Gerard J Fulda

Gerard J Fulda
Christiana Care Health System · Department of Surgery

About

93
Publications
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Introduction
Skills and Expertise
Additional affiliations
June 1990 - present
Christiana Care Health System
Position
  • Chairman, Department of Surgery

Publications

Publications (93)
Chapter
This is a unique question‐and‐answer chapter for surgical residents and trainees, concentrating on the obstetric critical care. Critical care for the pregnant patient requires a broad understanding of the fetal risk of common Intensive Care Unit medications. Among benzodiazepines, lorazepam has been shown to be teratogenic in animal studies, for th...
Article
Full-text available
Abstract OBJECTIVE: To assess the effect of body mass index on ICU outcome and on the development of ICU-acquired infection. DESIGN: A substudy of the Intensive Care Over Nations audit. SETTING: Seven hundred thirty ICUs in 84 countries. PATIENTS: All adult ICU patients admitted between May 8 and 18, 2012, except those admitted for less than 24 hou...
Article
This document was developed through the collaborative efforts of the Society of Critical Care Medicine, the American College of Chest Physicians, and the Association of Organ Procurement Organizations. Under the auspices of these societies, a multidisciplinary, multi-institutional task force was convened, incorporating expertise in critical care me...
Article
Presented at the American College of Surgeons Committee on Trauma 2012 Delaware State Paper Competition and Region 3 Paper Competition (Christiana Care Health System, November 2012 Newark, Delaware).
Conference Paper
Catheter-associated urinary tract infections (CAUTI) are the most common type of healthcare-acquired infection. A 28-bed surgical critical care complex replaced their usual soap product with Castile soap products when bathing patients or performing perineal care for an 18-month period. CAUTI rate decreased from 6.18 infections/1000 catheter days to...
Article
Full-text available
Background: Progesterone has been associated with robust positive effects in animal models of traumatic brain injury (TBI) and with clinical benefits in two phase 2 randomized, controlled trials. We investigated the efficacy and safety of progesterone in a large, prospective, phase 3 randomized clinical trial. Methods: We conducted a multination...
Conference Paper
Full-text available
Background: Current ventilator bundles primarily aim to prevent pneumonia. New ventilator-associated event (VAE) definitions launched by the National Healthcare Safety Network (NHSN) in Jan 2013 detect other physiologic processes than pneumonia. Use of higher positive end-expiratory pressure (PEEP) may reduce other causes of VAE, such as atelectasi...
Article
Objective: This study examined outcomes in elderly TBI patients who underwent a cranial operation. Methods: We identified TBI patients > or = 65 who underwent a cranial operation from January 1, 2004 to December 31, 2008. Data collected included: age, admission GCS, mechanism of injury, ISS, Head AIS, type of operation, hemorrhage acuity, time t...
Article
Full-text available
Global epidemiological data regarding outcomes for patients in intensive care units (ICUs) are scarce, but are important in understanding the worldwide burden of critical illness. We, therefore, did an international audit of ICU patients worldwide and assessed variations between hospitals and countries in terms of ICU mortality. 730 participating c...
Poster
Full-text available
OBJECTIVES Simulation labs have enabled surgical residents to become familiar and gain proficiency on various procedures prior to operating on real patients. Not only can residents practice their technical skills, but the simulation lab can also be utilized to foster and improve communication skills. The goal of this station is to assess the role o...
Conference Paper
Introduction: Cerebral salt wasting (CSW) and the syndrome of inappropriate antidiuretic hormone release (SIADH) are two causes of hyponatremia in neurocritical care patients. CSW presents with decreased plasma volume (PV); SIADH presents with normal or increased PV. Clinical exam and CVP are unreliable for assessing circulating volume. Bedside iso...
Article
Background The Council of Medical Specialty Societies (CMSS) approved “Principles for the Development of Specialty Society Clinical Guidelines” as a set of standards that member societies could draw upon in developing their own development methodologies. Developed by the member societies in late 2012, the Principles are intended to provide a degree...
Article
Background In 2011 the Institute of Medicine (IOM) issued a report “Clinical Practice Guidelines We Can Trust” and “Standards for Systematic Reviews”. These documents represent an idealised approach to guideline development. The Council of Medical Specialty Societies (CMSS) was challenged to provide leadership on a pragmatic pathway for developing...
Article
One barrier for implementing programs of uncontrolled organ donation after the circulatory determination of death is the lack of consensus on the precise moment of death. Our panel was convened to study this question after we performed a similar analysis on the moment of death in controlled organ donation after the circulatory determination of deat...
Conference Paper
Full-text available
Introduction: ICUs practicing multi-professional (MP) critical care frequently incorporate a dedicated respiratory therapist (RRT) into their team. RRTs participate in extubation decisions in the ICU. Frequently extubations are not performed until after the AM rounding process. We recently increased the role of our RRT in the clinical decision proc...
Article
The American Association for the Surgery of Trauma challenged the trauma community to improve a 22 per cent average removal rate for retrievable inferior vena cava filters (r-IVCFs). Since 2006, we maintained a "filter registry" documenting all IVCFs placed in trauma patients. Our goal was to improve removal rates for r-IVCF. Patients receiving an...
Article
Postpartum hemorrhage is a leading cause of maternal mortality. Massive transfusion in obstetric patients is rare. Recombinant Factor VIIa (rFVIIa) use in trauma patients with massive transfusion is efficacious. Our goal was to evaluate the safety and efficacy of rFVIIa use in obstetric patients with massive postpartum hemorrhage (MPH). Patients re...
Article
This report presents the case of the emergency repair of a radiation-induced aortoesophageal fistula (AEF) with an endograft. The patient presented with multiple episodes of upper gastrointestinal bleeding. The fistula was discovered and treated in the operating room. The placement of a temporary aortic endograft was successful. The patient unfortu...
Article
Phlegmonous gastritis is a rare and often fatal condition that can affect healthy individuals in 50% of cases. The condition has been described in accounts dating back to the pre-antibiotic era, during which time mortality was nearly 100%. Over the past century, case reports average about one per year. The etiology remains unclear, although Strepto...
Article
Critical care workforce analyses estimate a 35% shortage of intensivists by 2020 as a result of the aging population and the growing demand for greater utilization of intensivists. Surgical critical care in the U.S. is particularly challenged by a significant shortfall of surgical intensivists, with only 2586 surgeons currently certified in surgica...
Article
Death statutes permit physicians to declare death on the basis of irreversible cessation of circulatory-respiratory or brain functions. The growing practice of organ donation after circulatory determination of death now requires physicians to exercise greater specificity in circulatory-respiratory death determination. We studied circulatory-respira...
Article
A widely held belief contends that food-induced proton pump activation is important for optimal proton pump inhibitor-induced inhibition of gastric acid secretion. This study was undertaken to assess intragastric acid control with intravenous (IV) esomeprazole in critically ill patients. This open-label, single-arm, exploratory trial was conducted...
Article
Adult trauma centers are major providers of medical management for pediatric trauma patients in the United States. Medication administration in this patient population is complex and fraught with potential error. We designed a multidisciplinary team consisting of a pediatric hospitalist, pediatric care coordinator, pediatric nurse, pharmacist, and...
Article
Full-text available
Fall from standing (FFS) has become one of the most common mechanisms of injury for admission to the trauma center in the elderly population. Many of these patients present anticoagulated with warfarin. This two-center study was designed to examine the effects of preinjury warfarin use on outcome in the elderly. A retrospective review of prospectiv...
Article
Resuscitative thoracotomy has an integral role for open cardiac massage and can be preformed after penetrating trauma with cardiovascular collapse. Its role in blunt trauma is questionable. We performed a retrospective chart review of patients who underwent an emergency department (ED) resuscitative thoracotomy. The goal was to define the role of r...
Article
Human polymerized hemoglobin (PolyHeme, Northfield Laboratories) is a universally compatible oxygen carrier developed to treat life-threatening anemia. This multicenter phase III trial was the first US study to assess survival of patients resuscitated with a hemoglobin-based oxygen carrier starting at the scene of injury. Injured patients with a sy...
Article
Trauma patients on prescribed warfarin therapy sustaining intracranial hemorrhage can be difficult to manage. Rapid normalization of coagulopathy is imperative to operative intervention and may affect outcomes. To identify and expedite warfarin reversal, we designed a protocol to administer a prothrombin complex concentrate. A Proplex T protocol wa...
Article
In 2004, Christiana Care Health System (Christiana Care), a 1,100-bed tertiary care facility, used the Surviving Sepsis Campaign guidelines as the foundation for an independent initiative to reduce the mortality rate by at least 25%. In 2004, an interdisciplinary sepsis team developed a process for rapidly recognizing at-risk patients; evaluating a...
Article
PURPOSE: The mortality of severe sepsis exceeds 40%. Recently, the treatment of severe sepsis has focused on management guidelines which incorporate multiple therapeutic approaches. These guidelines include algorithms for resuscitation, vasopressors, antibiotic administration, blood transfusions, rhAPC, and glucose control. In 2005 our institution...
Article
Successfully managing pain for the trauma patient decreases morbidity, improves patient satisfaction, and is an essential component of critical care. Using patient-controlled analgesia (PCA) morphine to control pain may be complicated by concerns of respiratory depression, hemodynamic instability, addiction, urinary retention, and drug-induced ileu...
Article
The purpose of this study was to assess the utility of two levels of hyperglycemia as predictors for mortality and infectious morbidity in traumatically injured patients. All patients >or= 17 years old presenting to a Level I trauma center as a "trauma alert" or a "trauma code" from January 1, 2000, through December 31, 2000, were reviewed. Hypogly...
Article
Intensivists frequently collaborate with plastic and reconstructive surgeons in treating patients with major wounds, following significant reconstructive procedures, and following free-tissue transfers. Pressure ulcers are a significant source of morbidity and mortality in the intensive care unit; prevention, early recognition, and multidisciplinar...
Article
The value of an in-house trauma surgeon is debated. Previous studies focus on comparing in-house and on-call surgeons at different institutions or different periods in time. The purpose of this study was to simultaneously evaluate in-house and on-call trauma surgeons in a single Level I trauma center and to determine the impact of in-house trauma s...
Article
Background: Thoracostomy tube (TT) placement constitutes primary treatment for traumatic hemopneumothorax. Practice patterns vary widely, and criteria for management and removal remain poorly defined. In this cohort study, we examined the impact of implementation of a practice guideline (PG) on improving management efficiency of thoracostomy tube....
Article
In summary, BAI is a lethal result of severe blunt trauma. It should be considered in all patients who sustained injury by a deceleration or acceleration mechanism, especially in the face of physical or radiographic findings suggestive of mediastinal injury. Angiography remains the "gold standard" for diagnosis, although CT scanning is taking more...
Article
Full-text available
To evaluate changes in serum and urinary zinc, cobalt, copper, iron, and calcium concentrations in critically ill patients receiving propofol containing disodium edetate (disodium ethylenediaminetetraacetic acid [EDTA]) versus sedative agents without EDTA. This was a randomised, open-label, parallel-group study with randomisation stratified by base...
Article
To compare propofol with disodium edetate (EDTA) and propofol without EDTAwhen used for the sedation of critically ill surgical intensive care unit (ICU) patients. Prospective, randomised, multicentre trial. A total of 122 surgical ICU patients who required intubation and mechanical ventilation. Patients were randomised to receive either propofol o...
Article
To discover if a consumer-driven process is fueling the high rate of cholecystectomies in the laparoscopic era. A 12-question survey. A 1000-bed, university-affiliated hospital. Patients admitted for elective cholecystectomies. Survey responses suggesting positive perceptions about laparoscopic cholecystectomy persuade patients to undergo gallbladd...
Article
Sedation regimens for head-injured patients are quite variable. The short-acting sedative-anesthetic agent propofol is being increasingly used in such patients, yet little is known regarding its safety and efficacy. In this multicenter double-blind trial, a titratable infusion of 2% propofol accompanied by low-dose morphine for analgesia was compar...
Article
Introduction: Providing adequate pain management to patients with acute thoracic injuries is essential. Proper pain management decreases morbidity and improves patient satisfaction. PCA morphine may be limited due to concerns about addiction, respiratory depression, hemodynamic instability, urinary retention, and drug induced ileus. Morphine is rap...
Article
Full-text available
Recent reports showed lack of effectiveness of pulmonary artery catheterization in critically ill medical patients and relatively late-stage surgical patients with organ failure. Since invasive monitoring requires critical care environments, the early hemodynamic patterns may have been missed. Ideally, early noninvasive hemodynamic monitoring syste...
Article
Introduction: Hospital information systems (HIS)are rapidly evolving. Large amounts of data are now available for each intensive care unit (ICU) patient However, even computerized charting systems fail to capture all the information required for multidisciplenary ICU rounds and quality monitoring. This additional information is traditionally record...
Article
Introduction: Pain is a major concern of patients in the intensive care unit (ICU). Unrelieved pain increases morbidity and mortality and may increase hospital length of stay. Recent attention to these facts has led to the development of pain management guidelines. The purpose of this study was to determine the impact of implementation of nursing p...
Article
The purpose of this study was to determine the adequacy and accuracy of lateral cervical spine radiographs in the initial evaluation of alert, high-risk trauma patients evaluated at a Level I trauma center. Data were obtained retrospectively through review of trauma service admissions from January 1, 1994, to July 31, 1995. Included were all patien...
Article
Despite multiple inquiries, there are no available tests to definitively detect blunt myocardial injury. The evaluation of patients with chest wall injuries without other indications for intensive care unit (ICU) admission has ranged from a single emergency department electrocardiogram (ECG) to 72 hours of continuous electrocardiographic monitoring...
Article
The purpose of this prospective study was to assess the impact of a two-tiered trauma response protocol on the expediency of identification, evaluation, and treatment of trauma patients in the Emergency Department. At a Level I Trauma Center serving a suburban/urban population of approximately one million people, Emergency Department length of stay...
Article
Objective : The purpose of this prospective study was to assess the impact of a two-tiered trauma response protocol on the expediency of identification, evaluation, and treatment of trauma patients in the Emergency Department. Materials and Methods : At a Level I Trauma Center serving a suburban/urban population of approximately one million people,...
Article
A case is reported of a patient who sustained a tracheobronchial tear as a result of an assault rather than the typical crushing trauma associated with such an injury. A review of tracheobronchial injuries is presented.
Article
Airbags have been shown to save lives and reduce head, neck, and upper torso trauma associated with motor vehicle crashes. However, airbags have also been implicated as the source of facial and orbital injury. We report the case of a patient who suffered bilateral lenticular subluxation, anterior chamber hemorrhages, and minor facial lacerations as...
Article
Airbags have been shown to save lives and reduce head, neck, and upper torso trauma associated with motor vehicle crashes. However, airbags have also been implicated as the source of facial and orbital injury. We report the case of a patient who suffered bilateral lenticular subluxation, anterior chamber hemorrhages, and minor facial lacerations as...