The acute phase management of spinal cord injury affecting polytrauma patients: the ASAP study.

BACKGROUND: Few data on the management of acute phase of traumatic spinal cord injury (tSCI) in patients suffering polytrauma are available. As the therapeutic choices in the first hours may have a deep impact on outcome of tSCI patients, we conducted an international survey investigating this topic. METHODS: The survey was composed of 29 items. The main endpoints of the survey were to examine: (1) the hemodynamic and respiratory management, (2) the coagulation management, (3) the timing of magnetic resonance imaging (MRI) and spinal surgery, (4) the use of corticosteroid therapy, (5) the role of intraspinal pressure (ISP)/spinal cord perfusion pressure (SCPP) monitoring and (6) the utilization of therapeutic hypothermia. RESULTS: There were 171 respondents from 139 centers worldwide. A target mean arterial pressure (MAP) target of 80-90 mmHg was chosen in almost half of the cases [n = 84 (49.1%)]. A temporary reduction in the target MAP, for the time strictly necessary to achieve bleeding control in polytrauma, was accepted by most respondents [n = 100 (58.5%)]. Sixty-one respondents (35.7%) considered acceptable a hemoglobin (Hb) level of 7 g/dl in tSCI polytraumatized patients. An arterial partial pressure of oxygen (PaO2) of 80-100 mmHg [n = 94 (55%)] and an arterial partial pressure of carbon dioxide (PaCO2) of 35-40 mmHg [n = 130 (76%)] were chosen in most cases. A little more than half of respondents considered safe a platelet (PLT) count > 100.000/mm3 [n = 99 (57.9%)] and prothrombin time (PT)/activated partial thromboplastin time (aPTT) < 1.5 times the normal control [n = 85 (49.7%)] in patients needing spinal surgery. MRI [n = 160 (93.6%)] and spinal surgery [n = 158 (92.4%)] should be performed after intracranial, hemodynamic, and respiratory stabilization by most respondents. Corticosteroids [n = 103 (60.2%)], ISP/SCPP monitoring [n = 148 (86.5%)], and therapeutic hypothermia [n = 137 (80%)] were not utilized by most respondents. CONCLUSIONS: Our survey has shown a great worldwide variability in clinical practices for acute phase management of tSCI patients with polytrauma. These findings can be helpful to define future research in order to optimize the care of patients suffering tSCI.

How to manage fever in brain-injured patients.

Fever represents a frequent and dangerous secondary insult for the injured brain and is often associated with worsened neurological outcomes. The identification of fever in the Neuro-Intensive Care Unit requires careful monitoring and rapid and effective treatment. The main objective of this article was to provide practical information regarding temperature monitoring, triggers for intervention and fever management in brain injured patients.

WSES consensus conference guidelines: monitoring and management of severe adult traumatic brain injury patients with polytrauma in the first 24 hours.

The acute phase management of patients with severe traumatic brain injury (TBI) and polytrauma represents a major challenge. Guidelines for the care of these complex patients are lacking, and worldwide variability in clinical practice has been documented in recent studies. Consequently, the World Society of Emergency Surgery (WSES) decided to organize an international consensus conference regarding the monitoring and management of severe adult TBI polytrauma patients during the first 24 hours after injury. A modified Delphi approach was adopted, with an agreement cut-off of 70%. Forty experts in this field (emergency surgeons, neurosurgeons, and intensivists) participated in the online consensus process. Sixteen recommendations were generated, with the aim of promoting rational care in this difficult setting.

Λ-enhanced grey molasses on the D2 transition of Rubidium-87 atoms.

Laser cooling based on dark states, i.e. states decoupled from light, has proven to be effective to increase the phase-space density of cold trapped atoms. Dark-states cooling requires open atomic transitions, in contrast to the ordinary laser cooling used for example in magneto-optical traps (MOTs), which operate on closed atomic transitions. For alkali atoms, dark-states cooling is therefore commonly operated on the D1 transition nS1/2 → nP1/2. We show that, for 87Rb, thanks to the large hyperfine structure separations the use of this transition is not strictly necessary and that "quasi-dark state" cooling is efficient also on the D2 line, 5S1/2 → 5P3/2. We report temperatures as low as (4.0 ± 0.3) µK and an increase of almost an order of magnitude in the phase space density with respect to ordinary laser sub-Doppler cooling.

Quantum breathing of an impurity in a one-dimensional bath of interacting bosons.

By means of the time-dependent density-matrix renormalization-group (TDMRG) method we are able to follow the real-time dynamics of a single impurity embedded in a one-dimensional bath of interacting bosons. We focus on the impurity breathing mode, which is found to be well described by a single oscillation frequency and a damping rate. If the impurity is very weakly coupled to the bath, a Luttinger-liquid description is valid and the impurity suffers an Abraham-Lorentz radiation-reaction friction. For a large portion of the explored parameter space, the TDMRG results fall well beyond the Luttinger-liquid paradigm.