Steven Vaslef

Steven Vaslef
Duke University Medical Center | DUMC · Department of Surgery

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75
Publications
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Introduction
Skills and Expertise

Publications

Publications (75)
Article
The relative contribution of specific postoperative complications on mortality after emergency operations has not been previously described. Identifying specific contributors to postoperative mortality following acute care surgery will allow for significant improvement in the care of these patients. Patients from the 2005 to 2011 American College o...
Article
Myeloid neoplasms are classified into five major categories. These patients may develop splenomegaly and require splenectomy to alleviate mechanical symptoms, to ameliorate transfusion-dependent cytopenias, or to enhance stem cell transplantation. The objective of this study was to determine which clinical variables significantly impacted morbidity...
Article
Controversy exists over optimal timing of tracheostomy in patients with respiratory failure after blunt trauma. The study aimed to determine whether the timing of tracheostomy affects mortality in this population. The 2008-2011 National Trauma Data Bank was queried to identify blunt trauma patients without concomitant head injury who required trach...
Article
Background Over the past two decades, laparoscopy has been established as a potentially superior technique in many general surgery procedures. Few studies, however, have examined the impact of laparoscopy on patients with symptomatic congestive heart failure (CHF). As pneumoperitoneum has known effects on cardiopulmonary physiology, patients with C...
Article
To compare early postoperative outcomes of patients undergoing different types of emergency procedures for bleeding or perforated gastroduodenal ulcers. Although definitive acid-reducing procedures are being used less frequently during emergency ulcer surgery, there is little published data to support this change in practice. A retrospective analys...
Article
The use and need of helicopter aeromedical transport systems (HEMSs) in health care today is based on the basic belief that early definitive care improves outcomes. Helicopter aeromedical transport system is perceived to be safer than ground transport (GT) for the interfacility transfer of patients who have sustained spinal injury because of the co...
Article
The objective of our analysis was to determine the optimal timing of cholecystectomy during admission for acute cholecystitis. All patients from the American College of Surgeons National Surgical Quality Improvement Program Participant User Files from 2005 through 2010 who underwent emergency cholecystectomy within 7 days of hospital admission for...
Article
Our objective was to study outcomes associated with open inguinal herniorrhaphy performed under locoregional (LR) versus general anesthesia (GA). National Surgical Quality Improvement Program (NSQIP) data from 2005 to 2009 was queried to capture patients undergoing initial unilateral inguinal herniorrhaphy. We excluded patients with incarcerated/st...
Article
Six years after initiating a monthly antibiotic cycling protocol in the surgical intensive care unit (SICU), we retrospectively reviewed antibiogram-derived sensitivities of predominant gram-negative pathogens before and after antibiotic cycling. We also examined susceptibility patterns in the medical intensive care unit (MICU) where antibiotic cyc...
Article
Previous studies of the center volume-outcomes relationship for severe trauma care have yielded conflicting findings regarding the presence or nature of such a relationship. Few studies have confined their analysis to Level I centers. We performed a retrospective analysis of severely injured adults treated from 2001 through 2006 in United States Le...
Article
The purpose of our study is to determine whether body mass index (BMI = weight in kg/height in meters(2)) was related to the rate of negative appendectomy in patients who underwent preoperative CT. A surgical database search performed using the procedure code for appendectomy identified 925 patients at least 18 years of age who underwent urgent app...
Article
1402 Objective Recombinant factor VIIa (rFVIIa) is used for hemophiliac patients with inhibitors against coagulation factor VIII or IX, but there is varied off-label use of rFVIIa for other patients. The aim of the present study was to examine our institution's off-label use of rFVIIa in an adult population. Methods We performed an IRB-approved r...
Article
Full-text available
Blunt thoracic trauma patients are at high risk of mortality when conventional mechanical ventilation fails to sustain respiratory function.We provide an overview of high-frequency oscillatory ventilation (HFOV) as a potential rescue therapy for such patients.Although few studies have examined the utilisation of HFOV specifically for blunt thoracic...
Article
Few studies have compared the post-injury outcomes of super-elderly patients to elderly patients. We performed a retrospective analysis of 1320 multi-trauma geriatric patients treated at a level I trauma center from 2003 through 2007. The outcomes of Super-Elderly (> or =80 years old; n = 422) and Elderly (60-79 years old; n = 898) patients were co...
Article
The purpose of this study was to determine if carcinoid tumors of the appendix were identified prospectively on preoperative CT at our institution during the last decade. A surgical database search performed using the Current Procedural Terminology codes for appendectomy and colectomy yielded 2108 patients who underwent appendectomy or colectomy wi...
Article
To determine the frequency of preoperative computed tomography (CT) in the evaluation of patients suspected of having appendicitis at one institution during the past 10 years and to determine whether changes in CT utilization were associated with changes in the negative appendectomy rate. Institutional review board approval was obtained, and a waiv...
Article
Trauma center designation can result in improved patient outcomes after injuries. Whereas the presence of trauma teams has been associated with improved trauma patient outcomes, the specific components, including the role of emergency medicine (EM)-trained, board-certified emergency physicians, have not been defined. To assess the outcomes of patie...
Article
The objective of our study was to assess the impact of injury intentionality on the outcomes and healthcare resource utilization of severely injured patients in the United States. The National Trauma Data Bank for the years 2001 through 2006 was used for our analysis. Adult patients with an injury severity score >or=15 were divided into three group...
Article
Introduction Multiseptate gallbladder is a rare congenital condition that may be asymptomatic or may lead to symptoms consistent with biliary colic, even in the absence of cholelithiasis. Discussion We present the case of a 19-year-old female who underwent an extensive gastrointestinal workup before she was referred for cholecystectomy, which led t...
Article
Severe pulmonary contusions are a common cause of acute respiratory distress syndrome (ARDS) and are associated with significant morbidity. High frequency oscillatory ventilation (HFOV) is a ventilatory mode that employs a lung protective strategy consistent with the ARDSNet low tidal volume ventilation strategy and may result in reduced morbidity....
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Full-text available
Fractures to the thoracolumbar spine (TLS) commonly occur because of major trauma mechanisms. In one series, 4.4% of all patients arriving at a Level I trauma center were diagnosed as having TLS fracture. Approximately 19% to 50% of these fractures in the TLS region will be associated with neurologic damage to the spinal cord. To date there are no...
Article
Antibiotic rotation has been proposed as a way to potentially reduce the development of antimicrobial resistant bacteria in intensive care units. We assessed the effect of an antibiotic rotation protocol on the antibiotic susceptibility profiles of three clinically relevant gram-negative microorganisms within our surgical intensive care unit (SICU)...
Article
Clinical research studies conducted in emergency settings under the waiver of consent provision outlined in federal regulations are uncommon, yet the importance of such research that may result in potentially lifesaving interventions is indisputable. Surgeons, as well as health care professionals in other disciplines of medicine, should be aware of...
Article
Preresuscitation Glasgow Coma Scale (P-GCS) score is frequently obtained in injured patients and incorporated into mortality prediction. Data on functional outcome in head injury is sparse. A large group of patients with head injuries was analyzed to assess relationships between P-GCS score, mortality, and functional outcome as measured by the Func...
Article
Pyridoxalated hemoglobin polyoxyethylene conjugate (PHP), a hemoglobin-based oxygen carrier, is effective in restoring hemodynamic balance and oxygen delivery after moderate hemorrhage but may be less effective in off-loading oxygen at the tissue level. Before-after trial. Animal research laboratory of an academic institution. Ten female Yorkshire...
Article
Sustained intraabdominal pressures of 14 to 20 mm Hg have significant pathophysiological consequences, but there is currently no satisfactory low-morbidity procedure appropriate for intervention early in the disease process of abdominal compartment syndrome (ACS). The anatomical principles of abdominal wall components separation were used to develo...
Article
Massive transfusion of blood products in trauma patients can acutely deplete the blood bank. It was hypothesized that, despite a large allocation of resources to trauma patients receiving more than 50 units of blood products in the first 24 hours, outcome data would support the continued practice of massive transfusion. A retrospective review of ch...
Article
Background: Massive transfusion of blood products in trauma patients can acutely deplete the blood bank. It was hypothesized that, despite a large allocation of resources to trauma patients receiving more than 50 units of blood products in the first 24 hours, outcome data would support the continued practice of massive transfusion. Methods: A retro...
Article
One of the perceived advantages of a hemoglobin-based blood substitute is the provision of oxygen-carrying capacity. Although the hemodynamic response to the infusion of acellular hemoglobin solutions has been extensively studied, less is known about the oxygen transport dynamics of such solutions. We hypothesized that acellular hemoglobin solution...
Article
Full-text available
Duke University Medical Center is a tertiary referral level one trauma hospital with a 16 bed surgical intensive care unit (SICU) averaging 1100 admissions per year. SICU patients include trauma, gastrointestinal, vascular, transplant, urology, orthopedics, otolaryngology and gynecology services. SICU admissions consist of postoperative, trauma via...
Article
To examine the speed of response of saline tonometry and an automated gas tonometry system by using standard tonometry catheters. In vitro validation study. Experimental research laboratory. Tonometry catheters were placed in a test chamber designed to simulate the lumen of a hollow viscus and were exposed to a rapid change in CO2 from 0% to 5% or...
Article
An abstract is unavailable. This article is available as HTML full text and PDF.
Article
To characterize patients with primary necrotizing fasciitis of the male genitalia (Fournier's gangrene) and to identify risk factors and prognostic variables of survival. Fifty consecutive patients with primary necrotizing fasciitis of the male genitalia treated at our institution during a 15-year period between 1984 and 1998 were retrospectively a...
Article
Previous research suggested that splanchnic hypoperfusion occurs after resuscitation with certain acellular hemoglobin solutions. We examined the influence of maltose content and oxygen affinity on resuscitation with various hemoglobin polyoxyethylene conjugate solutions after hemorrhage. Fifteen swine underwent hemorrhage and equal volume resuscit...
Article
Introduction: A tertiary care hospital has experienced increasing level of patient acuity, high census levels, and high volume elective Operating Room schedules leading to patient flow difficulties. This culminated in significant elective OR delays in 1997 and high levels of non-availability of critical care beds for trauma and transfer utilization...
Article
Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagulation in th...
Article
Full-text available
Intensive Care unit (ICU) management of critically ill patients often includes the requirement for tracheostomy and feeding access, most often a pecutaneous endoscopic gastrostomy (PEG). Although advances in ICU airway management include percutaneous tracheostomy, semi-open tracheostomy and conventional tracheostomy, the majority of critically ill...
Article
Background: Blunt vascular injuries to the head and neck (BHVI) represent some of the most devastating and morbid injuries seen by a trauma surgeon. This series reviewed the experience of a single institution to determine if diagnostic and therapeutic guidelines can be established for these uncommon injuries. In particular, the utility of anticoagu...
Article
Hemoglobin-based blood substitutes may cause vasoconstriction, which could limit organ perfusion during trauma resuscitation. We investigated the effect of two hemoglobin solutions on regional blood flow and mucosal perfusion in the gastrointestinal tract in a hemorrhagic shock model. Twenty-four swine were bled 30% of blood volume over 1 hour. Six...
Article
An unusual case of multiple impalement by chain-link fence posts is presented in which facial, thoracic, and abdominal injuries were sustained following a rollover motor vehicle crash. Torso impalement injuries are briefly reviewed and guidelines for the management of such injuries are described.
Article
The postoperative care of seriously injured trauma patients can be challenging and frustrating, yet very satisfying. Recent advances in critical care have been spurred on by improvements in technology, as well as by refinements of our understanding of the basic sciences such as physiology, microbiology, pharmacology, and molecular biology. As the p...
Article
Full-text available
Article
A semiempirical mathematical model of convective oxygen transport is used to design a new, low pressure loss, implantable artificial lung that could be used as a bridge to lung transplantation in patients with advanced respiratory failure. The mass transfer and flow friction relations pertinent to the design of a cross-flow hollow fiber membrane lu...
Article
A semi-empirical theoretical model of oxygen transfer is used to predict the rates of oxygen transfer to blood in hollow fiber membrane oxygenators over a wide range of inlet conditions. The predicted oxygen transfer rates are based on performance of the devices with water, which is more cost effective and easier to handle than blood for in vitro e...
Article
The authors designed and tested an artificial lung intended for intrathoracic implantation as a bridge to lung transplantation in chronic pulmonary insufficiency or as an alternative in the treatment of advanced acute respiratory failure. The prototype devices are comprised of 380 microns outer diameter polypropylene matted fibers with a blood path...
Article
Previous studies showed that a new generation of perfluorocarbon (PFC) emulsions increased tissue PO2 in the cat retina to a degree that could not be explained by the small increase in arterial O2 content seen after the infusion of low doses of 1 g PFC/kg body weight. It seems that increased O2 delivery at the tissue level after PFC infusion is cau...
Article
Thesis (Ph. D.)--Northwestern University, 1990. Includes bibliographical references (p. 118-123). Includes abstract and vita. "An intravascular lung assist device, ILAD, has been designed and developed to temporarily support the injured natural lungs in patients with the severe form of the Adult Respiratory Distress Syndrome."--Abstract, p. iii. Ph...
Article
Intravascular lung assist devices (ILADs) must provide sufficient gas transport without excessive pressure drop. In vitro studies of fiber-bundle devices determined the effect of geometric configuration on gas transfer efficiency, the amount of surface area needed to achieve sufficient gas transport, and the relationship between gas transport and b...
Article
Thesis (B.S.)--Massachusetts Institute of Technology, Dept. of Chemical Engineering, 1980. Includes bibliographical references (leaves 49-53).

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