ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundThe rate and magnitude of pH changes in the bowel during hemorrhagic shock are greater than those in the stomach, implying that gastric intramucosal pH may not be a reliable indicator of gut perfusion. Here, we evaluate near-infrared spectroscopy (NIRS) to assess bowel pH in a swine shock model.MethodsLaparotomy was performed to place flow probes, pH microelectrodes, and NIRS probes. Shock was maintained for 45 minutes at a blood pressure of 45 mm Hg, and resuscitation was achieved with shed blood and lactated Ringer's solution to baseline over 60 minutes.ResultsHemodynamic measurements were significantly reduced during shock. Lactic acid peaked during resuscitation and remained elevated. NIRS-measured pH was correlated to electrode-measured pH (R2= 0.903 [ischemia] and R2= 0.889 [reperfusion]). Estimated measurement accuracy after subject-specific offset correction was 0.083 pH units during ischemia and 0.076 pH units during reperfusion.ConclusionNIRS determination of small-bowel pH may be a good tool to monitor the adequacy of resuscitation.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundIntra-abdominal hypertension and abdominal compartment syndrome cause significant morbidity and mortality in surgical and trauma patients. Maintenance of intravascular preload and use of open abdomen techniques are essential. The accuracy of pulmonary artery occlusion pressure (PAOP) and central venous pressure (CVP) in patients with intra-abdominal hypertension has been questioned.MethodsTwenty surgical and trauma patients with intra-abdominal hypertension requiring open abdominal decompression were monitored using volumetric thermodilution pulmonary artery catheters. Hemodynamic, oxygenation, inspiratory, and intravesicular pressure measurements were collected prospectively. PAOP, CVP, and right ventricular end-diastolic volume index (RVEDVI) were compared as estimates of preload status.ResultsMultiple regression analysis demonstrated that cardiac index correlated significantly better with RVEDVI (r = 0.69) than with PAOP (r = -0.27) or CVP (r = -0.28) during resuscitation after open abdominal decompression (p < 0.0001).ConclusionRVEDVI is superior to PAOP and CVP as an estimate of preload status in patients with an open abdomen.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundAlthough rapid fluid resuscitation continues to be an important component of the initial therapy for trauma patients, it remains unknown whether the rate of fluid administration after trauma-hemorrhage has any deleterious or beneficial effects on immunity.MethodsMale C3H/HeN mice were subjected to sham operation or soft-tissue trauma (midline laparotomy) and hemorrhagic shock (mean arterial blood pressure of 35 +/- 5 mm Hg for 90 minutes) followed by resuscitation with four times the volume of shed blood in the form of lactated Ringer's solution over 30 minutes (rapid rate), 60 minutes (moderate rate), or 120 minutes (slow rate). The animals were killed at either 4 hours or 4 days after the end of trauma-hemorrhage. Spleens were harvested and splenocyte interleukin (IL)-3 and interferon-gamma (IFN-gamma) release as well as splenic macrophage IL-1 beta and IL-6 release were determined.ResultsThe results indicate that at 4 hours after trauma-hemorrhage, splenocyte IL-3 and IFN-gamma release were significantly depressed in all animals subjected to trauma-hemorrhage compared with sham-operated animals. At 4 days after trauma-hemorrhage, splenocyte IL-3 and IFN-gamma release were restored in mice resuscitated with the slow rate of resuscitation; however, the release of these cytokines remained significantly depressed in animals resuscitated with the moderate or rapid rates. Splenic macrophage IL-1 beta and IL-6 release were significantly depressed at 4 hours after trauma-hemorrhage. At 4 days after trauma-hemorrhage, the release of these proinflammatory cytokines was still depressed in animals resuscitated with the rapid rate. In contrast, splenic macrophage IL-1 beta and IL-6 release were restored in mice receiving the slow rate of resuscitation.ConclusionThese results suggest that a slower rate of fluid resuscitation after trauma-hemorrhage leads to a faster restoration of the depressed cell-mediated immunity, whereas rapid fluid resuscitation produces a prolonged depression of immune responses. In view of this, we propose that a prospective clinical study of this type must be performed in a select group of trauma patients to determine whether or not a slower rate of fluid resuscitation also improves immune responses in trauma patients.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundImmune responses are markedly depressed very early after the onset of hemorrhage. Furthermore, endothelial cell dysfunction occurs after trauma-hemorrhage and may contribute to alterations in immune function. Recent studies have shown that administration of L-arginine restores the depressed organ blood flow, probably because of the provision of substrate for constitutive nitric oxide synthase. It remains unknown, however, whether administration of L-arginine would have any salutary effect on the depressed macrophage function after trauma-hemorrhage.MethodsMale rats underwent midline laparotomy (i.e., trauma was induced). After this, the animals were bled to and maintained at a mean blood pressure of 40 mm Hg until 40% of the maximum shed blood volume was returned in the form of lactated Ringer's solution. Sham-operated rats underwent both femoral artery cannulation and ligation, but these animals were neither bled nor resuscitated. Hemorrhaged rats were then resuscitated with lactated Ringer's solution, receiving four times the maximum shed blood volume over 1 hour. During resuscitation, one group received 300 mg/kg L-arginine and the other group received saline (vehicle) intravenously. At 4 hours after resuscitation, splenic and peritoneal macrophage interleukin (IL)-1 beta and IL-6 release as well as plasma IL-6 were measured.ResultsSplenic and peritoneal macrophage IL-1 beta and IL-6 release was significantly decreased in trauma-hemorrhage vehicle-treated rats. Administration of L-arginine after trauma-hemorrhage, however, improved splenic and peritoneal macrophage IL-1 beta and IL-6 release. Moreover, the up-regulated plasma levels of IL-6 were attenuated by L-arginine administration.ConclusionL-Arginine administration after trauma-hemorrhage significantly improves the depressed macrophage function, presumably by decreasing the increased plasma IL-6 levels and improving organ blood flow. Early enhancement of the depressed constitutive nitric oxide synthase activity by provision of L-arginine after trauma-hemorrhage, therefore, represents a novel and safe approach for improving the depressed immune function and decreasing plasma IL-6 levels under such conditions.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundPostinjury neutrophil (PMN) priming identifies the injured patient at risk for the subsequent development of multiple organ failure (MOF). PMN priming has previously been shown to cause enhanced release of proteases and superoxide. PMNs, however, are a rich source of proinflammatory cytokines, such as interleukin (IL)-8 and tumor necrosis factor (TNF), which have been implicated in the development of MOF. PMNs also make IL-1ra, which is an anti-inflammatory cytokine that inhibits IL-1. It is our hypothesis that postinjury PMNs are primed for increased stimulated release of the proinflammatory cytokines IL-8 and TNF but not the anti-inflammatory cytokine IL-1ra.MethodsTwelve trauma patients with a mean Injury Severity Score of 24 (+/- 4.6) and 10 elective surgical patients were studied. Postinjury PMNs were isolated from blood obtained at presentation (within 2 hours after injury) and 24 hours after trauma. PMNs from elective surgical patients were obtained preoperatively, immediately postoperatively, and at 24 hours. The PMNs were stimulated with platelet-activating factor (200 nM)/N-formyl-methionyl-leucyl-phenylalanine (1 [micro sign]mol/L) or lipopolysaccharide (100 ng/mL) incubated for 24 hours in RPMI-1640, and release of IL-8, TNF, and IL-1ra were measured.ResultsPostinjury PMNs were primed for both platelet-activating factor/N-formyl-methionyl-leucyl-phenylalanine-stimulated and lipopolysaccharide-stimulated IL-8 and TNF release at 2 hours after injury (fourfold increase of IL-8 release and fivefold increase of TNF release), whereas elective surgical patients demonstrated no priming. In contrast, postinjury patients were not primed for increased release of the counterinflammatory cytokine IL-1ra, suggesting a specific postinjury up-regulation of IL-8 and TNF.ConclusionAfter injury, PMNs are primed for proinflammatory cytokine release in addition to superoxide and elastase. This augmented release of IL-8 and TNF may be involved in the subsequent development of organ dysfunction and ultimately MOF.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundWe conducted this study to determine whether the dry fibrin sealant dressing (DFSD) would stop bleeding from a grade V liver injury and to evaluate the effects of leaving the absorbable DFSD in survival animals.MethodsTwenty-four swine (40 +/- 3.0 kg) received a uniform grade V liver injury and were randomized to one of four 1-hour treatment groups: (1) gauze packing, (2) DFSD, (3) immunoglobulin G placebo dressing, and (4) no treatment. All animals were resuscitated with lactated Ringer's solution. Total blood loss (TBL), mean arterial pressure, resuscitation volume, and laboratory data were monitored for 1 hour after injury. Four swine were treated with the DFSD after grade V injury and allowed to survive for 7 or 14 days.ResultsThe TBL was 1,104 +/- 264 mL (mean +/- SEM), 544 +/- 104 mL, 4,223 +/- 1,555 mL, and 6,026 +/- 1,020 mL for groups 1, 2, 3, and 4 respectively. TBL in DFSD animals was less than that in animals treated with gauze packing (p = 0.06). Grade V injuries were uniform among the 1-hour groups, and no evidence of intrahepatic abscess, unusual adhesions, or hepatic vein, vena caval, or pulmonary thromboses were noted in the long-term survival animals.ConclusionIn this model of grade V liver injury, blood loss with the DFSD was 51% of that observed with standard gauze packing (not statistically different). Initial survival data revealed no complications attributable to the fibrin dressing. DFSD may provide simple, rapid, and definitive hemorrhage control in life-threatening liver injuries without the need for reoperation.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID

摘要:

BackgroundFractures of the femoral head and neck in children have a risk of severe complications, especially femoral head necrosis. We performed a long-term follow-up study of patients treated at our institution.MethodsPatients were reexamined at least 3 years after trauma and were included if they were younger than 17 years old at the time of injury, if there was no history of previous fracture, and if there was no history of underlying bone disease. Fractures were classified according to Delbet, and outcome was graded according to Ratliff. Anterior capsulotomy was not performed, and stabilization devices were placed short of the epiphysis except for type I fractures.Results18. At last follow-up, 20 patients presented with good function, 5 with fair outcome, and 3 with poor results; all of the latter suffered type I fractures. Eighteen patients had no restrictions in activities of daily living or during sports activities. In six other patients, the inability to participate in sports was attributable to head trauma, amputation, or peripheral neurologic damage.ConclusionWe found favorable long-term outcome in type II to type IV fractures. In these patients, restrictions of function were usually caused by other associated injuries. All patients with type I fractures presented with poor outcome secondary to their proximal femoral fractures, and not because of other associated injuries. Type I fractures during childhood and adolescence represent an unsolved problem.

ISSN:0022-5282    

出版商:OVID    

年代:1999

数据来源: OVID