J Trauma
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Randomized Controlled Trial Clinical Trial
Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma.
The objective was to test prospectively supranormal values of cardiac index (CI), oxygen delivery index (DO2I), and oxygen consumption index (VO2I) as resuscitation goals to improve outcome in severely traumatized patients. We included patients > or = 16 years of age who had either (1) an estimated blood loss > or = 2000 mL or (2) a pelvic fracture and/or two or more major long bone fractures with > or = four units of packed red cells given within six hours of admission. ⋯ The 50 protocol patients had a significantly lower mortality (9 of 50, 18% vs. 24 of 65, 37%) and fewer organ failures per patient (0.74 +/- 0.28 vs. 1.62 +/- 0.45) than did the 75 control patients. We conclude that increased CI, DO2I, and VO2I seen in survivors of severe trauma are primary compensations that have survival value; augmentation of these compensations compared to conventional therapy decreases mortality.
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To determine if pre-existing conditions significantly improve the ability of current (TRISS and ASCOT) methods for predicting survival of patients with trauma from low falls. ⋯ Pre-existing conditions and male gender are significantly related to survival of patients with trauma from low falls, and should be included along with age and the various physiologic and anatomic measures currently being used to predict survival for those patients.
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Seventy-five patients with 81 femoral shaft fractures were treated with unreamed antegrade intramedullary nailing using a titanium alloy implant (AIM femoral nail, ACE Medical) with static interlocking. There were 73 closed fractures and 8 open fractures. Six patients had bilateral femoral shaft fractures. ⋯ Two patients died of severe head injuries and one patient died of multiple organ failure. The infection rate was 0%, and uneventful consolidation of the fractures was seen in all cases within a mean of 3.8 months. Neither in the case of nails nor in the case of interlocking bolts did an implant failure occur.
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To determine the value of abdominal roentgenograms after aortography for detecting additional organ injuries, we retrospectively evaluated the abdominal and pelvic roentgenograms after aortography of 170 trauma patients who underwent arch aortography to detect aortic rupture. In 160 (94%) of 170 patients, the results of arch studies were normal. ⋯ Thirty-one (18%) of 170 patients had associated injuries demonstrated by the roentgenograms taken after aortography, including pelvic or femoral fractures (13%), pelvic hematomas (5.8%), renal injuries (1.1%), and bladder ruptures (2.9%). We conclude that abdominal and pelvic pain roentgenograms should be part of a routine arch aortography performed for blunt chest trauma to detect additional organ injuries that frequently accompany injuries from motor vehicle crashes.
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Analyses were conducted to estimate the effectiveness of airbags in reducing driver fatalities in motor vehicle crashes. ⋯ Various estimates of airbag effectiveness are beginning to yield consistent results. These analyses confirm that driver airbags are reducing fatalities in the frontal crashes for which they are designed.