictor of in trauma patients with high airway pressures associated positive pressure ventilation and end-expiratory Methods Volumetric catheters were placed 52 mechanically ventilated patients. Regression analysis performed on 986 sets hemodynamic data comparing RVEDVI to cardiac...