Inflammatory markers

Dunham, C. Michael; Frankenfield, David C.; Belzberg, Howard; Wiles, Charles E.; Cushing, Brad M.; Grant, Z.

doi:10.1097/00003246-199404000-00024

Cited by 29 publications

(7 citation statements)

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“…Following the 48-hour postinjury TC assessment, patients with late VAP had a subsequent further decrease in TC. This is consistent with our previous documentation [11] and that of other investigators who find HC with infectious complications [10,16,21,22]. After this TC nadir, resolution of late VAP showed an improvement in HC with a significant increase in TC.…”

Section: Discussionsupporting

confidence: 93%

“…This evaluation showed a reduction of 48-hour postinjury TC to be almost 50% of the expected levels, with a decrement in TC near 90 mg/dL. Others have also found substantial HC following traumatic injury [10,11,15-17]. Several injury traits had an association with the magnitude of 48-hour postinjury HC.…”

Section: Discussionmentioning

confidence: 75%

“…Substantial HC occurred at 48 hours postinjury and late VAP had an association with increased days of mechanical ventilation. Other investigators have also found significant HC following traumatic injury [10,11,15-17] and an increase in ventilator days with VAP [4-7]. Of the numerous potential risk factors assessed, only the interactive variable, ISS ≥ 20-&-TC ≥ 90 mg/dL, had an independent association with late VAP.…”

Section: Discussionmentioning

confidence: 87%

“…After combining and critically reviewing an expanding literature, there is an impression that HC is the conventional, if not universal, human response to severe trauma, [10,11,15-17] surgery, [18,24-26] infection, [10,11,16,21,22] and critical illness [27]. It is also noteworthy the degree of HC has been shown to correlate with death in ICU, [27] general surgical, [25,26] trauma, [16] and cardiothoracic surgical [24] patients.…”

Section: Discussionmentioning

confidence: 99%

“…The secondary objective was to assess potential early risk factors, e.g., Injury Severity Score (ISS) and smoking status, for the development of VAP. Because the first author has published on total blood cholesterol (TC) in other trauma populations, [10,11] we monitor TC, an inflammatory marker, daily in our intensive care unit (ICU). Based on the work by Woiciechowsky and Cohen, we selected 48-hour TC as a potential risk factor for VAP.…”

Section: Introductionmentioning

confidence: 99%

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Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

Dunham

Chirichella

2011

Lipids Health Dis

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BackgroundPost-traumatic ventilator-associated pneumonia (VAP) is a substantial clinical problem that increases hospital costs and typically adds to the duration of mechanical ventilation. We evaluated the impact of VAP on ventilator days. We also assessed 48-hour total blood cholesterol (TC) and other potential risk factors for the development of VAP.MethodsWe performed a retrospective study of consecutive trauma patients requiring emergency tracheal intubation and evaluated TC, age, gender, ethanol status, smoker status, injury mechanism, chest injury, brain injury, Injury Severity Score (ISS), shock, day-one hypoxemia, and RBC transfusion as potential risks for VAP.ResultsThe 152 patients had ISS 28.1, brain injury 68.4%, VAP 50.0%, ventilator days 14.3, and death 9.9%. Ventilator days were increased with late VAP (p < 0.0001). TC was 110.7 mg/dL with expected TC 197.5 mg/dL. TC was lower with chest injury, shock, and RBC transfusion but, higher with brain injury (p ≤ 0.01). TC decreased as ISS increased (p = 0.01). However, one patient subset (ISS ≥ 20-&-TC ≥ 90 mg/dL) had a relative increase in TC despite an increase in ISS. ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only independent predictor of late VAP (OR 3.0; p = 0.002). ISS ≥ 20-&-TC ≥ 90 mg/dL and day-one hypoxemia were the only independent predictors for increased ventilator days (p = 0.01). ISS ≥ 20-&-TC ≥ 90 mg/dL, but not ISS alone, was the only predictor of death (OR 3.8; p = 0.03).ConclusionsSevere traumatic injury produced substantial hypocholesterolemia that is greater with chest injury, shock, and RBC transfusion, but less with brain injury. Total blood cholesterol tended to decrease with increasing injury severity. However, attenuated hypocholesterolemia (ISS ≥ 20-&-TC ≥ 90 mg/dL) represents a unique response that can occur with critical injury. Attenuated hypocholesterolemia signals early risk for late VAP, ventilator dependency, and death.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

Dunham

Chirichella

2011

Lipids Health Dis

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The role of the microcirculation in multiple organ dysfunction syndrome (MODS): a review and perspective

Kirkpatrick

Bittinger

Klein

et al. 1996

Vichows Archiv A Pathol Anat

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Major advances in intensive care medicine during the past two decades have altered the spectrum of disease encountered by intensive care physicians, anaesthesiologists, traumatologists and pathologists. One of the most important manifestations of severe trauma or infections is the multiple organ dysfunction syndrome (MODS), a life-threatening condition that often ends in multiple organ failure (MOF) and death. Evidence gathered from clinical and morphological observations in humans, taken together with experimental animal studies and a vast accumulation of in vitro data, clearly indicate that the microcirculation lies at the centre of this complex process, which results in peripheral vascular insufficiency, inadequate oxygen delivery to vital organs, and hence, severe organ dysfunction. The multifunctional nature of the endothelium makes it a prime candidate for study of the pathomechanisms of MODS. This paper reviews the evidence for the hypothesis that the microcirculation, and in particular its endothelial component, has a central role in the pathogenesis of MODS. The evidence is reviewed principally from the standpoints of classical morbid anatomy and cell pathobiology.

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Changes in cholesterol and its precursors during the first days after major trauma

Bakalář

Hyspler

Pachl

et al. 2003

Wien Klin Wochenschr

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Inflammatory markers

Cited by 29 publications

References 0 publications

Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

Attenuated hypocholesterolemia following severe trauma signals risk for late ventilator-associated pneumonia, ventilator dependency, and death: a retrospective study of consecutive patients

The role of the microcirculation in multiple organ dysfunction syndrome (MODS): a review and perspective

Changes in cholesterol and its precursors during the first days after major trauma

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