Objective The aim of this study was to examine cardiac dysfunction during the first two weeks after isolated traumatic brain injury (TBI) and its association with in-hospital mortality. Methods After Institutional Review Board approval, data from adult patients, with isolated TBI who underwent echocardiography during the first 2 weeks after TBI between 2003-2010 were examined. Patients with preexisting cardiac disease were excluded. Clinical characteristics and echocardiogram reports were abstracted. Cardiac dysfunction was defined as left ventricular ejection fraction (LVEF) < 50% or presence of regional wall motion abnormality (RWMA). Interventions None Measurement and Main Results We examined data from 139 patients with isolated TBI who underwent echocardiographic evaluation. Patients were aged 58 ± 20 years, 66% were males and 62.6% had subdural hematoma; admission Glasgow Coma Scale score (GCS) was 3 ± 1 (3-15) and head abbreviated injury scale (AIS) was 4 ± 1 (2-5). Of this cohort, 22.3% had abnormal echocardiogram: reduced LVEF was documented in 12% (LVEF 43 ± 8%), and 17.5% of patients had a RWMA. Hospital day 1 was the most common day of echocardiographic exam. Abnormal echocardiogram was independently associated with all cause in-hospital mortality (9.6 [2.3-40.2]; p= 0.002). Conclusions Cardiac dysfunction in the setting of isolated TBI occurs and is associated with increased in hospital mortality. This finding raises the question as to whether there are uncharted opportunities for a more timely recognition of cardiac dysfunction and subsequent optimization of the hemodynamic management of these patients.

Background: Some of the challenges in the delivery of high-quality end-of-life care in the ICU include the variability in the characteristics of patients with certain illnesses and the practice of critical care by different specialties. Methods: We examined whether ICU attending specialty was associated with quality of end-of-life care by using data from a clustered randomized trial of 14 hospitals. Patients died in the ICU or within 30 h of transfer and were categorized by specialty of the attending physician at time of death (medicine, surgery, neurology, or neurosurgery). Outcomes included family ratings of satisfaction, family and nurse ratings of quality of dying, and documentation of palliative care in medical records. Associations were tested using multipredictor regression models adjusted for hospital site and for patient, family, or nurse characteristics. Results: Of 3,124 patients, the majority were cared for by an attending physician specializing in medicine (78%), with fewer from surgery (12%), neurology (3%), and neurosurgery (6%). Family satisfaction did not vary by attending specialty. Patients with neurology or neurosurgery attending physicians had higher family and nurse ratings of quality of dying than patients of attending physicians specializing in medicine ( P , .05). Patients with surgery attending physicians had lower nurse ratings of quality of dying than patients with medicine attending physicians ( P , .05). Chart documentation of indicators of palliative care differed by attending specialty. Conclusions: Patients cared for by neurology and neurosurgery attending physicians have higher family and nurse ratings of quality of dying than patients cared for by medicine attending physicians and have a different pattern of indicators of palliative care. Patients with surgery attending physicians had fewer documented indicators of palliative care. These fi ndings may provide insights into potential ways to improve the quality of dying for all patients.

An initial pre-defined list of preliminary EPA titles was derived from the EPA titles for anesthesiology training developed by the Royal College of Physicians and Surgeons of Canada 19 and those developed for anesthesiology training in the Netherlands.

Effective outcomes in cardiothoracic surgical research using rodents are dependent upon adequate techniques for intubation and mechanical ventilation. Multiple methods are available for intubation of the rat; however, not all techniques are appropriate for survival studies. This article presents a refinement of intubation techniques and a simplified mechanical ventilation setup necessary for intrathoracic surgical procedures using volatile anesthetics. The procedure is defined and complications of the procedure are elucidated that provide a justification for animal numbers needed for initiating new studies. Lewis rats weighing 178-400 g (287 +/- 44) were anesthetized using Enflurane and intubated with a 16-G angiocatheter using transillumination. Mechanical ventilation (85 bpm, 2.5 mL TV, enflurane 1.5-2%) maintained adequate sedation for completion of an intrathoracic procedure. Complications of the intubation and ventilation included mortality from anesthetic overdose, intubation difficulty, pneumothorax, traumatic extubation, and ventilation disconnection. Anesthetic agents and their related effects on the rat heart and reflexes are compared. This article also underscores the importance of refinement, reduction, and replacement in the context of cardiothoracic surgery using rodent models.

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Routinely targeting prophylactic HV using crystalloids does not result in a higher circulating BV compared to targeting NV, but the possibility of clinically unrecognized hypovolemia remains.