The Journal of surgical research
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Impaired function of cluster of differentiation 14-positive (CD14+) monocytes (MOs) after major surgical trauma is believed to predispose to infectious complications. Postoperative decreases in human leukocyte antigen (HLA)-DR expression, tumor necrosis factor-alpha (TNF-alpha) production and interleukin (IL)-12 synthesis have been reported. There are no studies comparing absolute MO counts and MO cytokine synthesis in peripheral blood and stimulated cultures. ⋯ The immediate postoperative period is associated with an increase in the absolute MO numbers and an impairment of MO function, which is reflected in a reduced capacity to synthesize IL-12 and TNF-alpha and a decreased ability to express HLA-DR and present antigens. Whereas the cytokine-producing capacity returns to normal levels on d3, the suppression of HLA-DR expression persists.
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The Trauma Related Injury Severity Score (TRISS) has been previously validated to predict outcomes in nonintubated, nonparalyzed trauma patients. The purpose of this study was to assess the impact of scene vital signs on predicting survival in intubated trauma patients. ⋯ Traditionally, patients arriving at trauma centers intubated are either excluded from the trauma registry or have their physiological score "modified" to account for pharmacologically altered respiratory rate and Glasgow Coma Scale. In intubated patients, TRISS using scene vital signs more reliably predicts survival and does so with far fewer "unexpected" outcomes than with other available scoring systems.
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The implementation of the 80-h work week restrictions implemented by the Accreditation Council for Graduate Medical Education (ACGME) in July 2003 were intended, in part, to improve patient outcomes by reducing fatigue-related resident errors. Although concerns were raised regarding the possibility for increased error due to decreased continuity of patient care, recent studies have shown no significant change in mortality or complication rates since the onset of these new restrictions. This study is the first to examine the effects of the 80-h work week on mortality in trauma patients on a national level. ⋯ Despite the great deal of controversy surrounding the 80-h work week, few papers exist that specifically examine patient mortality within the field of trauma surgery. This large retrospective analysis demonstrates slightly decreased mortality and morbidity among trauma patients in university hospitals nationwide after implementation of the 80-h work week, even when controlling for possible confounders. Although these differences are not likely to be clinically important, the data are statistically very significant. Therefore, we conclude that the 80-h work week has not resulted in any significant deterioration in patient outcomes in this particular population.
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The use of non-heart-beating donors (NHBD) has been propagated as an alternative to overcome the scarcity of pulmonary grafts. The presence of postmortem thrombi, however, is a concern for the development of primary graft dysfunction. In this isolated lung reperfusion study, we looked at the need and the best route of preharvest pulmonary flush. ⋯ RF of lungs from NHBD improves graft function by elimination of microthrombi from the pulmonary vasculature, resulting in lower pulmonary vascular resistance upon reperfusion.
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Massive hemorrhage results in hypovolemia and hypotension that activate the sympathetic-adrenal-system, the hypothalamic-pituitary-adrenal axis, and induce metabolic changes such as hyperglycemia. Blood loss during surgery, however, is rapidly compensated by intravenous fluids to minimize negative impact on circulation. The aim of this study was to develop an experimental model for studies of the stress response and metabolic alterations seen after major abdominal surgery by combining intestinal resection with compensated non-hypotensive blood loss. ⋯ Surgical trauma combined with compensated non-hypotensive blood loss induced persistent volume-dependent hyperglycemia that did not depend on changes in plasma corticosterone and, in the early postoperative phase, MAP and catecholamines. Our data indicate that blood loss per se, without causing hypotension or acute elevations in catecholamines, can induce marked postoperative hyperglycemia. The experimental model presented in this report will be a useful tool to further elucidate mechanisms underlying the changes in glucose metabolism seen after surgical injury.