Juan C. Duchesne, MD, FACS, FCCP, FCCM
Division Chief Trauma/Acute and Critical Care
Summary: Tulane University School of Medicine will soon be participating in a research study lead by the University of Pittsburgh School of Medicine funded by the Department of Defense (DOD) aimed at improving survival among people who have difficulty breathing after a trauma.
Nine academic medical centers, stretching from Georgia to Oregon, are involved in the study, which will enroll more than 2,000 people age 15 and older who are taken to an adult trauma center. In addition to Tulane University and University of Pittsburgh, centers participating in PACT are East Carolina University, NC; Emory University, GA; Cook County Trauma Services, IL; University of Louisville, KY; Oregon Health and Science University; LA; Vanderbilt University, TN; and Washington University, MO.
This research study called, “PACT: Prehospital Airway Control Trial,” aims to compare different ways to help people with traumatic injuries breathe. Between 8% and 15% of people with traumatic injuries die because they didn’t get good enough help breathing. Read More
Currently, prehospital providers typically use one of two methods to help people breathe; one is with a tube in the windpipe, called an endotracheal (ET) tube, and the other is with a device that sits over the windpipe called a supraglottic airway (SGA). Although both methods are currently used, we don’t know which one is better. To test this, we will ask some providers to use whatever method they would normally use and some providers to try using the SGA first, and we will compare the two groups.
One in five preventable deaths from trauma occur because the patient is having difficulty breathing. In the U.S., most EMS personnel will secure an injured person’s airway with either an endotracheal tube or a supraglottic device, both of which help get oxygen to an injured person’s lungs. Both consist of tubes that go through the mouth into or above the airway, and are then connected to a ventilation device – either a machine or a bag that can be pumped with the hand – to deliver oxygen to the lungs.
Endotracheal intubation requires the clinician to move the patient’s tongue aside, see the vocal chords and thread a tube between them into the patient’s windpipe. The supraglottic device also consists of a flexible tube inserted through the mouth, but instead of having to be threaded through the vocal chords, it sits at the back of the throat, above the windpipe. The supraglottic is believed to be easier to place in the field because it doesn’t require seeing the vocal chords, meaning the airway can be secured faster and with less interruption of resuscitation efforts. But, when placed correctly, the endotracheal tube may be associated with less risk of the patient breathing fluid into the lungs and other device-related complications.
Participating EMS services will start by using their normal procedures to secure an airway and the trial will collect data on patient outcomes. Then, the services will switch to trying the supraglottic airway first. If it fails, they can then decide whether to try the supraglottic again or switch to endotracheal intubation.
Regardless of the study, the injured person would still need help breathing and would likely receive one of these two methods anyway. Because traumatically injured patients cannot consent to the trial, they will be automatically enrolled if they fit the criteria. Once patients are stable, they’ll be notified that they were enrolled and can opt out of continued collection data from their medical records.
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Dr. Nichols, firstname.lastname@example.org
Summary: Retrospective review of a single institution's use of antibiotics after penetrating trauma with hollow viscus perforation. Patient demographics, organs injured and transfused blood units will be analyzed as well as an operative approach to repair, antibiotics used, duration of antibiotics and development of surgical site infection. Using this data we hope to identify risk factors for developing postoperative surgical infections, determine the ideal type of antibiotic and duration of use. We plan to compare our data with a series of studies published in '84-'85 by Dr. Nichols evaluating similar endpoints and apply a developed algorithm that was used to calculate the probability of infection. We will apply this algorithm to our data to calculate the probability of infection in different antibiotic durations and wound closure techniques.