ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

An uncommon cause of sepsis in patients with large burns is occult intracompartmental infection. A multi-institution review of 1171 burn admissions identified 5 patients (0.4%) who developed intracompartmental sepsis presenting with fever and purulent drainage or fever, erythema swelling on clinical examination. Contributing factors may have included high-volume resuscitation, delayed escharotomy, extravasated intraosseous infusion, cannulation-related arterial injury splinting or positioning diffculties. A high index of suspicion and an aggressive surgical approach facilitate successful management of this unusual problem.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Increased gut permeability (GP) following burn injury has been implicated in the predisposition to sepsis andmultiple systems organ failure (MSOF). Since previous studies have identified only “global” alterations in GP, we examined the jejunum, ileum colon individually for GP using probes of two different sizes: fluorescein isothiocyanate-dextran-3 (FDEX, molecular weight 4387 d) and horseradish peroxidase (HRP, molecular weight 40,000 d). Animals were examined for GP at 1, 2, or 4 days following burn. The GP was significantly increased in all segments combined following burn injury to both the small probe (FDEX, p < 0.001) and the larger probe (HRP, p < 0.06) versus controls. The GP was significanty greater for FDEX versus HRP (p < 0.001). Jejunal permeability to FDEX and HRP increased most at 24 hours. Ileal and colonic GP to FDEX increased early also, but were higher at days 2 and 4. These results suggest that, following burn injury, there is differential GP that is size and site dependent that increased GP may last well beyond 24 hours postburn despite feeding.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Splanchnic ischemia, leading to intestinal mucosal damage, is thought to be common in patients after severe trauma. The adequacy of mucosal oxygenation can indirectly be determined by gastric intramucosal pH (pHi) measurement. We prospectively examined the posttraumatic gastric pHi values in 15 multiple trauma patients. In all patients gastric pHi was measured using a tonometer via the nasogastric route. A pHi value ≤ 7.32 was used to differentiate between normal and low gastric pHi. Six hours after the injury four patients showed abnormally low pHi levels. Four other patients with normal initial pHi values exhibited low pHi vlaues during one or more of the next measuring periods. Three of these eight patients developed major complications (two, ARDS) and two of them subsequently died. The seven remaining patients never had abnormal pHi levels and all patients had an uncomplicated recovery. Although intestinal ischemia was expected to be a common condition in multiple trauma patients, no consistent pattern of abnormal pHi measurements in the direct posttraumatic course could be discovered. No correlation was found between initial pHi values (at 6 hours) and ISS, shock lactic acidosis or APACHE II scores on admission. It is concluded that monitoring gastric pHi is useful in severely injured patients admitted to the ICU.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The accuracy and reliability of the relationship between arterial and end-tidal carbon dioxide (Petco2), expressed as the gradient, P(a - et)CO2, was assessed with 171 comparisons in nine mechanically ventialted trauma patients. The P(a - et)CO2, was 14 ± 11 mm Hg. (mean ± standard deviation). The positive correlation between Paco2(44 ± 10 mm Hg) and Petco2(30 ± 10 mm Hg) for the study population (reflected by r = 0.64, p = 0.001; but r2= 0.41) indicated statistical significance, but only 40% of the changes reflected a linear relationship. Seventyeight percent of individual patients had significant correlations of Paco2and Petco2(p > 0.02 to p > 0.001). Changes in Petco2erroneously predicted the Paco2changes in 27% of comparisons with 15% false decreases and 12% false increses. Trends in P(a - et)co2magnitude are not reliable concordant direction changes in Petco2and Paco2are not assured.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Recent years have seen a renewed interest in the use of hypertonic-hyperoncotic solutions as plasma volume expanders for the treatment of hemorrhagic hypotension. In particular, a number of studies in experimental animals have addressed the efficacy and safety of small-volume infusions of 7.5% NaCI/6% dextran 70 (HSD). Employing models of fixed volume or fixed pressure hemorrhage, HSD has improved survival and reversed many of the hemodynamics, hormonal metabolic abnormalities associated with hemorrhagic shock. In the few human field trials completed to date, HSD has been shown to be potentially beneficial in hypotensive trauma patients who require surgery or have concomitatant head injury. Extensive toxicologic evaluations and lack of report of adverse effects in the human trials indicate that, at the proposed therapeutic dose of 4 mL/kg, HSD should present little risk.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Antibiotic impregnated beads are being used increasingly in the initial treatment of open fracture wounds, producing high antibiotic levels localy, over the first few days. Pellets were prepared to assess the release of the following antibiotics: benzylpenicillin, flucloxacilin, amoxycillin, amoxycillin-clavulanate (Co-Amoxiclav), ciprofloxacin, imipenem, or gentamicin; the carrier material was either polymethylmethacrylate (PMMA) or plaster of Paris (PoP). Elution of antibiotic over 72 hours from the pellets in vitro was determined using an agar-diffusion microbiologic assay. The initial rapid release of antibiotic lasted 12–24 hours, with release from PoP pellets at least four-fold greater than that from corresponding PMMA pellets. A second phase consisted of a sustained but gradually diminishing elution. The release of antibiotics from PoP pellets compared favorably with that from the PMMA beads currently used. We conclude that PoP pellets may be particularly suitable for short-term applications such as infection prophylaxis in open fractures.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

The involvement of cytokines in trauma still has not been satisfactorily elucidated. The development of multiorgan failure, the very serious complication of multiple truma with high mortality, should also be controlled by cytoknes, endotoxin other mediators. We therefore prospectively studied 42 consecutive patients with multiple traums admitted from June to December 1992 to the Research Institute for Traumatology and Surgery in Brno. Study patients were characterized by Injury Severity Score (ISS), Revised Trauma Score TRISS methodology. In all patients, tumor necrosis factor alpha (TNF-α) and interleukin (IL) 1, 2 6 levels were investigated. Of the cytokines, only IL-6 levels were elevated at admission and significant correlation with ISS was observed (r = 0735; p > 0.001). Multiple organ failure (MOF) developed in 14 patients (seven died) and it was not possible to predict this MOF development nor survival by initial cytokine levels. A significant difference was observed when IL-6 concentrations one day before death (423 ± 105 pg/mL) were compared with the highest concentrations in MOF survivors (112 ± 71 pg/mL; p > 0.001). This difference was found also for TNF (528 ± 314 pg/mL vs. 216 ± 165 pg/mL; p > 0.05). None of six MOF patients with IL-6 > 400 pg/mL survived. In conclusion, the IL-6 and TNF-α levels seem to play a significant role in multiple trauma and their late elevation in patients with MOF conveeyed a poor prognosis. A significant correlation between initial IL-6 levels and ISS was observed. Other cytokines did not show dynamic changes durig the study.

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID

摘要:

Retrospective analysis was performed on the medical records of 251 patients treated for cardiac injuries at Highland General Hospital trauma facility in Alameda County, California, to identify factors that contribute to patient survival and predict death. Thirty-six patients (14%) had blunt injuries, 153 patients (61%) had gunshot wounds (GSW) 62 patients (25%) had stab wounds. The overall survival rate was 18.7%, GSW survival was 6.5%, stab wound survival was 37.1% blunt injury survival was 40%. Patients who arrived with some vital signs had 62.2% survival and patients who arrived with absent vital signs had

ISSN:0022-5282    

出版商:OVID    

年代:1994

数据来源: OVID