Incidence and Significance of Cardiac Troponin I Release in Severe Trauma Patients

2004 ◽  
Vol 101 (6) ◽  
pp. 1262-1268 ◽  
Author(s):  
Alain R. Edouard ◽  
Marie-Louise Felten ◽  
Jean-Louis Hebert ◽  
Claudine Cosson ◽  
Laurent Martin ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Time Course ◽  
Chest Trauma ◽  
Troponin I ◽  
Severe Trauma ◽  
Surgical Intensive Care Unit ◽  
Trauma Patients ◽  
Surgical Intensive Care ◽  
Myocardial Contusion ◽  
Significant Release

Background The incidence and significance of troponin I release and its mechanism are unknown in severe trauma patients. The characteristics of this release were prospectively studied in such patients and correlated with presence of shock, existence of myocardial contusion, and outcome. Methods During a 24-month period, serial electrocardiogram recordings and troponin I measurements were performed in all trauma patients admitted at a surgical intensive care unit. The diagnosis of a significant myocardial contusion was made on electrocardiographic criteria. According to the time course of troponin I, three groups of patients were defined a priori: very transient (</= 12 h) and limited release (troponin I < 2 microg/l), transient (</= 36 h) and significant release (troponin I >/= 2 microg/l), and sustained (> 36 h) and significant release (troponin I > 2 microg/l). In the last group, coronary artery angiography was performed. Results The incidence of troponin I release was 12% (95% confidence interval [CI], 9.6-14.4%) in 728 patients. A significant myocardial contusion was found in 35 patients (5%; 95% CI, 3.4-6.6%) and may occur in the absence of chest trauma and without troponin I release. Sensitivity, specificity, and positive and negative predictive values of troponin I for the diagnosis of myocardial contusion were 63, 98, 40, and 98%, respectively. Troponin I release was observed in 54 early (> 48 h) survivors (7%; 95% CI, 5.6-9.6%) without preexisting coronary artery disease. A sustained and significant release of troponin I (17 patients) was frequently associated with chest trauma (82%) and constantly with electrocardiographic abnormalities. A coronary artery injury was found in 7 patients (2 major and 5 minor vascular injuries) (1% of the whole group; 95% CI, 0.4-2.0%). Mortality was similar in early survivors with (15%; 95% CI, 7-27%) or without (12%; 95% CI, 9-14%) troponin I release. The odds ratio for late mortality was 1.32 (95% CI, 0.61-2.85) in patients with troponin I release. Conclusions Serial electrocardiogram recordings and troponin I assessments may be proposed for initial screening in high-risk trauma patients to detect anatomical cardiac injuries through the time course of circulating protein. Troponin I release does not have a prognosis value in trauma patients.

Mild to Moderate to Severe: What Drives the Severity of ARDS in Trauma Patients?

2018 ◽  
Vol 84 (6) ◽  
pp. 808-812 ◽  
Author(s):  
Pamela Daher ◽  
Pedro G. Teixeira ◽  
Thomas B. Coopwood ◽  
Lawrence H. Brown ◽  
Sadia Ali ◽  
...  
Keyword(s):  
Risk Factors ◽  
Chest Trauma ◽  
Surgical Intensive Care Unit ◽  
Trauma Patients ◽  
Surgical Intensive Care ◽  
Total Blood ◽  
Factors Associated ◽  
Severity Of Disease ◽  
Chest Injuries ◽  
Independent Risk Factors

Acute respiratory distress syndrome (ARDS) is a complex inflammatory process with multifactorial etiologies. Risk factors for its development have been extensively studied, but factors associated with worsening severity of disease, as defined by the Berlin criteria, are poorly understood. A retrospective chart and trauma registry review identified trauma patients in our surgical intensive care unit who developed ARDS, defined according to the Berlin definition, between 2010 and 2015. The primary outcome was development of mild, moderate, or severe ARDS. A logistic regression model identified risk factors associated with developing ARDS and with worsening severity of disease. Of 2704 total patients, 432 (16%) developed ARDS. Of those, 100 (23%) were categorized as mild, 176 (41%) as moderate, and 156 (36%) as severe. Two thousand two hundred and seventy-two patients who did not develop ARDS served as controls. Male gender, blunt trauma, severe head and chest injuries, and red blood cell as well as total blood product transfusions are independent risk factors associated with ARDS. Worsening severity of disease is associated with severe chest trauma and volume of plasma transfusion. Novel findings in our study include the association between plasma transfusions and specifically severe chest trauma with worsening severity of ARDS in trauma patients.

scholarly journals Characterization of the microflora of ventilator-associated respiratory tract infections in patients with severe trauma

2015 ◽  
Vol 20 (1) ◽  
pp. 8-13
Author(s):  
O. A Orlova ◽  
V. G Akimkin
Keyword(s):  
Respiratory Tract ◽  
Respiratory Tract Infections ◽  
Respiratory Infections ◽  
Severe Trauma ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Microbial Associations ◽  
Initial Severity ◽  
Tract Infections

Rationale The relevance of ventilator-associated respiratory tract infections in severe injury patients (SIP) is associated with both features of causative pathogens and the initial severity of the state of patients. Among causative pathogens nosocomial flora is dominant. Purpose - to perform an analysis of the microbiological monitoring of ventilator-associated respiratory tract infections in SIP. The analysis was based on the results of a prospective epidemiological, clinical, and instrumental study of 100 SIP with ventilator-associated respiratory tract infections, stayed in the surgical intensive care unit. The proportion of ventilator-associated respiratory infections in the structure of nosocomial infections in these patients is between 90 - 95%, at that there was revealed the prevalence of nosocomial pneumonia (61%). Ventilator-associated respiratory tract infection most commonly occurs during the first 10 days of mechanical ventilation. The prevailing flora was represented by Gram negative Acinetobacter baumamnnii (40.3 ± 2.1%) and Pseudomonas aeruginosa (38.4% ± 3.2%). Isolated microorganisms possessed multiple antibiotic resistance, with the greatest extent to aminoglycosides - 69.5%, fluoroquinolones - 40.3%, penicillin - 37.6%; cephalosporins (third generation) - 33.8%. There is noted marked preponderance of microbial associations compared with monocultures 57.1 ± 5.3%.

Management of Pulseless and Apneic Trauma Patients: Are Aggressive Measures Justified?

2007 ◽  
Vol 73 (1) ◽  
pp. 62-66
Author(s):  
Chong-Jeh Lo ◽  
Wen-Ling Chang
Keyword(s):  
Cardiopulmonary Resuscitation ◽  
Emergency Room ◽  
Operating Room ◽  
Spontaneous Respiration ◽  
Surgical Intensive Care Unit ◽  
Trauma Patients ◽  
Surgical Intensive Care ◽  
Female Ratio ◽  
Surgical Exploration ◽  
Resuscitated Patients

This study prospectively examined the care of trauma patients in extremis on presentation to a tertiary medical center between January 2000 and August 31, 2002. There were 144 patients who presented without a pulse or spontaneous respiration and required cardiopulmonary resuscitation (mean age, 41.5 ± 2.3 years; male-to-female ratio, 105:39). Successfully resuscitated patients, who were either admitted to the surgical intensive care unit (SICU) or who were taken to the operating room for surgical exploration, had significantly shorter duration of cardiopulmonary resuscitation (14.55 ± 1.64 minutes vs. 33.32 ± 1.23 minutes; P < 0.001) and received less amounts of epinephrine than those who died in the emergency room ( P < 0.05). One hundred sixteen patients died in the emergency room. Nineteen admitted patients died within 24 hours of presentation. Nine patients survived beyond 24 hours and all of them were admitted directly to the SICU for the management of brain injury. Six patients were taken to the operating room for surgical exploration to control the bleeding; all of them died in the operating room or shortly thereafter in the SICU. No patient in this study survived to be discharged. The financial cost of successfully resuscitated patients was significantly higher than that of patients who died in the emergency room ( P < 0.001). Instead of insisting on aggressive measures to resuscitate trauma patients in extremis on presentation, the authors suggest we should redirect that fervor toward efforts made to promote trauma awareness and injury prevention programs.

Diurnal salivary cortisol measurement in the neurosurgical-surgical intensive care unit in critically ill acute trauma patients

2014 ◽  
Vol 21 (12) ◽  
pp. 2150-2154 ◽  
Author(s):  
Viktor Bartanusz ◽  
Michael G. Corneille ◽  
Salvador Sordo ◽  
Marianne Gildea ◽  
Joel E. Michalek ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Salivary Cortisol ◽  
Surgical Intensive Care Unit ◽  
Trauma Patients ◽  
Surgical Intensive Care ◽  
Acute Trauma

scholarly journals Progression of Fibrinogen Decrease during High Dose Tigecycline Therapy in Critically Ill Patients: A Retrospective Analysis

2021 ◽  
Vol 10 (20) ◽  
pp. 4702
Author(s):  
Benedikt Treml ◽  
Sasa Rajsic ◽  
Tobias Hell ◽  
Dietmar Fries ◽  
Mirjam Bachler
Keyword(s):  
Risk Factors ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Time Course ◽  
Surgical Intensive Care Unit ◽  
High Dose ◽  
Coagulation Disorder ◽  
Surgical Intensive Care ◽  
Intensive Care Patients

Tigecycline is a novel glycylcycline broad-spectrum antibiotic offering good coverage for critically ill patients experiencing complicated infections. A known side effect is a coagulation disorder with distinct hypofibrinogenemia. To date, the information on possible risk factors and outcomes is sparse. Therefore, the aim of this study is to examine the time course of fibrinogen level changes during tigecycline therapy in critically ill patients. Moreover, we sought to identify risk factors for coagulopathy and to report on clinically important outcomes. We retrospectively reviewed all intensive care patients admitted to our General and Surgical Intensive Care Unit receiving tigecycline between 2010 and 2018. A total of 130 patients were stratified into two groups based on the extent of fibrinogen decrease. Patients with a greater fibrinogen decrease received a higher dose, a longer treatment and more dose changes of tigecycline, respectively. In regard to the underlying pathology, these patients showed higher inflammation markers as well as a slightly reduced liver synthesis capacity. We, therefore, conclude that such a fibrinogen decrease may be based upon further impairment of liver synthesis during severe inflammatory states. To decrease the risk of bleeding, cautious monitoring of coagulation in critically ill patients treated with high-dose tigecycline is warranted.

Prophylactic Enoxaparin in Critically Ill Trauma Patients: Evaluation of the Initial Dose

2021 ◽  
pp. 001857872110673
Author(s):  
Kaitlyn J. Agedal ◽  
Elizabeth A. Feldman ◽  
Robert W. Seabury ◽  
William Darko ◽  
Luke A. Probst ◽  
...  
Keyword(s):  
Critically Ill ◽  
Patient Population ◽  
Trough Level ◽  
Statistical Tests ◽  
Coagulation Cascade ◽  
Surgical Intensive Care Unit ◽  
Trauma Patients ◽  
Surgical Intensive Care ◽  
Increased Risk ◽  
Trough Levels

Background: Trauma patients are at increased risk of developing venous thromboembolism given alterations in the coagulation cascade. Chemoprophylaxis with standard dosing of enoxaparin 30 mg subcutaneously twice daily has evolved to incorporate the use of anti-factor Xa (AFXa) trough level monitoring given concerns for decreased enoxaparin bioavailability in this patient population. Current available evidence suggests low rates of goal AFXa trough level achievement with standard enoxaparin dosing. Our study aims to identify the incidence of critically ill trauma patients that did not achieve goal AFXa trough levels and attempts to identify predictors that may influence the lack of achievement of goal levels. Methods: This was a retrospective, cohort analysis performed at a single academic medical center. Adult patients 18 years or older admitted to the surgical intensive care unit secondary to trauma who were initiated on standard prophylactic enoxaparin and had at least 1 AFXa trough level representative of steady state were included. Patient demographics and clinical data were collected, and descriptive statistics were utilized. All statistical tests were 2-tailed and a P < .05 was considered significant. Variables with a P < .10 on univariable analysis were included in a multivariable logistic regression analysis. Results: A majority of our patient population did not achieve goal AFXa trough levels while receiving standard doses of prophylactic enoxaparin (82.4% [108/131]). Sub-target AFXa levels were associated with higher creatinine clearance values. Positive predictors of obtaining target AFXa levels included automobile versus pedestrian mechanism of injury and requiring an enoxaparin dose escalation to at least 40 mg twice daily. Conclusions: Our study found low rates of achievement of goal AFXa trough levels in critically ill trauma patients receiving standard prophylactic enoxaparin dosing. Certain variables were identified as negative and positive predictors for achievement of goal AFXa trough levels, although the biologic plausibility of these predictors is questionable and requires further investigation.

Selective Serotonin Reuptake Inhibitor Therapy Reduces Time to Emergence and Arousal from TBI-induced Prolonged Coma: A Pilot Study

2020 ◽  
Author(s):  
Omar Danner K
Keyword(s):  
Minimally Conscious State ◽  
The United States ◽  
Selective Serotonin ◽  
Surgical Intensive Care Unit ◽  
Control Group ◽  
Trauma Patients ◽  
Surgical Intensive Care ◽  
Glascow Coma Scale ◽  
Severe Tbi ◽  
Prolonged Coma

Objective: Traumatic Brain Injury (TBI) continues to be a significant cause of death and disability in the United States and is commonly due to sudden, forceful impacts to the head. This may lead to disruption of neurological and neurochemical functioning of the brain, resulting in coma (Glascow Coma Scale score (GCS) ≤ 8). The objective of this study is to evaluate the potential effect of Selective Serotonin Re-uptake Inhibitors(SSRI), sertraline, on improvement in the level of consciousness and motor function in patients with prolonged, refractory coma after severe TBI. It has been theorized that the administration of SSRIs may shorten the time to emergence from comain trauma victims presenting with low GCS scores. Methods: The data from 14 trauma patients with severe TBI and Refractorycoma (RC) as defined by a GCS score <8 (coma) for >6 days admitted to the surgical intensive care unit (SICU) at a busy urban level 1 trauma center was retrospectively collected and screened. The patients were started on sertraline between 7 to 21 days after sustaining TBI-induced coma, principally based on attending judgment and preference, and were compared to a control group of similar TBI-induced prolonged coma patients admitted to the ICU during the study period who did not receive SSRI therapy. Results: In the study, 100% of the SSRI group became aroused to a GCS >8 and 66.7% (6/9) emerged to a minimally conscious state or regained consciousness based on a GCS scores >9 or 9T over a period of 11.9 days after initiation of therapy whereas 60% of control patients (3/5) emerged from coma. Conclusion: SSRI therapy using Sertraline may be associated with shorter time to emergence and improved reactiveness in patients with prolonged refractory coma states post-TBI.

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