Clinical Impact of a Dedicated Trauma Hybrid Operating Room.
Clinical Impact of a Dedicated Trauma Hybrid Operating Room.
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DOI：
10.1016/j.jamcollsurg.2020.11.008
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发表时间：
2021-04
影响因子：
5.2
通讯作者：
Smith RS
中科院分区：
文献类型：
--
作者：
Loftus TJ;Croft CA;Rosenthal MD;Mohr AM;Efron PA;Moore FA;Upchurch GR Jr;Smith RS
早期出血控制对于最佳创伤护理至关重要。混合手术室提供了先进的血管造影和手术止血技术的早期伴随性能，但其临床影响尚不清楚。在此，我们提出我们的初步经验，一个专门的，创伤混合手术室。本回顾性队列分析了在一级创伤中心接受即刻手术的292例成人创伤患者，比较了在实施专用创伤混合手术室后接受治疗的患者（n = 186）与历史对照组（n = 106）。主要结局为出血控制时间（收缩压≥ 100 mmHg，无需持续使用血管加压药或输血）、早期血液制品给药和并发症。两个队列的患者特征相似（年龄41岁，25%为女性，38%为穿透性创伤）。混合队列的初始血红蛋白较低（10.2 vs. 11.1 g/dL，p = 0.001），接受主动脉复苏性血管内球囊闭塞的患者比例较高（9% vs. 1%，p = 0.007）。队列的病例组合和心胸或血管手术的术中会诊相似（13%）。21%的混合病例包括血管造影术。在混合队列中，手术室到达和出血控制之间的间隔更短（49 vs. 60分钟，p = 0. 005）。从到达后4 - 24小时，混合队列的红细胞输注（0.0 vs. 1.0，p = 0.001）和血浆输注（0.0 vs. 1.0，p <0.001）较少。混合队列的感染并发症（15% vs. 27%，p = 0.009）和呼吸机天数（2.0 vs. 3.0，p = 0.011）较少，住院死亡率相似（13% vs. 10%，p = 0.579）。实施专门的创伤混合手术室与早期出血控制和早期输血、感染并发症和呼吸机天数减少相关。
Early hemorrhage control is essential to optimal trauma care. Hybrid operating rooms offer early, concomitant performance of advanced angiographic and operative hemostasis techniques, but their clinical impact is unclear. Herein, we present our initial experience with a dedicated, trauma hybrid operating room. This retrospective cohort analysis of 292 adult trauma patients undergoing immediate surgery at a Level I trauma center compared patients managed after implementation of a dedicated, trauma hybrid operating room (n=186) with historic controls (n=106). The primary outcomes were time to hemorrhage control (systolic blood pressure ≥100 mmHg without ongoing vasopressor or transfusion requirements), early blood product administration, and complications. Patient characteristics were similar between cohorts (age 41 years, 25% female, 38% penetrating trauma). The hybrid cohort had lower initial hemoglobin (10.2 vs. 11.1 g/dL, p=0.001) and a greater proportion of patients undergoing resuscitative endovascular balloon occlusion of the aorta (9% vs. 1%, p=0.007). Cohorts had similar case mixes and intraoperative consultations with cardiothoracic or vascular surgery (13%). Twenty-one percent of all hybrid cases included angiography. The interval between OR arrival and hemorrhage control was shorter in the hybrid cohort (49 vs. 60 minutes, p=0.005). From 4–24 hours after arrival, the hybrid cohort had fewer red cell (0.0 vs. 1.0, p=0.001) and plasma transfusions (0.0 vs. 1.0, p<0.001). The hybrid cohort had fewer infectious complications (15% vs. 27%, p=0.009) and ventilator days (2.0 vs. 3.0, p=0.011), and similar in-hospital mortality (13% vs. 10%, p=0.579). Implementation of a dedicated, trauma hybrid operating room was associated with earlier hemorrhage control and fewer early blood transfusions, infectious complications, and ventilator days.
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DOI：
10.1186/cc13775
发表时间：
2014-03-18
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kalanuria AA;Ziai W;Mirski M
通讯作者：
Mirski M
影响因子：
3.4
作者：
Ogura, Takayuki;Lefor, Alan T.;Morita, Hideo
通讯作者：
Morita, Hideo
影响因子：
2.6
作者：
Coccolini, Federico;Ceresoli, Marco;Horer, Tal M.
通讯作者：
Horer, Tal M.
DOI：
10.1186/cc3779
发表时间：
2005
期刊：
Critical care (London, England)
影响因子：
--
作者：
Kauvar DS;Wade CE
通讯作者：
Wade CE
DOI：
10.1097/ta.0000000000002819
发表时间：
2020-09
期刊：
The journal of trauma and acute care surgery
影响因子：
--
作者：
Nguyen M;Pirracchio R;Kornblith LZ;Callcut R;Fox EE;Wade CE;Schreiber M;Holcomb JB;Coyle J;Cohen M;Hubbard A
通讯作者：
Hubbard A