J Trauma
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1,026 multiple trauma patients (P) were compared to P with chest injuries (PCT) (407). Severity indices were related to type of thoracic injury and mortality. The Injury Severity Score (ISS), Glasgow Coma Scale (GCS), Trauma Score (TS), CHOP, and the Respiratory Index (RI) were used. ⋯ ISS and RI scores for PCT survivors were greater than ISS + RI scores for P survivors (p less than 0.05 and p less than 0.01). ISS values for LC, HA, and PN PCT survivors were greater than the ISS of P survivors (p less than 0.01). Nonsurviving PCTs, especially those with lung contusion, showed a highly significant increase in ISS and RI scores.
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Ideal resuscitation would simultaneously replete intravascular volume and minimize cerebral edema. We assessed the effects of hypertonic saline (HS) shock resuscitation on cerebral edema after head injury. Rats were subjected to hemorrhagic shock (40 mm Hg for 1 hour) in the presence or absence of mechanical brain injury, followed by 1 hour of resuscitation with either hypertonic saline (6.5%) or lactated Ringer's (LR). After resuscitation, animals were sacrificed and brain water contents determined. ⋯ HS resuscitation of hemorrhagic shock decreases brain water content in uninjured but not injured brain. HS may be useful in resuscitation of combined hemorrhagic shock and head injury.
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Multicenter Study Clinical Trial
Resource use, efficiency, and outcome prediction in pediatric intensive care of trauma patients.
To study the impact of trauma patients on Pediatric Intensive Care Units (PICUs), 164 trauma patients' data from 1,075 consecutive admissions to five PICUs were reviewed. Resource use (Therapeutic Intervention Scoring System [TISS] points) and mortality risks (Physiologic Stability Index [PSI] and Pediatric Risk of Mortality [PRISM] scores) were obtained daily for all patients. Trauma patients constituted 15.2% of all PICU patients, and used 14.9% of patient care days and 14.5% of TISS points. ⋯ Trauma patients are a minority of PICU patients and deaths. Their resource use is proportional to their numbers, although less efficient than for nontrauma patients. PSI and PRISM are accurate mortality risk predictors for trauma patients.
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In an attempt to assess the changes occurring to the coagulation profile during internal active core rewarming with partial cardiopulmonary bypass (CPB) without heparin anticoagulation, five pigs were anesthetized, and a model for severe to moderate hypothermia was created. Femoral-femoral bypass with Bio-Pump, heat exchanger, and a membrane oxygenator were used during the rewarming for 64.8 +/- 8.5 minutes. There were no statistically significant changes in platelet count, platelet index, activated clotting time (ACT), partial thromboplastin time (PTT), prothrombin time (PT), fibrinogen, fibrinogen index and fibrin split products (p greater than 0.05). ⋯ The components of the CPB circuit showed no signs of formation of aggregates or thrombi. The results of this study are attributed to the nonthrombogenic, atraumatic design of the Bio-Pump and the enhanced physiological fibrinolysis seen in the first hour of CPB. We concluded that heparinless CPB may serve as a safe alternative for active core rewarming for severe to moderate hypothermia.