J Trauma
-
The ability to rapidly and accurately triage, evacuate, and utilize appropriate interventions can be problematic in the early decision-making process of trauma care. With current methods of prehospital data collection and analysis, decisions are often based upon single data points. This information may be insufficient for reliable decision-making. To date, no studies have attempted to utilize data at multiple time points for purposes of enhancing prediction, nor have studies attempted to synthesize prediction models with data reflecting both large-vessel venous and arterial injuries. Therefore, we performed a retrospective study to examine the potential utility of dynamic neural networks in predicting mortality using highly discretized uncontrolled hemorrhagic shock data. ⋯ This study demonstrates that PNN models can effectively harness the dynamic nature of uncontrolled hemorrhagic shock data, despite utilizing data from large-vessel arterial and venous injuries. Utilizing the dynamic nature of hemorrhagic shock data in PNNs may ultimately allow the development of novel decision assist devices.
-
Patients with chronic alcohol abuse constitute approximately 50% of trauma care patients, and these patients have a two- to fourfold increase in posttraumatic infectious complications. Cytokines such as interleukin-6 (IL-6) and interleukin-10 (IL-10) and the adhesion molecule soluble endothelial selectin (sE-selectin) have been found to play an important role in the initial inflammatory response to trauma and the development of early and late multiple organ dysfunction syndrome (MODS). The aim of this study was to compare the immune modulation and clinical relevance between chronic alcoholic and nonalcoholic patients following trauma. ⋯ The significantly elevated levels of IL-6, IL-10, and sE-selectin in chronic alcoholic trauma patients on admission to the ICU could play an important role in the development of MODS in intensive care. In patients with high levels of inflammatory mediators, immune modulatory treatment before the development of MODS may be considered.
-
Apoptosis in organs of rats in early stage after polytrauma combined with shock was researched. ⋯ Apoptosis was induced in thymus, spleen, liver, lung, and intestine in early stage after polytrauma combined with shock, which may play partial roles in the development of multiple organ failure.
-
Traumatic brain injury (TBI) is a leading cause of morbidity and mortality in trauma patients. Cerebral perfusion pressure (CPP) directed ICU management is recommended for patients with severe TBI. It, however, requires an invasive device to measure intracranial pressure (ICP). Transcranial cerebral oximetry is a noninvasive method utilizing near-infrared technology to indirectly measure cerebral saturation (StCO2). ⋯ In this pilot study, StCO2 correlated significantly with CPP. A StCO2 > or = 75 suggests that CPP is adequate, while < 55 suggests an inadequate CPP. Although these results should be confirmed in a larger study, StCO2 may serve as a noninvasive measurement of cerebral perfusion in the patient with a TBI or, at the very least, a sensitive indicator for the need to begin monitoring the ICP.
-
Comparative Study
Percutaneous endoscopic gastrostomy: the preferred method of elective feeding tube placement in trauma patients.
The purpose of this study was to determine whether gastric feeding tubes placed by the percutaneous endoscopic route resulted in fewer and less severe complications than open surgical gastrostomy (SG). ⋯ Gastrostomy tubes placed via the percutaneous endoscopic route had a significantly lower complication rate than surgically placed tubes. In addition, the charges incurred for their placement were also significantly less. Based on the findings of this study, PEG should be considered as the method of choice for gastric feeding tube placement for trauma patients who do not have specific contraindications to the procedure.