Early Predictors of Postinjury Multiple Organ Failure

Sauaia, Angela; Moore, Frederick A.; Moore, Ernest E.; Haenel, James B.; Read, Robert; Lezotte, Dennis C.

doi:10.1001/archsurg.1994.01420250051006

Cited by 454 publications

(240 citation statements)

References 20 publications

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“…Hypoperfusion, frequently resulting from a low cardiac output (compared with the required for that current physiological status) [42], causes cellular damage, activation of inflammatory response, and increases multiple organ dysfunction syndrome and death risks, if not corrected in a few hours [43][44][45][46][47][48].…”

Section: Recognizing a State Of Shockmentioning

confidence: 99%

“…The most extensively studied is base deficit. It has been shown in animal and clinical studies of hemorrhagic shock that the severity of metabolic acidosis determined by this method correlates with a higher probability of death [67][68][69], as well as with a higher risk of multiple organ dysfunction syndrome [43,48]. The velocity of normalization of the base deficit has not been related with the prognosis.…”

Section: Endpoints For the Resuscitationmentioning

confidence: 99%

“…This concept has been challenged by the understanding of the tolerance of low levels of hemoglobin by the critically ill patient, and by the knowledge of the detrimental effects of transfusion in terms of immunosuppresion [80,81], increased risk of infection [82], increased risk of blood-borne infection acquisition [79], increased risk of multiorgan failure [43,48], and death [83], when compared with matched critically ill patients.…”

Section: Transfusion Threshold and Coagulopathy Correctionmentioning

confidence: 99%

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Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

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Section: Recognizing a State Of Shockmentioning

confidence: 99%

Section: Endpoints For the Resuscitationmentioning

confidence: 99%

Section: Transfusion Threshold and Coagulopathy Correctionmentioning

confidence: 99%

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Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

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“…Uncontrolled hemorrhage is the second leading cause of death in civilian trauma [1] and the leading cause of preventable death in military trauma [1][2][3][4][5][6][7][8][9]. Historically, 20% of combat casualties were killed in action.…”

Section: Introductionmentioning

confidence: 99%

The Effects of BleedArrest, Celox, and TraumaDex on Hemorrhage Control in a Porcine Model

Gegel

Burgert

Cooley

et al. 2010

Journal of Surgical Research

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Background. Hemorrhage is the second leading cause of death in civilian trauma and the leading cause of preventable death in military trauma. The purpose of this study was to examine the effectiveness of three hemostatic agents: BleedArrest, TraumaDex, and Celox.Materials and Methods. This was a prospective, experimental study using male Yorkshire swine. The pigs (n [ 5 per group) were randomly assigned to one of the following: BleedArrest, TraumaDex, Celox, or control. To simulate a trauma injury, the investigators generated a complex groin injury with transection of the femoral artery and vein in all pigs. After 1 min of uncontrolled hemorrhage, one of the hemostatic agents was poured into the wound, followed by standard wound packing. The control group underwent the same procedures with the exception of the hemostatic agents. In all groups, 5 min of direct manual pressure was applied to the wound followed by a standard pressure dressing. After 30 min, dressings were removed, and the amount of bleeding was determined.Results. There were significant differences between the BleedArrest (mean [ 21.2, SD ± 36.6 mL) TraumaDex (mean [ 68, SD ± 103.5 mL) and Celox (mean [ 18.l6, SD ± 41.6 mL) groups compared with Control group (mean [ 230, SD ± 154 mL) (P < 0.05). However, there were no statistically significant difference between BleedArrest, TraumaDex, and Celox groups (P [ 0.478).Conclusions. BleedArrest, Celox, and TraumaDex were statistically and clinically superior at controlling hemorrhage compared with the standard pressure dressing in the control group. Published by Elsevier Inc.

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“…The critical nature of the population is supported further by the significantly higher AIS, NISS, Marshall and Denver scores, which combined, represent markers associated with increased critical illness, prolonged time to recovery [19], worsening immune dysfunction [24][25][26][27], increased mortality, and worse clinical outcomes overall [19,28]. Marshall and Denver scores are measurements used to evaluate multiple-organ dysfunction syndrome that have been valid and are indicators of adverse outcomes in critical illness [29]. There has also been suggestion that CDI, in general, represents a marker for poor outcome [4].…”

Section: Discussionmentioning

confidence: 99%

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

Vanzant

Ozrazgat‐Baslanti

Liu

et al. 2015

Surgical Infections

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Background: The epidemiology of Clostridium difficile-associated infection (CDI) has changed, and it is evident that susceptibility is related not only to exposures and bacterial potency, but host factors as well. Several small studies have suggested that CDI after trauma is associated with a different patient phenotype. The purpose of this study was to examine and describe the epidemiologic factors associated with C. difficile in blunt trauma patients without traumatic brain injury using the Trauma-Related Database as a part of the ''Inflammation and Host Response to Injury'' (Glue Grant) and the University of Florida Integrated Data Repository. Methods: Previously recorded baseline characteristics, clinical data, and outcomes were compared between groups (67 C. difficile and 384 uncomplicated, 813 intermediate, and 761 complicated non-C. difficile patients) as defined by the Glue Grant on admission and at days seven and 14. Results: The majority of CDI patients experienced complicated or intermediate clinical courses. The mean ages of all cohorts were less than 65 y and CDI patients were significantly older than uncomplicated patients without CDI. The CDI patients had increased days in the hospital and on the ventilator, as well as significantly higher new injury severity scores (NISS), and a greater percentage of patients with NISS > 34 points compared with non-CDI patients. They also had greater Marshall and Denver multiple organ dysfunction scores than non-CDI uncomplicated patients, and greater creatinine, alkaline phosphatase, neutrophil count, lactic acid, and P i O 2 : F i O 2 compared with all non-CDI cohorts on admission. In addition, the CDI patients had higher glucose concentrations and base deficit from uncomplicated patients and greater leukocytosis than complicated patients on admission. Several of these changes persisted to days seven and 14. Conclusion: Analysis of severe blunt trauma patients with C. difficile, as compared with non-CDI patients, reveals evidence of increased inflammation, immunosuppression, worse acute kidney injury, higher NISS, greater days in the hospital and on the ventilator, higher organ injury scores, and prolonged clinical courses. This supports reports of an increased prevalence of CDI in a younger population not believed previously to be at risk. This unique population may have specific genomic or inflammation-related risk factors that may play more important roles in disease susceptibility. Prospective analysis may allow early identification of at-risk patients, creation of novel therapeutics, and improved understanding of how and why C. difficile colonization transforms into infection after severe blunt trauma.

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Early Predictors of Postinjury Multiple Organ Failure

Cited by 454 publications

References 20 publications

Critical Care Issues in the Early Management of Severe Trauma

Critical Care Issues in the Early Management of Severe Trauma

The Effects of BleedArrest, Celox, and TraumaDex on Hemorrhage Control in a Porcine Model

Clostridium difficile Infections after Blunt Trauma: A Different Patient Population?

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