J Trauma
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Splanchnic ischemia, leading to intestinal mucosal damage, is thought to be common in patients after severe trauma. The adequacy of mucosal oxygenation can indirectly be determined by gastric intramucosal pH (pHi) measurement. We prospectively examined the posttraumatic gastric pHi values in 15 multiple trauma patients. ⋯ Although intestinal ischemia was expected to be a common condition in multiple trauma patients, no consistent pattern of abnormal pHi measurements in the direct posttraumatic course could be discovered. No correlation was found between initial pHi values (at 6 hours) and ISS, shock, and lactic acidosis or APACHE II scores on admission. It is concluded that monitoring gastric pHi is useful in severely injured patients admitted to the ICU.
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The involvement of cytokines in trauma still has not been satisfactorily elucidated. The development of multiorgan failure, the very serious complication of multiple trauma with high mortality, should also be controlled by cytokines, endotoxin, and other mediators. We therefore prospectively studied 42 consecutive patients with multiple trauma admitted from June to December 1992 to the Research Institute for Traumatology and Surgery in Brno. ⋯ In conclusion, the IL-6 and TNF-alpha levels seem to play a significant role in multiple trauma and their late elevation in patients with MOF conveyed a poor prognosis. A significant correlation between initial IL-6 levels and ISS was observed. Other cytokines did not show dynamic changes during the study.
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Comparative Study
Blood transfusions: for the thermally injured or for the doctor?
Because of the inherent risks of blood transfusions, including the transmission of viral and other infectious diseases, it is important to re-evaluate blood transfusion policies. ⋯ Routinely transfused patients, on average, received over 5 units more blood than the selective group without any apparent clinical benefit. Thus, the results of this pilot study support a policy of selective blood transfusions in burn patients.
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Recent years have seen a renewed interest in the use of hypertonic-hyperoncotic solutions as plasma volume expanders for the treatment of hemorrhagic hypotension. In particular, a number of studies in experimental animals have addressed the efficacy and safety of small-volume infusions of 7.5% NaCl/6% dextran 70 (HSD). ⋯ In the few human field trials completed to date, HSD has been shown to be potentially beneficial in hypotensive trauma patients who require surgery or have concomitant head injury. Extensive toxicologic evaluations and lack of reports of adverse effects in the human trials indicate that, at the proposed therapeutic dose of 4 mL/kg, HSD should present little risk.
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A three-year retrospective and prospective study was conducted in the North Coast EMS Region of California to evaluate the effectiveness of a rural trauma program and its impact on patient outcome. Two hundred sixty-six patients with major trauma were identified. Age, hospital and prehospital Trauma Scores (TS), Revised Trauma Scores (RTS), Injury Severity Scores (ISS), and Mechanism of Injury (MOI) were recorded. ⋯ Blunt trauma accounted for the majority of injuries (82.1%) and the primary cause was motor vehicle crashes (63.8%). The z (mortality) and M statistics were -2.33 (p = 0.020) and 0.66, respectively. Thus a significant improvement in survival rates resulted compared with MTOS baseline norms.