The American surgeon
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The American surgeon · Feb 1992
Emergency central venous catheterization during resuscitation of trauma patients.
Central venous catheterization during resuscitation of trauma patients remains controversial. Such catheterizations performed at the UMDNJ-Robert Wood Johnson Medical School at Camden Cooper Hospital/University Medical Center (Camden, NJ) trauma center for the period January 1, 1988 to December 31, 1989 were retrospectively reviewed. Patients with underlying hemothorax, pneumothorax, or resuscitative thoracotomy were excluded. ⋯ The complication rate for patients surviving the resuscitation (230 catheterizations) was 7.8 per cent. There were no catheter-related deaths. In conclusion, emergency central venous catheterization during resuscitation of trauma patients carries a relatively low risk of serious complications when performed by experienced physicians.
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The authors studied the impact of intensive care unit (ICU) acquired nosocomial infections on surgical patients stratified by severity of illness before acquisition of the infection. Data were analyzed from 2,122 consecutive patients admitted to a 20 bed surgical intensive care unit (SICU) from January 1, 1988 to December 31, 1988. The simplified acute physiology score (SAPS), a measure of illness severity that correlates with mortality, was calculated for all patients on their first SICU day. ⋯ The authors found that the monthly incidence of isolates of Xanthomatous maltophilia, a multiply-resistant nosocomial organism, reflected the overall incidence of nosocomial infections in the SICU. They observed a decline in the number of new X. maltophilia isolates and nosocomial infections concomitant with the introduction of gown and glove contact isolation procedures. The authors conclude that nosocomial infections in the SICU setting are directly related to increased patient morbidity and mortality depending, in part, on severity of illness upon admission.(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Dec 1991
The relationship between ARDS, pulmonary infiltration, fluid balance, and hemodynamics in critically ill surgical patients.
Hypervolemia from fluid overload with resultant pulmonary edema is thought to be a frequent cause of Adult Respiratory Distress Syndrome (ARDS). However, ARDS may also occur as a result of the hypovolemic shock of surgery or trauma. To develop an appropriate rationale for fluid therapy in high-risk surgical patients, the relationship between fluid balance, hemodynamics, the onset of ARDS by physiologic criteria (shunt greater than or equal to 20%, and/or PaO2/FiO2 ratio less than 250) and the onset of pulmonary infiltration (PI) associated with ARDS were examined. ⋯ ARDS by physiologic criteria occurred in 29 of 50 (58%) patients; 27 of these 29 (94%) also developed +2 or greater PI. The mean onset times of ARDS and of +2 PI were 40 +/- 41 hours and 40 +/- 38 hours, respectively. The ARDS patients had a significantly smaller net positive fluid balance than the non-ARDS patients over the first 40 hours after admission (+6,831 ml +/- 4,909 ml vs 12,440 ml +/- 7,817 ml, (P less than 0.01)).(ABSTRACT TRUNCATED AT 250 WORDS)
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The American surgeon · Dec 1991
Superoxide dismutase polyethylene glycol improves survival in hemorrhagic shock.
Oxygen free radicals are known to form after reperfusion of ischemic tissue. To test the role and importance of oxygen free radicals in hemorrhagic shock, an animal model of hemorrhagic shock and resuscitation was utilized. Sprague-Dawley rats were anesthetized with halothane and then subjected to approximately 50 per cent blood volume hemorrhage (30 cc/kg), followed by a 60 min shock period. ⋯ The group treated with SOD-PEG demonstrated significantly increased survival rates vs the group treated with LR (67% vs 25%, P = 0.02). The group treated with CAT-PEG demonstrated no significant improvement in survival when compared to the LR-treated group (20% vs 24%). These data suggest that treatment directed toward oxygen free radicals and reperfusion injury may play an important role in hemorrhagic shock resuscitation.
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The author evaluated 203 consecutive patients with severe chest trauma admitted to the trauma center between 1985 and 1989. The goal was to identify risk factors that play a significant role in mortality of patients with pulmonary contusion. There were 160 men and 43 women. ⋯ Average blood loss was 1,047 cc (range 0 to 14,300 cc), but the difference was not statistically significant between survivors and nonsurvivors in the authors' series. Injuries to the central nervous system were present in 80 (40%) of the patients and were associated with death in 30 (68%) of the cases. Age, severity of injury, associated head trauma, and shock were the most important factors affecting survival in the authors' patients with pulmonary contusion.