scholarly journals Temporary Abdominal Closure Is Associated with Increased Risk for Fungal Intra-Abdominal Infections in Trauma Patients

2020 ◽  
Vol 21 (9) ◽  
pp. 745-751
Author(s):  
Christina X. Zhang ◽  
Rohit R. Rasane ◽  
Qiao Zhang ◽  
Ricardo A. Fonseca ◽  
Jose A. Aldana ◽  
...  
Keyword(s):  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Increased Risk ◽  
Abdominal Infections

Surgical Complications and Causes of Death in Trauma Patients that Require Temporary Abdominal Closure

2005 ◽  
Vol 71 (3) ◽  
pp. 219-224 ◽  
Author(s):  
JosÉ A. Montalvo ◽  
JosÉ A. Acosta ◽  
Pablo RodrÍguez ◽  
Kathia Alejandro ◽  
AndrÉs SÁrraga
Keyword(s):  
Surgical Complications ◽  
Causes Of Death ◽  
Surgical Complication ◽  
Damage Control ◽  
Multiple Logistic Regression Analysis ◽  
Hypovolemic Shock ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure

Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.

scholarly journals Modified Opsite® Sandwich for Temporary Abdominal Closure: A Non-Traumatic Experience

2007 ◽  
Vol 89 (1) ◽  
pp. 57-61 ◽  
Author(s):  
JM Wilde ◽  
MA Loudon
Keyword(s):  
Critically Ill ◽  
Damage Control ◽  
Injured Patient ◽  
Damage Control Surgery ◽  
Traumatic Experience ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Operative Severity Score

INTRODUCTION Laparostomy techniques have advanced since the advent of damage control surgery for the critically injured patient. Numerous methods of temporary abdominal closure (TAC) are described in the literature with most reports focusing on trauma. We describe a modified technique for TAC and report its use in a series of critically ill non-trauma patients. PATIENTS AND METHODS Eleven patients under the care of one consultant underwent TAC over a 36-month period. A standardised technique was used in all cases and this is described. Severity of illness at the time of the first laparotomy was assessed using the Portsmouth variant of the Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity (P-POSSUM). RESULTS Nineteen TACs were performed in 11 patients with a variety of serious surgical conditions. In-hospital mortality was zero despite seven of the patients having an individual P-POSSUM predicted mortality in excess of 50%. The laparostomy dressing proved simple in construction, facilitated nursing care and was well-tolerated in the critical care environment. All patients underwent definitive fascial closure during the index admission. CONCLUSIONS Laparostomy is a useful technique outwith the context of trauma. We have demonstrated the utility of the modified Opsite® sandwich vacuum pack for TAC in a series of critically ill patients with a universally favourable outcome. This small study suggests that selective use of TAC may reduce surgical mortality.

The use of temporary abdominal closure in low-risk trauma patients

2012 ◽  
Vol 72 (3) ◽  
pp. 601-608 ◽  
Author(s):  
Matthew J. Martin ◽  
Quinton Hatch ◽  
Bryan Cotton ◽  
John Holcomb
Keyword(s):  
Low Risk ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure

Temporary abdominal closure with polytetrafluoroethylene prosthetic mesh in critically ill non-trauma patients

Hernia ◽  
2014 ◽  
Vol 19 (2) ◽  
pp. 329-337 ◽  
Author(s):  
A. Robin-Lersundi ◽  
V. Vega Ruiz ◽  
J. López-Monclús ◽  
A. Cruz Cidoncha ◽  
A. Abella Alvarez ◽  
...  
Keyword(s):  
Critically Ill ◽  
Prosthetic Mesh ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure

Open Abdomen in Trauma and Critical Care

2017 ◽  
Vol 37 (5) ◽  
pp. 22-45 ◽  
Author(s):  
Eleanor R. Fitzpatrick
Keyword(s):  
Critical Care ◽  
Open Abdomen ◽  
Damage Control ◽  
Management Strategies ◽  
Damage Control Surgery ◽  
Standard Of Care ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Abdominal Closure ◽  
Planned Reoperation

The open abdomen technique and temporary abdominal closure after damage control surgery is fast becoming the standard of care for managing intra-abdominal bleeding and infectious or ischemic processes in critically ill patients. Expansion of this technique has evolved from damage control surgery in severely injured trauma patients to use in patients with abdominal compartment syndrome due to acute pancreatitis and other disorders. Subsequent therapies after use of the open abdomen technique and temporary abdominal closure are resuscitation in the intensive care unit and planned reoperation to manage the underlying cause of bleeding, infection, or ischemia. Determining the need for this potentially lifesaving intervention and managing the wound after the open abdomen has been created are all within the realm of critical care nurses. Case studies illustrate the implementation of the open abdomen technique and patient management strategies.

scholarly journals Older trauma patients are at high risk of delirium, especially those with underlying dementia or baseline frailty

2021 ◽  
Vol 6 (1) ◽  
pp. e000639
Author(s):  
Danielle Ní Chróinín ◽  
Nevenka Francis ◽  
Pearl Wong ◽  
Yewon David Kim ◽  
Susan Nham ◽  
...  
Keyword(s):  
Older Patients ◽  
Multivariable Analysis ◽  
Primary Outcome Measure ◽  
Hospital Length ◽  
Assessment Tools ◽  
Hospital Length Of Stay ◽  
Trauma Patients ◽  
Level Of Evidence ◽  
Increased Risk ◽  
History Of

BackgroundGiven the increasing numbers of older patients presenting with trauma, and the potential influence of delirium on outcomes, we sought to investigate the proportion of such patients who were diagnosed with delirium during their stay—and patient factors associated therewith—and the potential associations between delirium and hospital length of stay (LOS). We hypothesized that delirium would be common, associated with certain patient characteristics, and associated with long hospital LOS (highest quartile).MethodsWe conducted a retrospective observational cohort study of all trauma patients aged ≥65 years presenting in September to October 2019, interrogating medical records and the institutional trauma database. The primary outcome measure was occurrence of delirium.ResultsAmong 99 eligible patients, delirium was common, documented in 23% (23 of 99). On multivariable analysis, adjusting for age, frailty and history of dementia, frailty (OR 4.09, 95% CI 1.08 to 15.53, p=0.04) and dementia (OR 5.23, 95% CI 1.38 to 19.90, p=0.02) were independently associated with likelihood of delirium. Standardized assessment tools were underused, with only 34% (34 of 99) screened within 4 hours of arrival. On univariate logistic regression analysis, having an episode of delirium was associated with long LOS (highest quartile), OR of 5.29 (95% CI 1.92 to 14.56, p<0.001). In the final multivariable model, adjusting for any (non-delirium) in-hospital complication, delirium was independently associated with long LOS (≥16 days; OR 4.81, p=0.005).DiscussionIn this study, delirium was common. History of dementia and baseline frailty were associated with increased risk. Delirium was independently associated with long LOS. However, many patients did not undergo standardized screening at admission. Early identification and targeted management of older patients at risk of delirium may reduce incidence and improve care of this vulnerable cohort. These data are hypothesis generating, but support the need for initiatives which improve delirium care, acknowledging the complex interplay between frailty and other geriatric syndromes in the older trauma patients.Level of evidenceIII.

scholarly journals Outcomes of major trauma among patients with chronic kidney disease and receiving dialysis in Nova Scotia: a retrospective analysis

2021 ◽  
Vol 6 (1) ◽  
pp. e000672
Author(s):  
Ryan Pratt ◽  
Mete Erdogan ◽  
Robert Green ◽  
David Clark ◽  
Amanda Vinson ◽  
...  
Keyword(s):  
Chronic Kidney Disease ◽  
Nova Scotia ◽  
Kidney Disease ◽  
Hospital Mortality ◽  
Major Trauma ◽  
Injury Severity ◽  
Cox Regression ◽  
Trauma Patients ◽  
Risk Of Death ◽  
Increased Risk

BackgroundThe risk of death and complications after major trauma in patients with chronic kidney disease (CKD) is higher than in the general population, but whether this association holds true among Canadian trauma patients is unknown.ObjectivesTo characterize patients with CKD/receiving dialysis within a regional major trauma cohort and compare their outcomes with patients without CKD.MethodsAll major traumas requiring hospitalization between 2006 and 2017 were identified from a provincial trauma registry in Nova Scotia, Canada. Trauma patients with stage ≥3 CKD (estimated glomerular filtration rate <60 mL/min/1.73 m2) or receiving dialysis were identified by cross-referencing two regional databases for nephrology clinics and dialysis treatments. The primary outcome was in-hospital mortality; secondary outcomes included hospital/intensive care unit (ICU) length of stay (LOS) and ventilator-days. Cox regression was used to adjust for the effects of patient characteristics on in-hospital mortality.ResultsIn total, 6237 trauma patients were identified, of whom 4997 lived within the regional nephrology catchment area. CKD/dialysis trauma patients (n=101; 28 on dialysis) were older than patients without CKD (n=4896), with higher rates of hypertension, diabetes, and cardiovascular disease, and had increased risk of in-hospital mortality (31% vs 11%, p<0.001). No differences were observed in injury severity, ICU LOS, or ventilator-days. After adjustment for age, sex, and injury severity, the HR for in-hospital mortality was 1.90 (95% CI 1.33 to 2.70) for CKD/dialysis compared with patients without CKD.ConclusionIndependent of injury severity, patients without CKD/dialysis have significantly increased risk of in-hospital mortality after major trauma.

scholarly journals Thrombelastography and Thrombelastometry

2013 ◽  
Vol 13 (1) ◽  
pp. 14-20
Author(s):  
Lukas Duraj ◽  
J. Stasko ◽  
M. Hasko ◽  
M. Fedor ◽  
P. Chudy ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Cardiac Surgery ◽  
Extracorporeal Circulation ◽  
Early Identification ◽  
Fetal Loss ◽  
Clinical Applications ◽  
Trauma Patients ◽  
Compact Mapping ◽  
Transfusion Requirements ◽  
Increased Risk

Abstract The term thrombelastography / thrombelastometry was used to describe the trace produced from measurement of the viscoelastic changes associated with fibrin polymerization. The result of measurement is a compact mapping of the various stages of haemostasis. One of the first real clinical applications of this method was the haemostatic monitoring of liver transplantation and cardiac surgery using extracorporeal circulation. In trauma patients the thrombelastography /thrombelastometry was proved to predict early transfusion requirements. Another authors suggest thrombelastography /thrombelastometry as a possible tool for early identification of pregnant women at increased risk of fetal loss. This article provides overview on the development of thrombelastography / trombelastometry and its possible use in laboratory of haemostasis.

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