Critical care medicine:

BACKGROUND: Physiotherapists play a key role in respiratory care for mechanically ventilated (MV) patients. Despite this, there is limited understanding of which interventions are commonly utilised to treat respiratory compromise in this cohort or what key barriers exist to their implementation.

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CONCLUSIONS: We successfully established a mouse intensive care unit that integrated all critical aspects of a human intensive care unit simultaneously. By highlighting sex- and age-related differences following lipopolysaccharide stimulation and mechanical ventilation, our study underscored the need for diversity in preclinical models to improve translation of findings on critical illnesses like acute lung injury into clinical settings.

Abstract: Tracheal intubation (TI) of an obstetrical patient around the time of delivery can be an upsetting event for involved providers. It can also cause an unpredictable use of intensive care resources. Its incidence is currently poorly characterized in the literature. We analyzed the 2019 National Inpatient Sample (NIS) to assess the incidence rate and associated risk factors. Patients were identified by International Classification of Diseases, 10th edition codes for delivery of a child. Measured endpoints were the incidence of TI and factors associated. Categorical variables were compared using Chi squared or Fisher's Exact. Continuous variables were compared using the Student T-test or the Mann Whitney rank sum U-test. A logistic regression model was created to determine the odds for each variable contributing to TI. A P value of 0.05 was considered the minimum standard for significance. There was a low rate of TI (0.03%). Mortality was rare (0.004%) and there was a higher rate of mortality among patients who underwent tracheal intubation (5.5% vs 0.003% among patients not intubated,  < .001). The majority of intubations occurred among patients who delivered via CD. Pneumonia, cardiomyopathy, eclampsia, and postpartum hemorrhage were all independently associated with increased odds for TI. There are risk factors which may increase the likelihood for tracheal intubation. The diagnosis of a cardiomyopathy was strongly associated with an increased odds for TI and may result from acute respiratory failure. PPH and eclampsia were also associated with a greater odds for intubation.

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This study investigated the association between repetitive head impacts (RHIs) and multimodal neuroimaging, biomechanical, and neuropsychological data in 72 youth football players and 17 controls, aged 8-12 years. Helmet sensors measured RHI exposure while imaging and psychological data were collected before and after the season. Risk-weighted exposure metrics were calculated to quantify cumulative RHI exposure. Changes in magnetoencephalography (MEG) and diffusion kurtosis imaging were analyzed by calculating voxel-wise difference, and z-score maps were thresholded with respect to controls. Using linear regression, statistically significant positive associations were observed between abnormally increased MEG-measured theta (5-7 Hz) power and RHI measures. No associations were found between RHI and other neuroimaging metrics. Football players and controls exhibited significant yet divergent associations between alpha (8-12 Hz) power as well as mean kurtosis and neuropsychological changes. These findings indicate a potential association between youth football players' exposure to RHI and neurophysiological alterations.

OBJECTIVES: Despite the known burden of inappropriate overtriage of patients with facial injuries on the health care system, no comprehensive guidelines for the transfer of these patients exist. The aim of this study was to define guidelines regarding which patients with isolated craniomaxillofacial trauma require transfer to higher levels of care.

BACKGROUND: Survival prediction models use arrival vital signs, rather than prehospital (PH) vital signs to estimate expected survival of injured patients. Prehospital blood product transfusion (PHBPT) has been associated with improvement in shock index (SI) during transport. The objective of this study was to examine the effect of PHBPT on expected and observed survival.

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BACKGROUND: Liver injury is common in children with blunt or penetrating injury. In rare cases with devastating biliary or vascular injury, or posttraumatic acute hepatic failure, liver transplantation may be warranted. Outcomes of liver transplant after traumatic hepatic injury in children are not known. We hypothesized that pediatric patients who underwent liver transplantation after traumatic liver injury would have a decreased graft survival and similar patient survival, compared with children who underwent liver transplantation for other nontrauma indications.

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CONCLUSIONS: Our findings provide robust evidence of a dose-dependent association between sepsis and increased dementia risk, particularly vascular dementia, even after adjusting for competing mortality risks.

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