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The influence of metabolic imbalances and oxidative stress on the outcome of critically ill polytrauma patients: a review

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Burns & Trauma 2017年第1期5卷 17-23页

作者： Alexandru Florin Rogobete Dorel Sandesc Marius Papurica Emil Robert Stoicescu Sonia Elena Popovici Lavinia Melania Bratu Corina Vernic Adriana Mariana Sas Adrian Tudor Stan Ovidiu Horea Bedreag Faculty of Medicine Victor Babes University of Medicine and PharmacyStr.Eftimie Murgu Nr.2Timisoara300041TimisRomania Clinic of Anaesthesia and Intensive Care Emergency County Hospital“PiusBrinzeu”Bd.Liviu Rebreanu Nr.156Timisoara300736TimisRomania

The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.

关键词： Critically ill Energy expenditure Indirect calorimetry Metabolic disaster Oxidative stress Overfeeding Underfeeding polytrauma

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Orthopaedic management in the polytrauma patient

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Frontiers of Medicine 2012年第3期6卷 234-242页

作者： Jason J.Halvorson Holly T-P.Pilson Eben A.Carroll Zhongyu John Li Department of Orthopaedic Surgery Wake Forest Baptist HealthMedical Center BlvdWinston-SalemNC 27103USA

The past century has seen many changes in the management of the polytraumatized orthopaedic *** recommendations for non-operative treatment have evolved into early total care(ETC)and damage control orthopaedic(DCO)treatment *** principles force the treating orthopaedist to take into account multiple patient parameters including hypothermia,coagulopathy and volume status before deciding upon the operative *** requires a multidisciplinary approach involving critical care physicians,anesthesiologists and others.

关键词： damage control orthopaedics early total care polytrauma

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Rehabilitation nursing for an earthquake survivor with severe polytrauma:A case report and literature review

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Journal of Integrative Nursing 2020年第3期2卷 149-152页

作者： Chun‑Yi XU Fang TANG Department of Orthopedic Sichuan Academy of Medical Sciences and Sichuan Provincial People’s HospitalChengduChina

The aim of this article is to summarize the experience of rehabilitation nursing of one case of severe polytrauma caused by *** key points of the rehabilitation nursing include body posture nursing,orthopedic rehabilitation nursing,pulmonary function rehabilitation nursing,bladder rehabilitation nursing,nutritional support,and psychological rehabilitation *** the comprehensive rehabilitation nursing interventions,satisfactory outcomes were obtained,and the patient was successfully recovered and discharged after 2 months.

关键词： Earthquake polytrauma rehabilitation nursing

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One successful case of 6-organ-failure after severe polytrauma

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Chinese Medical Journal 1998年第2期 91-93页

作者：孙长怡李力群马占忠

Ｏｎｅｓｕｃｃｅｓｆｕｌｃａｓｅｏｆ６ｏｒｇａｎｆａｉｌｕｒｅａｆｔｅｒｓｅｖｅｒｅｐｏｌｙｔｒａｕｍａＳｕｎＣｈａｎｇｙｉ孙长怡，ＬｉＬｉｑｕｎ李力群ａｎｄＭａＺｈａｎｚｈｏｎｇ马占忠ＳｕｒｇｅｒｙＩｎｔｅｎｓ... 详细信息

Ｏｎｅｓｕｃｃｅｓｆｕｌｃａｓｅｏｆ６ｏｒｇａｎｆａｉｌｕｒｅａｆｔｅｒｓｅｖｅｒｅｐｏｌｙｔｒａｕｍａＳｕｎＣｈａｎｇｙｉ孙长怡，ＬｉＬｉｑｕｎ李力群ａｎｄＭａＺｈａｎｚｈｏｎｇ马占忠ＳｕｒｇｅｒｙＩｎｔｅｎｓｉｖｅＣａｒｅＵｎｉｔ，Ｂｅｉｊｉ...

关键词：李力群 successful organ-failure severe case polytrauma One after

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What are the ten new commandments in severe polytrauma management？

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World Journal of Emergency Medicine 2010年第2期1卷 85-92页

作者： CW Kam CH Lai SK Lam FL So CL Lau KH Cheung Accident ＆ Emergency Department Tuen Mun Hospital Hong Kong China

This review aims to provide a concise overview of the trauma management evolution in the past decade. 1） Trauma care priorities have incorporated staff protection against infection and early decision making in addition to the conventional ABCDE. 2） Five stratified levels for DAM have replaced the non-specific conventional Plans A ＆ B. 3） CT scanning can be the tunnel to death for the hemodynamically unstable patient. 4） DPL has virtually been replaced by the FAST USG. 5） Direct whole-body MDCT provides rapid imaging diagnosis ＆ expedites the definitive treatment but carries high radiation hazards. 6） The dynamic shock assessment by fluid resuscitation response provides more outcome-specific evaluation than the static blood volume loss model. 7） DCR comprising of permissive hypotension, hemostatic resuscitation ＆ DCS aims to overcome the lethal triad of trauma. Early transfusion of blood components of FFP ＆ platelet concentrates improves the outcome in massive blood transfusion. 8） DCS aims to rectify the deranged physiology and not to fully restore the damaged anatomy. 9） A pre-defined protocol for major pelvic fracture can be life-saving and the novel Pre-PPP （pre-peritoneal pelvic packing） may further reduce mortality coupled with the necessary TCAE. 10） Injury prevention is equally important if not more than the trauma resuscitation ＆ operation.

关键词： polytrauma Priorities DAM CT MDCT DPL FAST Fluid resuscitation responder DCR DCS Pre-PPP Injury prevention

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Accuracy and outcome of rapid ultrasound in shock and hypotension （RUSH） in Egyptian polytrauma patients

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Chinese Journal of Traumatology 2018年第3期21卷 156-162页

作者： Adel Hamed Elbaih Ahmed Mohamed Housseini Mohamed E.M. Khalifa Department of Emergency Medicine Faculty of Medicine Suez Canal University Egypt Department of Radiology Faculty of Medicine Suez Canal University Egypt Department of Anesthesia and Intensive Care Faculty of Medicine Suez Canal University Egypt

Purpose：＂polytrauma＂ patients are of a higher risk of complications and death than the summation of expected mortality and morbidity of their individual injuries. The ideal goal in trauma resuscitation care is to identify and treat all injuries. With clinical and technological advanced imaging available for diagnosis and treatment of traumatic patients, point of care-rapid ultrasound in shock and hypotension （RUSH） significantly affects modern trauma services and patient outcomes. This study aims to evaluate the accuracy of RUSH and patient outcomes by early detection of the causes of unstable polytrauma. Methods： This cross-sectional, prospective study included 100 unstable polytrauma patients admitted in Suez Canal University Hospital. Clinical exam, RUSH and pan-computed tomography （pan-CT） were conducted. The result of CT was taken as the standard. Patients were managed according to the advanced trauma life support （ATLS） guidelines and treated of life threatening conditions if present. Patients were followed up for 28 days for a short outcome. Results： The most diagnostic causes of unstability in polytrauma patients by RUSH are hypovolemic shock （64%）, followed by obstructive shock （14%）, distributive shock （12%） and cardiogenic shock （10%） respectively. RUSH had 94.2% sensitivity in the diagnosis of unstable polytrauma patients; the accuracy of RUSH in shock patients was 95.2%. Conclusion： RUSH is accurate in the diagnosis of unstable polytrauma patients; and 4% of patients were diagnosed during follow-up after admission by RUSH and pan-CT.

关键词： polytrauma Shock Rapid ultrasound in shock and hypotension

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Application value of machine learning models in predicting intraoperative hypothermia in laparoscopic surgery for polytrauma patients

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World Journal of Clinical Cases 2024年第24期12卷 5513-5522页

作者： Kun Zhu Zi-Xuan Zhang Miao Zhang The Second Department of Anesthesia Tianjin HospitalTianjin 300211China Department of War Rescue Training Qingdao Special Servicemen Recuperation Center of PLA NavyQingdao 266001Shandong ProvinceChina Department of Internal Medicine Qingdao Fushan Elderly ApartmentsQingdao 266001Shandong ProvinceChina

BACKGROUND Hypothermia during laparoscopic surgery in patients with multiple trauma is a significant concern owing to its potential *** learning models offer a promising approach to predict the occurrence of intraoperative *** To investigate the value of machine learning model to predict hypothermia during laparoscopic surgery in patients with multiple *** This retrospective study enrolled 220 patients who were admitted with multiple injuries between June 2018 and December *** these,154 patients were allocated to a training set and the remaining 66 were allocated to a validation set in a 7:3 *** the training set,53 cases experienced intraoperative hypothermia and 101 did *** regression analysis was used to construct a predictive model of intraoperative hypothermia in patients with polytrauma undergoing laparoscopic *** area under the curve(AUC),sensitivity,and specificity were *** Comparison of the hypothermia and non-hypothermia groups found significant differences in sex,age,baseline temperature,intraoperative temperature,duration of anesthesia,duration of surgery,intraoperative fluid infusion,crystalloid infusion,colloid infusion,and pneumoperitoneum volume(P0.05).The results of the logistic regression analysis showed that age,baseline temperature,intraoperative temperature,duration of anesthesia,and duration of surgery were independent influencing factors for intraoperative hypothermia during laparoscopic surgery(P0.05).The predictive model had AUCs of 0.850 and 0.829 for the training and validation sets,*** Machine learning effectively predicted intraoperative hypothermia in polytrauma patients undergoing laparoscopic surgery,which improved sur

关键词： polytrauma Laparoscopic surgery Hypothermia Related factor Risk prediction

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CT Scans in Primary Survey for polytrauma Patients

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Advances in Computed Tomography 2013年第2期2卷 46-51页

作者： Purnajyoti Banerjee Soumen Rudra Madhusree Ghosh Praveen Panose Department of Obstetrics & Gynaecology St George’s Hospital London UK Department of Trauma & Orthopaedics East Surrey Hospital Redhill UK

Managing critically injured patients are challenging. Victims of major trauma often present with a host of unknowns including the exact site and nature of injury with a need for urgent diagnosis and resuscitation. It takes significant clinical expertise to detect multiple injuries and implement life or limb saving treatment within a short period of time. Conventional radiographs and focused assessment with sonography for trauma (FAST) scans are useful adjuncts to help in initial diagnosis. Conventional computer tomography (CT) investigations have been used for secondary survey in these scenarios. We reviewed the guidelines that regulate the use of CT scans in multiple injured patients in the UK. CT imaging is rapidly emerging as an adjunct to primary survey. It allows quick detection of major organ injury allowing focussed treatment whilst simultaneous initial resuscitation is underway. Availability of adequate resources is needed for widespread adaptation of this technique that involves manpower, relocation and refurbishment of the CT suites. Although it is not yet clear if using CT imaging during primary survey reduces mortality, it surely results in more organised patient care and efficient use of resources in an acute setting.

关键词： CT polytrauma Primary Survey

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Role of Multidetector CT in Evaluation of polytrauma Patients

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Open Journal of Emergency Medicine 2014年第3期2卷 49-52页

作者： Amit Nandan Dhar Dwivedi Department of Radiodiagnosis and Imaging Institute of Medical Sciences Banaras Hindu University Banaras India

Trauma is the leading cause of death in age group less than 45 years. In trauma, time is one of the most crucial factors in predicting prognosis. Outcomes are greatly improved when critical interventions are provided within the golden hour following injury. Whole body multidetector computerised tomography (WBMDCT) can decrease this critical time and increase survival. Emergency CT plays a major role in diagnostic workflow in the evaluation of patients with polytrauma. MDCT scanners are widely used because they rapidly produce high-resolution scans of large areas, offering short examination times for multiple body regions under emergency conditions. Such examinations most often include the head, cervical spine, and thorax to pelvis. Role of MDCT in head trauma remains unparalleled for reasons like its widespread availability and capability to reveal skull fractures, primarily because it is a fast and efficient method to triage the patients with treatable conditions mandating urgent surgical intervention such as extra axial hematomas, mass effect, herniations of brain, hydrocephalus, and midline shift and hence preventing secondary brain injury. MDCT angiography is an important tool to screen patients with suspected vascular injury.

关键词： polytrauma Whole Body Multidetector CT Major Vascular Injuries Major Visceral Injuries

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Management of polytrauma patients in emergency department:An experience of a tertiary care health institution of northern India

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World Journal of Emergency Medicine 2013年第1期4卷 15-19页

作者： Puri Payal Goel Sonu Gupta Anil K Verma Prachi Department of Hospital Administration Post Graduate Institute of Medical Education and ResearchChandigarh and Department of Community MedicineSchool of Public HealthPGIMERChandigarhIndia

BACKGROUND:In a tertiary care institute of northern India,the emergency department receives an average of 6-7 patients with poly trauma every *** these patients,some come directly and many are referred from other hospitals from the *** problems are faced in the management of patients with poly *** study aimed to elicit various complaints,suggestions and possible solutions in the management of patients with poly ***:A retrospective cross sectional study was done on 210 patients in the emergency OPD for a period of 2 *** the records of the patients with poly trauma were studied and the problems during their management were measured against 6 predetermined steps(step Ⅰ to step Ⅵ).RESULTS:In the younger generation,males were predominantly the primary victims of poly trauma injury,and road traffic accident was the major etiological *** involving more than2 specialties induced many problems during the management of patients with poly *** 210 patients we studied,32 patients had problems at various steps and maximum problems in step Ⅲ,***-ordination between various specialties in the management of patients with poly ***:A proper poly trauma management team and a well defined standard operative procedure are the keys to effective management of patients with poly trauma by minimizing the problems encountered.

关键词： polytrauma Emergency department Triage

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