Use of intrathoracic pressure regulation therapy in breathing patients for the treatment of hypotension secondary to trauma.

BACKGROUND: Intrathoracic pressure regulation (IPR) therapy has been shown to increase blood pressure in hypotensive patients. The potential value of this therapy in patients with hypotension secondary to trauma with bleeding is not well understood. We hypothesized that IPR would non-invasively and safely enhance blood pressure in spontaneously breathing patients with trauma-induced hypotension. METHODS: This prospective observational cohort study assessed vital signs from hypotensive patients with a systolic blood pressure (SBP) ≤90 mmHg secondary to trauma treated with IPR (ResQGARD™, ZOLL Medical) by pre-hospital emergency medical personnel in three large US metropolitan areas. Upon determination of hypotension, facemask-based IPR was initiated as long as bleeding was controlled. Vital signs were recorded before, during, and after IPR. An increased SBP with IPR use was the primary study endpoint. Device tolerance and ease of use were also reported. RESULTS: A total of 54 patients with hypotension secondary to trauma were treated from 2009 to 2016. The mean ± SD SBP increased from 80.9 ± 12.2 mmHg to 106.6 ± 19.2 mmHg with IPR (p < 0.001) and mean arterial pressures (MAP) increased from 62.2 ± 10.5 mmHg to 81.9 ± 16.6 mmHg (p < 0.001). There were no significant changes in mean heart rate or oxygen saturation. Approximately 75% of patients reported moderate to easy tolerance of the device. There were no safety concerns or reported adverse events. CONCLUSIONS: These findings support the use of IPR to treat trauma-induced hypotension as long as bleeding has been controlled.

Prehospital pain assessment in pediatric trauma.

OBJECTIVE: Investigators implemented the current study to analyze the documentation of pain assessments and interventions for injured children in prehospital settings. METHODS: For this institutional review board-approved retrospective study, 696 Lucas County Emergency Medical Services trauma charts (46% of the county's total runs) from 2002 to 2004 were reviewed, and descriptive statistics of frequency were used to analyze pain-assessment documentation and interventions. RESULTS: Pain was noted in 64.1% (446/696) of subjects, a statement of "no pain" was noted in 17.2% (120/696) of subjects, and pain was undocumented in 18.7%. Only one trauma chart (1/696, 0.2%) indicated the appropriate use of a validated pain assessment tool (Verbal Rating Scale). There were no documented pain interventions provided to 86.6% (603/696) of all subjects, including 85.0% (379/446) with documented pain. Of all subjects, 13.4% (93/696) received pain interventions. Pharmacological interventions were used for 2.2% (15/696) of all subjects and 16.1% (15/93) of subjects with documented pain interventions. Nonpharmacologic interventions were used in 12.4% of cases (86/696), in which traction and splinting were the most common interventions (36/93, 38.7%), followed by saline flush with dressing (15/93, 16.1%). Diversion and distraction techniques were documented in five charts in which a pain intervention was documented (5/93, 5.4%). CONCLUSIONS: These results identify a void in the documentation of pain assessment and implementation of pain-control interventions for injured pediatric patients. Education for prehospital providers is recommended, emphasizing the importance of pain assessment and documentation of pain-control care for pediatric trauma patients.