Trauma Surgery

U-shaped SBP–outcome relationship in unstable pelvic fracture with TBI

This retrospective study of 204 patients with unstable pelvic fractures and TBI developed a prognostic nomogram for poor outcomes. Shock, abnormal systolic blood pressure, non-surgical management, and prolonged prothrombin time were independent predictors of poor prognosis. Risk of poor prognosis followed a U-shaped curve, lowest at SBP 110–122 mmHg. The nomogram and XGBoost model may support individualized blood pressure targets, coagulation monitoring, and decisions about operative pelvic stabilization. 1

PPIs outperform H2 blockers for stress ulcer prophylaxis in septic shock

In a multicenter cohort of 15,102 adults with septic shock, PPIs were compared with H2RAs for stress ulcer prophylaxis. After inverse probability weighting, PPIs were associated with fewer upper GI bleeds than H2RAs (OR 0.78, 95% CI 0.64–0.96). A famotidine-versus-pantoprazole sensitivity analysis showed similar benefit for PPIs. There were no significant differences in mortality, ventilator-associated pneumonia, C. difficile, or hospital length of stay. These data support PPIs as the preferred prophylaxis in septic shock when GI bleeding risk is a priority. 2

NIV preoxygenation reduces severe desaturation during emergency intubation

This network meta-analysis pooled 15 RCTs including 2,939 critically ill adults undergoing emergency intubation. All noninvasive respiratory support strategies improved lowest SpO2 compared with conventional oxygen therapy. NIV provided the largest benefit, improving nadir SpO2 more than HFOT. NIV also reduced severe desaturation events (SpO2 <80%) without increasing aspiration, hypotension, arrhythmia, barotrauma, or cardiac arrest. No strategy altered postintubation gas exchange, mechanical ventilation duration, or mortality versus conventional oxygen therapy. 3

Etomidate linked to higher mortality than ketamine in emergency RSI

This multicenter Brazilian registry emulated a target trial comparing ketamine versus etomidate for RSI in 1,810 critically ill adults. Despite higher shock indices and vasopressor use in ketamine recipients, weighted 28-day mortality was higher with etomidate (RR 1.14, 95% CI 1.03–1.27). Seven-day mortality was also higher with etomidate than ketamine. Ketamine was associated with more new hemodynamic instability within 30 minutes, but no differences emerged in first-pass success or severe hypoxemia. These data suggest ketamine may confer a survival advantage over etomidate despite more early hypotension risk. 4