Methods: This was a combination of a 5-year retrospective study (January 2002 to April 2007) and a 6-month prospective study (September 2007 to February 2008) of adult blunt trauma (BT) patients with thoracic injuries and a chest CT upon hospital arrival. The primary outcome was MV due to thoracic trauma. To ensure that MV was required for BPC and not for associated injuries,

all patients with significant extrathoracic injuries (Abbreviated Injury Scale score >2) were excluded. The extent of BPC was measured by two scoring systems.

Results: Of 392 patients (67% males; age, 48 years +/- 21 years; Abbreviated Injury Scale score chest, 3 +/- 1; and Injury Severity Score [ISS], 13 +/- 6), 243 (62%) had BPC. Twenty-five (6%) patients required MV and two (0.5%) died. The combination of Glasgow Coma Scale (GCS) score <14, selleck kinase inhibitor BPC score >2, and >4 ribs fractured predicted MV in 100% of the cases, and the absence of all factors precluded MV in 100%. In the prospective period of 6 months, 55 patients had BPC and we confirmed our finding that the absence of the three factors precludes MV.

Conclusion: A simple score derived by the initial chest CT, in combination with GCS and the number of fractured

ribs, can predict the need for MV early. In the presence of these predictors, patients should be admitted to a high level of monitoring.”
“The maximum rate of left ventricular pressure rise (LV dp/dt (max)) is a good indicator of ventricular contractility. However, its measurement requires invasive cardiac catheterization. By applying the relationship between the ratio of NSC 617989 HCl aorta (Ao) dp/dt (max) to LV dp/dt (max) and the mean artery pressure (MAP), we tested the possible noninvasive estimation of LV dp/dt

(max) by the maximum rate of pressure rise in peripheral arteries, as measured by tonometry. The study subjects were 31 children with cardiovascular disease. The PD98059 LV and Ao pressures were measured during cardiac catheterization, with simultaneous recording of the brachial (BrA) or radial (RaA) artery pressure. The relationships between BrA dp/dt (max) and Ao dp/dt (max) and between RaA dp/dt (max) and Ao dp/dt (max) were determined (Ao dp/dt (max) = 0.299 x BrA dp/dt (max) + 210.6, n = 17, r = 0.78, SEE = 74.0, P = 0.0002, and Ao dp/dt (max) = 1.442 x RaA dp/dt (max) + 165.9, n = 14, r = 0.87, SEE = 66.1, P = 0.0001). Using these relationships and the equation Ao dp/dt (max)/LV dp/dt (max) = 0.694 – 4.00 x 10(-3) x MAP, LV dp/dt (max) was estimated from BrA dp/dt (max) or RaA dp/dt (max). The estimated LV dp/dt (max) correlated well with the measured LV dp/dt (max) independent of the site of measurement (y = 0.912 x x + 112.9, r = 0.91, P < 0.0001). Furthermore, there was excellent correlation between the measured and estimated LV dp/dt (max) after changes in contractility with dobutamine in 10 randomly selected patients (y = 0.86 x x + 34.2, r = 0.77, P = 0.01).