Abstract:Aim: During rapid sequence intubation (RSI), the O 2 reserve limits the intubation duration. The study objective was to examine the impact of RSI on arterial blood gases (ABG) during the preoxygenation phase.Methods: This open, prospective clinical study examined samples of patients who had endotracheal intubation (ETI) as RSI between March 2014 and September 2014 in our emergency department. The variations in ABG PaO 2 and PaCO 2 before and after preoxygenation and after intubation were examined and compared … Show more
“…Severe trauma results in a strong inflammatory response and life-threatening complications. VAP in the ICU can be expected in critically injured cases who are on mechanical ventilation (MV) 19 , for more than 2 days, with an incidence ranging from 5% to 40% and a mortality rate of 10% 20 . The complex pathophysiology of MODS after trauma includes multifactorial pathologies such as initial exsanguination, MBT, and systemic inflammatory response, of which the most crucial is the severity of injury 21 .…”
OBJECTIVE:Rescuing severe trauma cases is extremely demanding. The present study purposed to analyze the efficiency of trauma management at Emergency Centre, University Clinical Centre of Serbia, Belgrade, included outcome within 28 days. METHODS: This retrospective study involved 131 intensive care unit trauma cases with total Injury Severity Score ≥16, in terms of administrating the two strategies: (i) definitive surgical repair and (ii) damage control laparotomy. RESULTS: The damage control laparotomy cases revealed statistically higher Injury Severity Score and APACHE II scores, significant brain dysfunction, and hemorrhagic shock on arrival (p<0.001). In addition, the damage control laparotomy had a higher rate of respiratory complications, multiple organ deficiency syndrome, and surgical wound complications (p=0.017, <0.001, and 0.004, respectively), with more days on mechanical ventilation (p=0.003). Overall mortality was 29.8%. Although higher early mortality within ≤24 h in the damage control laparotomy (p=0.021) had been observed, no difference between groups (p=0.172) after the 4th day of hospitalization was detected. CONCLUSIONS: Trauma patients have a high mortality rate in the 1st hours after the incident. Compelling evidence linking host and pathogen factors, such as mitochondrial apoptosis pathways, appears to correlate with loss of organ dysfunction, both cytopathologically and histopathologically. Adequate selection of patients necessitating damage control laparotomy, allowed by the World Society of Emergency Surgery, abdominopelvic trauma classifications, and improvements in resuscitation, may improve the results of severe trauma treatment.
“…Severe trauma results in a strong inflammatory response and life-threatening complications. VAP in the ICU can be expected in critically injured cases who are on mechanical ventilation (MV) 19 , for more than 2 days, with an incidence ranging from 5% to 40% and a mortality rate of 10% 20 . The complex pathophysiology of MODS after trauma includes multifactorial pathologies such as initial exsanguination, MBT, and systemic inflammatory response, of which the most crucial is the severity of injury 21 .…”
OBJECTIVE:Rescuing severe trauma cases is extremely demanding. The present study purposed to analyze the efficiency of trauma management at Emergency Centre, University Clinical Centre of Serbia, Belgrade, included outcome within 28 days. METHODS: This retrospective study involved 131 intensive care unit trauma cases with total Injury Severity Score ≥16, in terms of administrating the two strategies: (i) definitive surgical repair and (ii) damage control laparotomy. RESULTS: The damage control laparotomy cases revealed statistically higher Injury Severity Score and APACHE II scores, significant brain dysfunction, and hemorrhagic shock on arrival (p<0.001). In addition, the damage control laparotomy had a higher rate of respiratory complications, multiple organ deficiency syndrome, and surgical wound complications (p=0.017, <0.001, and 0.004, respectively), with more days on mechanical ventilation (p=0.003). Overall mortality was 29.8%. Although higher early mortality within ≤24 h in the damage control laparotomy (p=0.021) had been observed, no difference between groups (p=0.172) after the 4th day of hospitalization was detected. CONCLUSIONS: Trauma patients have a high mortality rate in the 1st hours after the incident. Compelling evidence linking host and pathogen factors, such as mitochondrial apoptosis pathways, appears to correlate with loss of organ dysfunction, both cytopathologically and histopathologically. Adequate selection of patients necessitating damage control laparotomy, allowed by the World Society of Emergency Surgery, abdominopelvic trauma classifications, and improvements in resuscitation, may improve the results of severe trauma treatment.
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