Arch Surg Chicago
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The differential roles of infection as a microbial phenomenon and sepsis as a host response were studied in 210 critically ill surgical patients. Infections occurred in 41.4% of all cases and in 82% of nonsurviving patients. Both infection and the expression of a septic response, measured as a sepsis score, were associated with significantly increased intensive care unit morbidity and mortality. ⋯ Nonsurvivors with sepsis, on the other hand, did not differ from survivors with respect to any variable reflecting infection but did have higher mean sepsis scores. Maximum sepsis scores and sepsis scores on the day of death were similar in patients dying without infection and those dying with uncontrolled infection. The magnitude of the host septic response, independent of the presence, bacteriologic characteristics, or control of infection, is an important determinant of outcome in critical surgical illness.
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We evaluated the role of nonoperative therapy in 16 patients with blunt multisystem trauma, hemodynamic stability following resuscitation, and major lobar liver injury; the patients were treated with a protocol of intensive care unit observation and computed tomographic scanning to identify and follow up the hepatic lesion. Computed tomographic scans showed right-lobe or bilobar liver lacerations and/or subcapsular hematomas in all patients and associated hemoperitoneum in 8 patients. Exploration was required in 2 patients; both were found to have a hemoperitoneum and a nonbleeding liver laceration. ⋯ The major advantage of a nonoperative approach is the opportunity to stabilize major extra-abdominal (particularly head) injuries as the first priority. Unstable hemodynamics, abdominal distension, and falling hematocrit are indications for prompt exploration. Nonoperative care of these injuries requires a strict treatment protocol.