Current concepts of polytrauma management: from ATLS to “damage control”

Stahel, Philip F.; Heyde, Christoph E.; Wyrwich, W.; Ertel, Wolfgang

doi:10.1007/s00132-005-0842-5

Cited by 57 publications

(17 citation statements)

References 77 publications

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“…Additionally, the NK cell activity remained suppressed for 2–4 weeks after major trauma (Jira, et al 1988). These responses are considered as damage control measures aimed at normalizing the innate host responses after tissue injury (Stahel, et al 2005) and support our findings showing reduced ASC gene expression in patients who developed sepsis following a major surgery.…”

Section: Discussionsupporting

confidence: 88%

Inflammasome expression and cytomegalovirus viremia in critically ill patients with sepsis

Singh

Inoue

Osawa

et al. 2017

Journal of Clinical Virology

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Background CMV viremia is a contributor to poor outcomes in critically ill patients with sepsis. Objectives To assess the expression levels of genes encoding inflammasome-related proteins in the development of CMV viremia in critically ill patients with sepsis. Study Design A cohort of CMV-seropositive critically ill patients with sepsis due to bloodstream infection underwent weekly testing for CMV viremia. Blood samples to evaluate mRNA levels of genes encoding CASP1, ASC, NLRP1, NLRP3, and NLRP12 were collected at the time of enrollment. Clinical outcomes were assessed at 30 days or until death/discharge from ICU. Results CMV viremia was documented in 27.5% (8/29) of the patients, a median of 7 days after the onset of bacteremia. Patients with sepsis who developed CMV viremia had higher CASP1 although this was not statistically significant (relative mean 3.6 vs 1.8, p=0.13). Development of high grade CMV viremia however, was significantly associated with CASP1; septic patients who developed high grade CMV viremia had significantly higher CASP1 than all other patients (relative mean 5.5 vs 1.8, p=0.016). Conclusions These data document a possible involvement of inflammasomes in the pathogenesis of CMV. Regulating the host immune response by agents that target these genes may have implications for improving CMV-related outcomes in these patients.

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Section: Discussionsupporting

confidence: 88%

Inflammasome expression and cytomegalovirus viremia in critically ill patients with sepsis

Singh

Inoue

Osawa

et al. 2017

Journal of Clinical Virology

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“…Aside from a clinical examination, X-rays of chest and pelvis in conjunction with ultrasonography [72] or occasionally diagnostic peritoneal lavage (DPL) [73] are recommended diagnostic modalities during the primary survey [57,74,75]. In selected centres, readily available computed tomography (CT) scanners [76] may replace conventional radiographic imaging techniques during the primary survey.…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Bouillon²,

et al. 2013

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient. When these recommendations are implemented patient outcomes may be improved.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document represents an updated version of the guideline published by the group in 2007 and updated in 2010. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on the appropriate use of vasopressors and inotropic agents, and reflect an awareness of the growing number of patients in the population at large treated with antiplatelet agents and/or oral anticoagulants. The current guideline also includes recommendations and a discussion of thromboprophylactic strategies for all patients following traumatic injury. The most significant addition is a new section that discusses the need for every institution to develop, implement and adhere to an evidence-based clinical protocol to manage traumatically injured patients. The remaining recommendations have been re-evaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsA comprehensive, multidisciplinary approach to trauma care and mechanisms with which to ensure that established protocols are consistently implemented will ensure a uniform and high standard of care across Europe and beyond.Please see related letter by Morel et alhttp://ccforum.com/content/17/4/442

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“…Aside from a clinical examination, X-rays of chest and pelvis in conjunction with focused abdominal sonography for trauma (FAST) [58] or diagnostic peritoneal lavage (DPL) [59] are recommended diagnostic modalities during the primary survey [37,60,61]. In selected centres, readily available computed tomography (CT) scanners [62] may replace conventional radiographic imaging techniques during the primary survey.…”

Section: Resultsmentioning

confidence: 99%

Management of bleeding following major trauma: an updated European guideline

et al. 2010

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IntroductionEvidence-based recommendations are needed to guide the acute management of the bleeding trauma patient, which when implemented may improve patient outcomes.MethodsThe multidisciplinary Task Force for Advanced Bleeding Care in Trauma was formed in 2005 with the aim of developing a guideline for the management of bleeding following severe injury. This document presents an updated version of the guideline published by the group in 2007. Recommendations were formulated using a nominal group process, the Grading of Recommendations Assessment, Development and Evaluation (GRADE) hierarchy of evidence and based on a systematic review of published literature.ResultsKey changes encompassed in this version of the guideline include new recommendations on coagulation support and monitoring and the appropriate use of local haemostatic measures, tourniquets, calcium and desmopressin in the bleeding trauma patient. The remaining recommendations have been reevaluated and graded based on literature published since the last edition of the guideline. Consideration was also given to changes in clinical practice that have taken place during this time period as a result of both new evidence and changes in the general availability of relevant agents and technologies.ConclusionsThis guideline provides an evidence-based multidisciplinary approach to the management of critically injured bleeding trauma patients.

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Current concepts of polytrauma management: from ATLS to “damage control”

Cited by 57 publications

References 77 publications

Inflammasome expression and cytomegalovirus viremia in critically ill patients with sepsis

Inflammasome expression and cytomegalovirus viremia in critically ill patients with sepsis

Management of bleeding and coagulopathy following major trauma: an updated European guideline

Management of bleeding following major trauma: an updated European guideline

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