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Resuscitation, Intensive care, Sepsis, Trauma

Christian David Weber, Rolf Lefering, Thomas Dienstknecht, Philipp Kobbe, Richard Martin Sellei, Frank Hildebrand, Hans-Christoph Pape
BACKGROUND: A broad range of systemic complications has been described to occur in patients with open major fractures. Various causes have been claimed to play a role. We therefore surveyed a nationwide trauma registry to assess risk factors associated with closed and various types of open femur fractures. METHODS: This was a cohort study in a nationwide population-based prospective database. Inclusion criteria for selection from database are as follows: individuals with femur fracture, age 16 years or older, and survival until primary admission...
November 2016: Journal of Trauma and Acute Care Surgery
Benjamin R Childs, Nickolas J Nahm, Timothy A Moore, Heather A Vallier
OBJECTIVES: To compare single versus multiple procedures in the same surgical setting. We hypothesized that complication rates would not be different and length of stay would be shorter in patients undergoing multiple procedures. DESIGN: Prospective, cohort. SETTING: Level 1 trauma center. PATIENTS/PARTICIPANTS: A total of 370 patients with high-energy fractures were treated after a standard protocol for resuscitation to lactate <4...
August 2016: Journal of Orthopaedic Trauma
Armonde A Baghdanian, Arthur H Baghdanian, Maria Khalid, Anthony Armetta, Christina A LeBedis, Stephan W Anderson, Jorge A Soto
Damage control surgery (DCS) is a limited exploratory laparotomy that is performed in unstable trauma patients who, without immediate intervention, would acutely decompensate. Patients usually present with shock physiology and metabolic derangements including acidosis, hypothermia, and coagulopathy. Delayed medical correction of these metabolic derangements leads to an irreversible state of coagulopathic hemorrhagic shock and inevitable patient demise. Therefore, once a patient meets DCS criteria, a limited exploratory laparotomy is performed to stabilize life-threatening injury and expedite initiation of medical resuscitation in the intensive care unit (ICU)...
October 2016: Emergency Radiology
Derek S Wheeler
The so-called "golden hour" of trauma resuscitation has been applied to a number of disease conditions in the intensive care unit (ICU) setting. For example, the "golden hour" as applied to the treatment of critically children and adults with severe sepsis and septic shock is based upon early recognition, early administration of antibiotics, and early reversal of the shock state. However, several clinical studies published over the last decade have called into question this time-honored approach and suggest that overly aggressive fluid resuscitation may cause more harm than good...
2015: Critical Care: the Official Journal of the Critical Care Forum
Mikael Eriksson, Olof Brattström, Johan Mårtensson, Emma Larsson, Anders Oldner
BACKGROUND: The trauma patient sustains numerous potentially harmful insults that may contribute to a notable risk of acute kidney injury (AKI). The aim of this study was to investigate the incidence of and to identify risk factors for AKI in severely injured trauma patients admitted to the intensive care unit (ICU). The patients were followed up for 1 year with respect to survival and end-stage renal disease. METHODS: Trauma patients admitted to the ICU for more than 24 hours at a Level I trauma center were included...
September 2015: Journal of Trauma and Acute Care Surgery
Guillaume Ducarme, Jean-François Hamel, Pierre-Emmanuel Bouet, Guillaume Legendre, Laurent Vandenbroucke, Loic Sentilhes
OBJECTIVE: To compare severe short-term maternal and neonatal morbidity associated with midpelvic and low pelvic attempted operative vaginal delivery. METHODS: Prospective study of 2,138 women with live singleton term fetuses in vertex presentation who underwent an attempted operative vaginal delivery in a tertiary care university hospital. We used multivariate logistic regression and propensity score methods to compare outcomes associated with midpelvic and low pelvic delivery...
September 2015: Obstetrics and Gynecology
Halden F Scott, Sara J Deakyne, Jason M Woods, Lalit Bajaj
OBJECTIVES: This study sought to determine the prevalence, test characteristics, and severity of illness of pediatric patients with systemic inflammatory response syndrome (SIRS) vital signs among pediatric emergency department (ED) visits. METHODS: This was a retrospective descriptive cohort study of all visits to the ED of a tertiary academic free-standing pediatric hospital over 1 year. Visits were included if the patient was <18 years of age and did not leave before full evaluation or against medical advice...
April 2015: Academic Emergency Medicine: Official Journal of the Society for Academic Emergency Medicine
A Perner, E Junttila, M Haney, K Hreinsson, R Kvåle, P O Vandvik, M H Møller
BACKGROUND: The task force on Acute Circulatory Failure of the Scandinavian Society of Anaesthesiology and Intensive Care Medicine produced this guideline with recommendations concerning the use of crystalloid vs. colloid solutions in adult critically ill patients with acute circulatory failure. METHODS: Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology was used to grade the quality of evidence and to determine the strengths of the recommendations...
March 2015: Acta Anaesthesiologica Scandinavica
Jason W Smith, R Neal Garrison, Paul J Matheson, Brian G Harbrecht, Matthew V Benns, Glen A Franklin, Keith R Miller, Matthew C Bozeman, J David Richardson
BACKGROUND: The success of damage-control surgery (DCS) for the treatment of trauma has led to its use in other surgical problems such as abdominal sepsis. Previous studies using direct peritoneal resuscitation (DPR) for the treatment of trauma have yielded promising results. We present the results of the application of this technique to patients experiencing abdominal sepsis. METHODS: We enrolled 88 DCS patients during a 5 year-period (January 2008 to December 2012) into a propensity-matched study to evaluate the utility of using DPR in addition to standard resuscitation...
September 2014: Journal of Trauma and Acute Care Surgery
Heiko Trentzsch, Rolf Lefering, Ulrike Nienaber, Robert Kraft, Eugen Faist, Stefan Piltz
OBJECTIVE: Analyze sex differences in TraumaRegister DGU (TR-DGU). BACKGROUND: Sex differences are considered to influence trauma outcomes. However, clinical study results are controversial. METHODS: Of 29,353 prospectively recorded cases of TR-DGU, we included primary trauma room admissions with Injury Severity Score of 9 or more into the analysis. Pairs (n = 3887) were formed from 1 male and 1 female according to age, mechanism, injury severity by Abbreviated Injury Scale (for head, thorax, abdomen, extremities), and occurrence of prehospital shock...
April 2015: Annals of Surgery
K Matsushima, M Khan, H L Frankel
BACKGROUND: Post-trauma resuscitation has evolved based on civilian and wartime experiences over the last decade. Similarly, data from large multicenter randomized trials have changed the management of critically ill trauma patients in the intensive care unit. METHODS: This is a review of the literature focusing on areas relevant to the management of trauma patients in the intensive care unit. RESULTS: The following topics are included: (1) ventilator management, (2) trauma sepsis, (3) use of vasopressors in hemorrhage, (4) glucose control, (5) nutrition, and (6) hemodynamic monitoring...
June 2014: Scandinavian Journal of Surgery: SJS
Kun Xiong, Linlin Wang, Xulin Chen, Yongqian Cao, Chuan Xiang, Lixiang Xue, Zhangcai Yan
OBJECTIVE: To summarized the projects received and funded in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from National Natural Science Foundation of China (NSFC) during 2010-2013, put forward the thinking and perspective of this future trend in these fields. METHODS: The number of the funded project and total funding in the fields of emergency and intensive care medicine/trauma/burns/plastic surgery from NSFC during 2010-2013 had been statistical analyzed, in the meantime, the overview situation of various branches in basic research and further preliminary analysis the research frontier and hot issues have been analyzed...
January 2014: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Jessalyn K Holodinsky, Derek J Roberts, Chad G Ball, Annika Reintam Blaser, Joel Starkopf, David A Zygun, Henry Thomas Stelfox, Manu L Malbrain, Roman C Jaeschke, Andrew W Kirkpatrick
INTRODUCTION: Although intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) are associated with substantial morbidity and mortality among critically ill adults, it remains unknown if prevention or treatment of these conditions improves patient outcomes. We sought to identify evidence-based risk factors for IAH and ACS in order to guide identification of the source population for future IAH/ACS treatment trials and to stratify patients into risk groups based on prognosis...
October 21, 2013: Critical Care: the Official Journal of the Critical Care Forum
Djillali Annane, Shidasp Siami, Samir Jaber, Claude Martin, Souheil Elatrous, Adrien Descorps Declère, Jean Charles Preiser, Hervé Outin, Gilles Troché, Claire Charpentier, Jean Louis Trouillet, Antoine Kimmoun, Xavier Forceville, Michael Darmon, Olivier Lesur, Jean Reignier, Jean Régnier, Fékri Abroug, Philippe Berger, Christophe Clec'h, Christophe Cle'h, Joël Cousson, Laure Thibault, Sylvie Chevret
IMPORTANCE: Evidence supporting the choice of intravenous colloid vs crystalloid solutions for management of hypovolemic shock remains unclear. OBJECTIVE: To test whether use of colloids compared with crystalloids for fluid resuscitation alters mortality in patients admitted to the intensive care unit (ICU) with hypovolemic shock. DESIGN, SETTING, AND PARTICIPANTS: A multicenter, randomized clinical trial stratified by case mix (sepsis, trauma, or hypovolemic shock without sepsis or trauma)...
November 6, 2013: JAMA: the Journal of the American Medical Association
Nootwadee Wankaew, Junya Jirapradittha, Pakaphan Kiatchoosakun
OBJECTIVE: To evaluate the morbidities and mortality of neonates delivered by elective repeated cesarean section vs. normal vaginal delivery among women with uncomplicated term pregnancies. MATERIAL AND METHOD: A retrospective descriptive study was done between January 2009 and December 2011 to determine the morbidities and mortality among uncomplicated term pregnancies at Srinagarind Hospital. Three hundred seventy two neonates delivered by elective repeated cesarean section vs...
June 2013: Journal of the Medical Association of Thailand, Chotmaihet Thangphaet
Sean M Bagshaw, Lakhmir S Chawla
BACKGROUND: Intravenous fluid therapy is one of the most frequent interventions provided to patients in the intensive care unit; however, the type of fluid (i.e., crystalloid or colloid) used for resuscitation remains controversial. The most common type of colloid administered to resuscitate critically ill patients is hydroxyethyl starch (HES); however, its safety and efficacy have not been rigorously evaluated in large pragmatic randomized trials, and emerging data have accumulated to question its potential for toxic adverse effects...
July 2013: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
Tomasz Targowski
Severe infections of the respiratory system are the most important causes of hospital mortality and often unfold as severe sepsis or septic shock. Systemic inflammatory response syndrome (SIRS) with infection evidence (known as sepsis) and septic shock (severe sepsis with hemodynamic instability relentless on fluid resuscitation) are major healthcare problems, affecting millions of individuals around the world and killing about one-third affected every year. Similarly to myocardial infarction or severe trauma rapid onset and appropriateness of medical management in the first hours of sepsis are key point for clinical outcome...
November 2012: Polski Merkuriusz Lekarski: Organ Polskiego Towarzystwa Lekarskiego
Matthew E Kutcher, Jun Xu, Ryan F Vilardi, Coral Ho, Charles T Esmon, Mitchell Jay Cohen
BACKGROUND: Tissue injury leads to the release of DAMPs (damage-associated molecular patterns) that may drive a sterile inflammatory response; however, the role of extracellular histone levels after traumatic injury remains unexplored. We hypothesized that extracellular histone levels would be increased and associated with poor outcomes after traumatic injury. METHODS: In this prognostic study, plasma was prospectively collected from 132 critically injured trauma patients on arrival and 6 hours after admission to an urban Level I trauma intensive care unit...
December 2012: Journal of Trauma and Acute Care Surgery
Rachel M Kruer, Christopher R Ensor
PURPOSE: The most recent published evidence on the use of colloids versus crystalloids in critical care is reviewed, with a focus on population-dependent differences in safety and efficacy. SUMMARY: Colloids offer a number of theoretical advantages over crystalloids for fluid resuscitation, but some colloids (e.g., hydroxyethyl starch solutions, dextrans) can have serious adverse effects, and albumin products entail higher costs. The results of the influential Saline Versus Albumin Fluid Evaluation (SAFE) trial and a subsequent SAFE subgroup analysis indicated that colloid therapy should not be used in patients with traumatic brain injury and other forms of trauma due to an increased mortality risk relative to crystalloid therapy...
October 1, 2012: American Journal of Health-system Pharmacy: AJHP
Juan C Duchesne, Eric Simms, Chrissy Guidry, Marquinn Duke, Esther Beeson, Norman E McSwain, Bryan Cotton
Hypertonic saline (HTS) is beneficial in the treatment of head-injured patients as a result of its potent cytoprotective effects on various cell lines. We hypothesize that low-volume resuscitation with 3 per cent HTS, when used after damage control surgery (DCS), improves outcomes compared with standard resuscitation with isotonic crystalloid solution (ICS). This is a 4-year retrospective review from two Level I trauma centers. Patients included had 10 units or more of packed red blood cells during initial DCS...
September 2012: American Surgeon
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