Der Unfallchirurg
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We measured the ventilatory pattern and additional work of breathing (WOBadd) at three different levels of inspiratory pressure support [IPS 5, 10, 15 mbar above positive end-expiratory pressure (PEEP)] and in a new ventilatory mode, automatic tube compensation (ATC), in nine operative patients without lung injury nine patients ventilated for several following acute respiratory insufficiency (ARI). In ATC, endotracheal tube resistance is compensated automatically by means of closed-loop control of the calculated tracheal pressure. Pressure support in this mode, i.e. airway pressure above PEEP, is equal to the actual flow-dependent pressure drop across the endotracheal tube (ETT). ⋯ These two patients were not extubated because they were dependent on an FIO2 > 0.5. Our results strongly indicate that ventilatory dependence in ARI patients may be caused by the ETT rather than by mechanical dysfunction of the lung. ATC is a very helpful mode to use in distinguishing between ventilatory failure caused by ETT and real ventilatory dependence.
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Comparative Study
[Results of primary unreamed tibial nailing of tibial fractures with severe open or closed soft tissue injuries].
Primary stabilization was performed in 72 tibial fractures with sever open (n = 37) or closed (n = 35) soft tissue injury using unreamed interlocking nails. In 60 (83%) cases the fractures healed without additional procedures. There were 2 cases of osteitis, but both these fractures healed after removal of the nail or after reamed nailing. ⋯ More secondary procedures, such as bone grafting or a change of the osteosynthesis technique, are necessary with external fixation than with unreamed nailing. Further advantages of unreamed nailing are the internal treatment of the fracture and the patient's greater comfort. Therefore, unreamed nailing can be recommended for the primary treatment of tibial fractures with severe open or closed soft tissue trauma.
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The blood loss during the acute period after complex pelvic trauma is finally responsible for the high mortality associated with this specific type of injury. Several protocols have been published for optimized management, but up to now comparable data are not available as no exact definitions exist judging the severity of trauma and blood loss. As part of a prospective study 19 patients after unstable pelvic injuries with unstable circulation underwent emergency stabilization by the pelvic C-clamp. ⋯ In conclusion the data proofed that early control of hemorrhage is fundamental for the prognoses after complex pelvic trauma. The estimation of the blood loss may help in indicating aggressive emergency procedures like emergency stabilisation, pelvic clamps, surgical exploration and tamponade. This calculation may be a basis for a more detailed analyses of this devastating injury and judging the benefit of different management protocols.