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A review in emergency central venous catheterization

Chinese Journal of Traumatology 2017年第3期20卷 137-140页

作者： osaree akaraborworn Division of Trauma and Surgical Critical Care Department of Surgery Faculty of Medicine Prince of Songkla University Hat Yai Songkhla 90110 Thailand

Central venous catheterization is widely used in the emergency setting. This review aims to assess central venous catheterization from the perspectives of types of catheters, sites of insertion, and techniques. In emergency conditions, non-tunneled catheters are preferred because the technique for its insertion is not complicated and less time-consuming. The size of catheter depends on the purpose of catheterization. For example, a large bore catheter is needed for rapid infusion. The ideal catheterization site should bear fewer thromboses, lower infectious rate, and fewer mechanical complications. Thus the femoral vein should be avoided due to a high rate of colonization and thrombosis while the subclavian vein seems to exhibit fewer infectious complications compared with other sites. The ultrasound-guided technique increases the success rate of insertion while decreases the mechanical complications rate.

关键词：导管静脉急诊插入技术血栓形成并发症感染率隧道式

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Combination of blood lactate level with assessment of blood consumption （ABC） scoring system： A more accurate predictor of massive transfusion requirement

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Chinese Journal of Traumatology 2018年第2期21卷 96-99页

作者： Wongsakorn Chaochankit osaree akaraborworn Burapat Sangthong Komet Thongkhao Department of Surgery Faculty of Medicine Prince of Songkla University Songkhla Thailand Trauma Unit Department of Surgery Faculty of Medicine Prince of Songkla University. Songkhla Thailand

OBJECTIVE:Exsanguination is the most common leading cause of death in trauma patients. The massive transfusion (MT) protocol may influence therapeutic strategies and help provide blood components in timely manner. The assessment of blood consumption (ABC) score is a popular MT protocol but has low predictability. The lactate level is a good parameter to reflect poor tissue perfusion or shock states that can guide the management. This study aimed to modify the ABC scoring system by adding the lactate level for better prediction of MT.;METHODS:The data were retrospectively collected from 165 trauma patients following the trauma activated criteria at Songklanagarind Hospital from January 2014 to December 2014. The ABC scoring system was applied in all patients. The patients who had an ABC score ≥2 as the cut point for MT were defined as the ABC group. All patients who had a score ≥2 with a lactate level >4 mmol/dL were defined as the ABC plus lactate level (ABC + L) group. The prediction for the requirement of massive blood transfusion was compared between the ABC and ABC + L groups. The ability of ABC and ABC + L groups to predict MT was estimated by the area under the receiver operating characteristic curve (AUROC).;RESULTS:Among 165 patients, 15 patients (9%) required massive blood transfusion. There were no significant differences in age, gender, mechanism of injury or initial vital signs between the MT group and the non-MT group. The group that required MT had a higher Injury Severity Score and mortality. The sensitivity and specificity of the ABC scoring system in our institution were low (81%, 34%, AUC 0.573). The sensitivity and specificity were significantly better in the ABC + L group (92%, 42%, AUC = 0.745).;CONCLUSIONS:The ABC scoring system plus lactate increased the sensitivity and specificity compared with the ABC scoring system alone.

关键词：系统预言喂奶消费评价输送水 ABC

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Prediction of massive transfusion in trauma patients in the surgical intensive care units (THAI-SICU study)

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Chinese Journal of Traumatology 2019年第4期22卷 219-222页

作者： osaree akaraborworn Onuma Chaiwat Sunisa Chatmongkolchart Chanatthee Kitsiripant Kaweesak Chittawatanarat Sunthiti Morakul Thammasak Thawitsri Petch Wacharasintg Sujaree Poopipatpab Waraporn Chau-In Chaiyapruk Kusumaphanyo Division of Trauma and Critical Care Department of Surgery Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand Department of Anesthesiology Faculty of Medicine Srinakharinwirot University Nakhon Nayok Thailand Department of Anesthesiology. Faculty of Medicine Siriraj Hospital Mahidol University Bangkok Thailand Department of Anesthesiology Faculty of Medicine Prince of Songkla University Hat Yai Songkhla Thailand Department of Surgery Faculty of Medicine Chiang Mai University Chiang Mai Thailand Department of Anesthesiology Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand Department of Anesthesiology Faculty of Medicine King Chulalongkorn Memorial Hospital Bangkok Chulalongkorn University Thailand Department of Anesthesiology Phramongkutklao Hospital Bangkok Thailand Department of Anesthesiology Navamindradhiraj University Bangkok Thailand Department of Anesthesiology Khon Kaen University Khon Kaen Thailand

Purpose: After damage control surgery, trauma patients are transferred to intensive care units to restore the physiology. During this period, massive transfusion might be required for ongoing bleeding and coagulopathy. This research aimed to identify predictors of massive blood transfusion in the surgical intensive care units (SICUs). Methods: This is an analysis of the THAI-SICU study which was a prospective cohort that was done in the 9-university-based SICUs in Thailand. The study included only patients admitted due to trauma mechanisms. Massive transfusion was defined as received >10 units of packed red blood cells on the first day of admission. Patient characteristics and physiologic data were analyzed to identify the potential factors. A multivariable regression was then performed to identify the significant model. Results: Three hundred and seventy patients were enrolled. Sixteen patients (5%) received massive transfusion in the SICUs. The factors that significantly predicted massive transfusion were an initial sequential organ failure assessment (SOFA)>9 (risk difference (RD) 0.13, 95% confidence interval (CI): 0.03—0.22, p = 0.01);intra-operative blood loss > 4900 mL (RD 0.33, 95% CI: 0.04—0.62, p = 0.02) and intra-operative blood transfusion > 10 units (RD 0.45, 95% Cl: 0.06 to 0.84, p = 0.02). The probability to have massive transfusion was 0.976 in patients who had these 3 factors. Conclusion: Massive blood transfusion in the SICUs occurred in 5%. An initial SOFA >9, intra-operative blood loss >4900 mL, and intra-operative blood transfusion >10 units were the significant factors to predict massive transfusion in the SICUs.

关键词： Massive transfusion Massive bleeding Surgical intensive care Multiple trauma

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