Trauma Surgery & Acute Care Open最新文献

{"title":"TCCACS and MDR 2026 introduction.","authors":"Mary Allen, Purvi Pravinchandra Patel, Kenneth L Mattox","doi":"10.1136/tsaco-2026-002312","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002312","url":null,"abstract":"","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002312"},"PeriodicalIF":2.2,"publicationDate":"2026-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141187/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843307","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Regional, multimodal, and opioid-sparing strategies after trauma: a review.","authors":"Emily Hancin, Purvi Pravinchandra Patel, Tanya Egodage","doi":"10.1136/tsaco-2026-002273","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002273","url":null,"abstract":"<p><p>Effective analgesia is fundamental in the management of trauma, critical care, and emergency surgical patients. However, historical reliance on opioid-based pain management strategies can be associated with adverse effects, including respiratory depression, delirium, and prolonged opioid exposure after discharge, leading to dependence. In response, multimodal analgesia strategies emphasizing non-opioid and regional techniques have become an important adjunct in trauma care pathways. This review summarizes current evidence supporting neuraxial anesthesia, peripheral and truncal nerve blocks, and non-opioid pharmacological agents as components of opioid-sparing analgesic techniques in injured and critically ill patients. Collectively, these pain management strategies support an evidence-based approach to analgesia that reduces opioid exposure and optimizes early walking and functional recovery in postoperative patients. Integration of these modalities into protocolized and perioperative pathways represents a critical step toward more effective analgesia for patients.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002273"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141092/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843274","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Crossing the blood-brain barrier: neurotrauma in disasters and resource-limited settings.","authors":"Michael J Anstadt, Tanya Egodage, Matthew J Martin, Purvi Pravinchandra Patel","doi":"10.1136/tsaco-2026-002281","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002281","url":null,"abstract":"<p><p>Traumatic brain injury (TBI) is a major cause of morbidity and mortality in natural disasters, armed conflict, and other resource-limited settings, where advanced imaging, invasive neuromonitoring, and specialized neurosurgical care, common in high-resource environments, are often unavailable. This narrative review summarizes the global health impact of TBI in austere conditions and outlines key management strategies and ethical considerations relevant to these contexts. Evidence from civilian disaster responses, military conflicts, and global health guidelines highlight the need for adaptable, physiology-driven approaches that prioritize prevention of secondary brain injury through avoidance of hypoxia, hypotension, and uncontrolled intracranial hypertension. In settings with constrained resources, clinicians rely heavily on neurological examinations and local imaging capabilities for the initial diagnosis and management. Low-cost interventions, including hyperventilation, raising the head of bed, and hyperosmolar therapy are first-line measures in response to clinical deterioration, whereas damage control neurosurgery incorporating rapid hemorrhage control, hematoma evacuation, and infection prevention is reserved for severe cases with prolonged transport times. Neurotrauma in disaster and resource-limited settings remains a significant global health challenge. Meaningful improvements in survival and outcomes for patients with TBI can be achieved through early resuscitation, vigilant clinical assessment, and timely surgical intervention, even in the absence of advanced neuromonitoring. Adaptable, resource-appropriate strategies are essential to optimizing neurotrauma care in austere environments.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002281"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141095/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843309","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ransomware attacks and cybersecurity concerns in modern hospitals: vulnerabilities and impacts on trauma centers and patient care.","authors":"Matthew J Martin, Purvi Pravinchandra Patel, Tanya Egodage","doi":"10.1136/tsaco-2026-002293","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002293","url":null,"abstract":"<p><p>Healthcare facilities and systems are at extremely high risk of cyberattacks, with ransomware posing a significant threat to hospital operations and patient safety. Trauma centers are at particular risk for the many potential adverse impacts of a ransomware attack given the time and resource dependency of emergency trauma and surgical care. This review highlights current knowledge on ransomware, its mechanisms, types of attacks, prevention strategies, immediate and delayed response protocols, and the emerging role of artificial intelligence in both cybersecurity attacks and defensive efforts. Emphasis is placed on the unique vulnerabilities of healthcare systems, including legacy IT infrastructure and human factors, and on best practices to mitigate risks. Effective prevention strategies include regular employee training programs to heighten awareness, implementation of robust backup and recovery systems to minimize downtime, and continuous updating of IT infrastructure to close security gaps. The review highlights lessons learned from recent ransomware attacks against trauma centers, including the critical importance of institutional leadership, employee training, and robust backup systems to ensure resilience against ransomware incidents.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002293"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141016/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843311","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Contemporary diagnosis and management of patients with adhesive small bowel obstruction.","authors":"Bonnie Du Cruz, Karyssa M Nelson, Carlos V R Brown","doi":"10.1136/tsaco-2026-002275","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002275","url":null,"abstract":"<p><p>Adhesive small bowel obstruction (aSBO) remains one of the most common causes of surgical admission and morbidity. With advancements in imaging and the advent of water-soluble contrast, management has become increasingly non-operative. Although this is successful in a majority of patients, patients who fail this trial without operation may face worse outcomes. Delays to surgical intervention are associated with increased rates of bowel ischemia, resection, infectious complications, and mortality. Optimal management therefore depends on early risk stratification, disciplined non-operative trials, and timely escalation to operation when indicated. This review summarizes contemporary evidence regarding pathogenesis, pathophysiology, epidemiology, diagnostic evaluation, management, and outcomes of aSBO, with a focus on practical decision-making. The evaluation of each patient's obstruction consists of subjective clinical findings in combination with objective data including labs and imaging. CT with intravenous contrast remains a cornerstone of diagnosis, allowing identification of obstruction severity and features concerning for ischemic physiology that mandates immediate operative exploration. In the absence of these findings, a structured trial of non-operative management may be pursued, including nasogastric decompression, intravenous resuscitation, electrolyte correction, and inpatient admission with close oversight from a surgical team. Water-soluble contrast studies serve as both a prognostic and therapeutic adjunct, as failure of contrast to reach the colon within 24 hours is strongly predictive of unsuccessful non-operative management. Operative management should be undertaken promptly in patients with clinical deterioration, imaging evidence of ischemia, or failure of non-operative therapy. Although open laparotomy remains the standard approach, laparoscopy may be considered in carefully selected patients in experienced hands. Across management strategies, early surgical ownership and avoidance of prolonged non-operative trials in high-risk patients are critical to optimizing outcomes. aSBO is best managed through structured algorithms that prioritize early diagnosis, time-sensitive reassessment, and decisive operative intervention when indicated.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002275"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141205/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843251","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fueling recovery: evidence-based ICU nutrition and immunonutrition strategies in 2026.","authors":"Daniel Dante Yeh","doi":"10.1136/tsaco-2026-002284","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002284","url":null,"abstract":"<p><p>Our understanding of the metabolic response to critical illness continues to evolve and delivery of nutrition therapy in the intensive care unit (ICU) has become more nuanced. Both underfeeding and overfeeding have recognized harms, and it is often challenging to provide the right dose at the right time by the right route to the right patient. The historic 'ebb and flow' model of critical illness metabolism has been replaced by a modern model describing early and late acute phase, chronic phase and convalescent phase. Macronutrient delivery should be tailored to not only the patient but also the phase of critical illness. In the absence of contraindications to enteral nutrition (EN), trophic rate EN should begin when acute resuscitation is complete, typically within 48 hours of ICU admission. During the first week or early acute phase of critical illness, energy delivery should be limited to no more than 70%-80% of 'full' nutrition because of the unavoidable presence of endogenous glucose production. Similarly, protein delivery should be limited to ≤1.2 g/kg/day. After the early acute phase, both energy and protein prescription should increase to 100% 'full' nutrition and 1.2-2.0 g/kg/day. In the chronic convalescent and post-ICU phase, even higher energy and protein prescriptions may be necessary to regain lost muscle mass and function. Early physical therapy or neuromuscular stimulation is safe, feasible and likely beneficial. Although intravenous glutamine and arginine are no longer recommended, there may be a role for intravenous fish oil and enteral glutamine (only for burns >20% Total Body Surface Area (TBSA)).</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002284"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141161/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surgical urgency and outcomes in nonagenarian and centenarian patients admitted to the ICU after hip replacement: a binational multicenter cohort study.","authors":"Je Min Suh, Dong-Kyu Lee, Angelina Yoon, Nattaya Raykateeraroj, Andrew Hardidge, Sophia Grobler, Grace Kwon, David Pilcher, Laurence Weinberg","doi":"10.1136/tsaco-2025-002194","DOIUrl":"https://doi.org/10.1136/tsaco-2025-002194","url":null,"abstract":"<p><strong>Introduction: </strong>The global population of nonagenarians and centenarians is expected to quadruple by 2050, resulting in increasing numbers of the oldest-old undergoing procedures such as hip replacement to maintain mobility and independence. Despite this trend, evidence on how surgical urgency affects outcomes in this population remains limited.</p><p><strong>Methods: </strong>We conducted a retrospective cohort study using data from the ANZICS Adult Patient Database (2010-2023), which captures 98% of intensive care units (ICUs) in Australia and 68% in New Zealand. The study included 1,578 nonagenarian and centenarian patients who underwent non-traumatic hip replacement and were admitted to intensive care. Outcomes examined were mortality at three time intervals (<30 days, 30-365 days and >365 days) and ICU and hospital length of stay. Analytical methods included propensity score matching, Cox regression, Kaplan-Meier curves and time-dependent area under the receiver operating characteristic curve analyses to assess the prognostic value of clinical scores and biomarkers.</p><p><strong>Results: </strong>Non-elective operation was associated with significantly higher mortality across all time points (HR 2.87 at <30 days; 3.02 at 30-365 days; 1.84 beyond 365 days). It was also linked to a 13.1% longer ICU stay (p=0.034). Acute Physiology and Chronic Health Evaluation III and Sequential Organ Failure Assessment scores showed strong predictive performance for short-term mortality, whereas age and sex had minimal prognostic value.</p><p><strong>Conclusion: </strong>Among nonagenarians and centenarians undergoing hip replacement, non-elective procedures were consistently associated with poorer outcomes, including higher mortality and longer ICU stay. Early risk stratification using routine clinical markers, together with proactive goals-of-care discussions, may improve perioperative management in this vulnerable population.</p><p><strong>Level of evidence: </strong>Level II Therapeutic/Care Management.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 2","pages":"e002194"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141227/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843286","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mental health after the sirens: moral injury in responders and survivors of disaster, mass casualty, and crisis care.","authors":"Natasha Keric, Chidinma Tiko-Okoye, Gerald Wang, Ian J Thomas, Purvi Pravinchandra Patel","doi":"10.1136/tsaco-2026-002282","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002282","url":null,"abstract":"<p><p>Healthcare professionals responding to disasters, mass casualty incidents, pandemics, and sustained high-acuity clinical environments face extraordinary ethical and emotional demands. While burnout and post-traumatic stress disorder (PTSD) have historically framed clinician distress, these constructs incompletely capture the moral and existential harm experienced when clinicians are forced to act in ways that conflict with deeply held professional and ethical values. Moral injury has emerged as a distinct framework to explain this phenomenon. This review synthesizes current understanding of moral injury in disaster, mass casualty, and crisis care settings, distinguishing it from burnout and PTSD, examines prevalence and impact on clinicians and healthcare systems, identifies unique individual, organizational, and situational risk factors, and reviews mitigation and recovery strategies across the disaster continuum. Critical gaps in measurement and research are highlighted, particularly in command-driven healthcare environments. Addressing moral injury requires system-level interventions, ethical transparency, and leadership accountability to sustain the healthcare workforce beyond the immediate crisis.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002282"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13141044/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843289","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"\"Do Everything\" versus realistic surgical interventions: navigating the road to shared decision-making in trauma surgery.","authors":"Victoria E Wagner, Ashna S Karpe, Martin L Blakely, Lillian S Kao, Thaddeus J Puzio","doi":"10.1136/tsaco-2026-002287","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002287","url":null,"abstract":"<p><p>\"DO EVERYTHING!!\" How many times have you heard that phrase from a distressed family member? We routinely receive this desperate plea, and our knee-jerk reaction is to press on, push harder, be more aggressive. We, as acute care surgeons, have spent our lives learning a craft geared towards \"doing everything\" to heal patients so this response comes naturally. However, how do we respond to \"do everything\" when the probability of a meaningful recovery is extremely low or non-existent? These situations create moral tension for surgeons who must reconcile the desire to preserve life with the obligation to avoid harm, respect patient values, and provide care that is medically appropriate. We will explore three components of this challenging topic: (1) the utility and limitations of risk calculators and prognostic tools in trauma, (2) the best case/worst case model as a structured communication strategy and (3) approaches to counseling families when expectations for recovery are not realistic. Together, these elements provide a framework for decision-making that is compassionate, ethically grounded, and anchored in clinical reality.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002287"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140996/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Take a deep breath: managing the challenges of acute respiratory distress syndrome cases.","authors":"Manuel Castillo-Angeles, Ali Salim","doi":"10.1136/tsaco-2026-002286","DOIUrl":"https://doi.org/10.1136/tsaco-2026-002286","url":null,"abstract":"<p><p>Acute respiratory distress syndrome (ARDS) remains a major challenge in trauma care, with high morbidity and mortality. Current management emphasizes lung-protective ventilation, careful fluid balance, and a multidisciplinary approach. New areas of discovery, such as ARDS phenotyping, precision medicine, ECMO innovations, and evolving adjunctive therapies, are reshaping practice and offering opportunities for improved outcomes. This comprehensive review highlights the current understanding of ARDS and management essentials and underscores the importance of emerging therapies that offer the clearest path to further reduce ARDS morbidity and mortality.</p>","PeriodicalId":23307,"journal":{"name":"Trauma Surgery & Acute Care Open","volume":"11 Suppl 1","pages":"e002286"},"PeriodicalIF":2.2,"publicationDate":"2026-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13140947/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147843304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}