[Positioning of external pelvic stabilization devices in patients with multiple injuries : Retrospective computed tomographic evaluation]. / Lage von externen Beckenstabilisatoren bei polytraumatisierten Patienten : Retrospektive computertomographische Evaluation.

BACKGROUND: Severe hemorrhage is a dreaded complication of pelvic fractures. It has a significant impact on early trauma-associated mortality. Hemorrhage that is secondary to pelvic fractures can be reduced by external stabilization devices. Despite the commercial availability of many different systems, they are infrequently used. The aim of this computed tomography (CT) study was to examine the use of external pelvic stabilization devices. METHODS: Between 1 January 2011 and 31 December 2015 a total of 982 images produced in CT trauma scans at a level 1 trauma centre were retrospectively examined with respect to the presence of external pelvic stabilizers. The type of device applied, its actual position including deviation from optimal position as well as pelvic parameters and complications were determined. RESULTS: In 67 out of 982 patients (6.82%) with suspected multiple trauma, an external pelvic stabilizer was employed. In 41.8% the devices were not placed in concordance with prevailing scientific knowledge, 53.73% of devices did not comply with the manufacturer's instructions and 51.85% of systems with pneumatic cuffs caused significant malrotation. In one patient the cuff induced hypoperfusion of the leg but without further sequelae. CONCLUSION: While the prehospital use of pelvic slings is increasing, misplacement is very common. Especially inconsistencies between manufacturers' manuals and current scientific knowledge warrant further improvement. In systems with pneumatic cuffs malrotation of the device is common and clinically relevant. Hypoperfusion of the lower extremities is possible and should be taken into account when employing these devices.

Bosentan effects on hemodynamics and clinical outcome in heart failure patients with pulmonary hypertension awaiting cardiac transplantation.

BACKGROUND: In heart failure (HF) patients, pulmonary hypertension (PH) is associated with a poor prognosis. We assessed whether low dose treatment with the dual endothelin-1 receptor antagonist bosentan is associated with improved hemodynamics and clinical outcome in these patients. METHODS: We performed a retrospective data analysis in 82 end-stage heart failure patients on the waiting list for cardiac transplantation since January 2006. All patients had pulmonary arterial pressure >35 mmHg, pulmonary vascular resistance >240 dyn × s × cm-5, and/or a transpulmonary gradient (TPG) >15 mmHg. Fifty-four patients received a median dose of 125 mg bid bosentan (BOS group), and 28 patients received standard medical treatment (CON group). Data were assessed until June 2009. RESULTS: Hemodynamic parameters improved significantly in the BOS group but remained unchanged in the CON group. The percentage of patients who fell below the thresholds of PAP, PVR, and TPG for cardiac transplantation increased significantly by 20.3%, 34.5%, and 20.8%, respectively (p = 0.007-0.013) in the BOS group, but did not change significantly in the CON group. One-year survival on the waiting list was approximately 20% higher in the BOS group than in the CON group (p = 0.020). Bosentan treatment remained an independent predictor of reduced mortality risk on the waiting list after propensity score adjustment (relative risk = 0.107; 95% CI: 0.013-0.869; p = 0.036). CONCLUSION: Treatment with the endothelin-1 antagonist bosentan is associated with improvements in hemodynamics and clinical outcome in end-stage heart failure patients with PH. If these results can be confirmed by randomized controlled trials, bosentan may represent a treatment option in these patients.