Management of the Open Abdomen in Obese Trauma Patients

2015 ◽  
Vol 81 (11) ◽  
pp. 1134-1137 ◽  
Author(s):  
Matthew Johnston ◽  
Karen Safcsak ◽  
Michael L. Cheatham ◽  
Chadwick P. Smith
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Resource Utilization ◽  
Fascial Closure ◽  
Trauma Patients ◽  
Temporary Abdominal Closure ◽  
Group 4 ◽  
Trauma Population ◽  
Group 1

Obesity incidence in the trauma population is increasing. Abdominal compartment syndrome has poor outcomes when left untreated. Surgeons may treat obese patients differently because of concern for increased morbidity and mortality. We studied the effects of body mass index (BMI) on resource utilization and outcome. An Institutional Review Board-approved retrospective review of trauma patients requiring temporary abdominal closure (TAC) was performed. Patients were stratified as follows: Group 1-BMI = 18.5 to 24.9 kg/m2, Group 2-BMI = 25 to 29.9 kg/m2, Group 3-BMI = 30 to 39.9 kg/m2, Group 4-BMI ≥ 40 kg/m2. Demographic data, illness severity as defined by Injury Severity Score, Acute Physiology and Chronic Health Evaluation Score Version II and Simplified Acute Physiology Score Version II scores, resource utilization, fascial closure rate, and survival were collected. About 380 patients required TAC. Median age of Group 1 was significantly lower than Groups 2 and 3 ( P = 0.001). Severity of illness did not differ. Group 4 had a longer intensive care unit stay compared with Groups 1 and 2 ( P = 0.005). Group 4 required mechanical ventilation longer than Group 1 ( P = 0.027). Hospital stay, fascial closure, and survival were equivalent. Obese trauma patients with TAC have a longer intensive care unit stay and more ventilator days, but there is no difference in survival or type of closure. TAC can be used safely in trauma patients with a BMI ≥ 30 kg/m2.

Health-Related Quality of Life and Rehabilitation Cost Following Intensive Care Unit Stay in Multiple Trauma Patients

2014 ◽  
Vol 21 (3) ◽  
pp. 115-121 ◽  
Author(s):  
Pantelis Stergiannis ◽  
Theodoros Katsoulas ◽  
George Fildissis ◽  
George Intas ◽  
Peter Galanis ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Trauma Patients ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related ◽  
Multiple Trauma Patients

Outcome following prolonged intensive care unit stay in multiple trauma patients

1991 ◽  
Vol 19 (3) ◽  
pp. 339-345 ◽  
Author(s):  
WENDELL A. GOINS ◽  
H. NEAL REYNOLDS ◽  
DAVID NYANJOM ◽  
C. MICHAEL DUNHAM
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Multiple Trauma ◽  
Trauma Patients ◽  
Multiple Trauma Patients

A Central Venous Line Protocol Decreases Bloodstream Infections and Length of Stay in a Trauma Intensive Care Unit Population

2009 ◽  
Vol 75 (12) ◽  
pp. 1166-1170 ◽  
Author(s):  
TherÈSe M. Duane ◽  
Holly Brown ◽  
C. Todd Borchers ◽  
Luke G. Wolfe ◽  
Ajai K. Malhotra ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Length Of Stay ◽  
Bloodstream Infections ◽  
Central Venous Line ◽  
Trauma Patients ◽  
Central Venous ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

We evaluated the benefit of a central venous line (CVL) protocol on bloodstream infections (BSIs) and outcome in a trauma intensive care unit (ICU) population. We prospectively compared three groups: Group 1 (January 2003 to June 2004) preprotocol; Group 2 (July 2004 to June 2005) after the start of the protocol that included minimizing CVL use and strict universal precautions; and Group 3 (July 2005 to December 2006) after the addition of a line supply cart and nursing checklist. There were 1622 trauma patients admitted to the trauma ICU during the study period of whom 542 had a CVL. Group 3 had a higher Injury Severity Score (ISS) compared with both Groups 2 and 1 (28.3 ± 13.0 vs 23.5 ± 11.7 vs 22.8 ± 12.0, P = 0.0002) but had a lower BSI rate/1000 line days (Group 1:16.5; Group 2:15.0; Group 3: 7.7). Adjusting for ISS group, three had shorter ICU length of stay (LOS) compared with Group 1 (12.11 ± 1.46 vs 18.16 ± 1.51, P = 0.01). Logistic regression showed ISS ( P = 0.04; OR, 1.025; CI, 1.001-1.050) and a lack of CVL protocol ( P = 0.01; OR, 0.31; CI, 0.13-0.76) to be independent predictors of BSI. CVL protocols decrease both BSI and LOS in trauma patients. Strict enforcement by a nurse preserves the integrity of the protocol.

Decreasing maintenance fluids in normotensive trauma patients may reduce intensive care unit stay and ventilator days

2016 ◽  
Vol 31 (1) ◽  
pp. 201-205 ◽  
Author(s):  
Galinos Barmparas ◽  
Ara Ko ◽  
Megan Y. Harada ◽  
Andrea A. Zaw ◽  
Jason S. Murry ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Trauma Patients ◽  
Maintenance Fluids

Preferences and Predictions Regarding Palliative Care in the Trauma Intensive Care Unit

2021 ◽  
pp. 000313482110335
Author(s):  
Katherine M. Kelley ◽  
Daisy Proksch ◽  
Sasha White ◽  
Jay Collins ◽  
Michael Martyak ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Palliative Care ◽  
Intensive Care ◽  
End Of Life ◽  
Trauma Patients ◽  
Chi Square ◽  
Comfort Care ◽  
Exact Test ◽  
Trauma Population ◽  
Chi Square Analysis

Introduction In the older intensive care unit (ICU) trauma population, it is common to have to make decisions about end-of-life. We sought to demonstrate uncertainty of patients and providers in this area. Methods Our study is a prospective observational study of trauma patients 50 years and older admitted to the ICU. Patients or surrogates completed a survey including questions regarding end-of-life. Team members were surveyed with their expectation for patient outcome and appropriateness of palliative or comfort care. Patients were followed up for 6 months. Chi-square analysis and Fisher’s exact test were performed. Results 100 patients had data available for analysis. Surveys were completed by the patient for 39 while a surrogate completed the survey for 61 patients. There was a significant increase in uncertainty if a surrogate answered or if there had been no prior discussions about end-of-life. Nurse, resident, and attending predictions about hospital survival were similar with all groups predicting survival in 82%. 6-month survivors were only predicted to be alive 75% of the time. Ideas about comfort care were similar but there was more variation regarding a palliative care consult with nurses saying yes in 27% of surveys while physicians only said yes in 18%. Conclusions The significantly higher rates of uncertainty for both surrogates or in cases where no prior discussion had been had highlight the importance of having more conversations about end-of-life and documentation of advance directives prior to traumatic events. The difference in team member ideas about palliative care demonstrates a need for improved team communication.

Prehospital Prediction of Intensive Care Unit Stay and Mortality in Blunt Trauma Patients

2005 ◽  
Vol 59 (2) ◽  
pp. 456-463 ◽  
Author(s):  
Belinda J. Gabbe ◽  
Peter A. Cameron ◽  
Rory Wolfe ◽  
Pam Simpson ◽  
Karen L. Smith ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Blunt Trauma ◽  
Trauma Patients

Methicillin-Resistant Staphylococcus aureus in a Trauma Population: Does Decolonization Prevent Infection?

2017 ◽  
Vol 83 (12) ◽  
pp. 1407-1412
Author(s):  
Robert A. Maxwell ◽  
Chasen A. Croft ◽  
C. Buddy Creech ◽  
Isaac Thomsen ◽  
Nicole Soper ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Staphylococcus Aureus ◽  
Intensive Care ◽  
Resistance Genes ◽  
Methicillin Resistant Staphylococcus Aureus ◽  
Genetic Relatedness ◽  
Trauma Patients ◽  
Methicillin Resistant ◽  
Trauma Population ◽  
Nasal Swabs

The purpose of this study was to determine if a decolonization regimen reduces the frequency of methicillin-resistant Staphylococcus aureus (MRSA) infections and if colonization isolates are genetically related to subsequent infectious strains. Trauma patients admitted to the intensive care unit with positive MRSA nasal swabs were randomized to either daily chlorhexidine gluconate (CHG) baths and mupirocin (MUP) ointment to the nares or soap and water baths and placebo ointment for five days. Nasal swabs performed at the end of treatment and invasive MRSA infections during the remaining hospitalization were compared with the original nasal isolate via polymerase chain reaction for genetic relatedness as well as CHG and MUP resistance genes. Six hundred and seventy-eight intensive care unit admissions were screened, and 92 (13.6%) had positive (+) MRSA nasal swabs over a 22-month period ending in 3/2014. After the five day treatment period, there were 13 (59.1%) +MRSA second nasal swabs for CHG + MUP and 9 (90%) for soap and water baths and placebo, P = 0.114. No isolates tested positive for the MUP or CHG resistance genes mupA and qacA/B but 7 of 20 (35%) contained smr. There were seven (31.8%) MRSA infections in the CHG group and six (60%) for soap, P = 0.244. All 13 patients with MRSA infections had the same MRSA isolate present in the original nasal swab. There was no difference in all-cause Gram-negative or positive infections for CHG versus soap, 12 (54.5%) versus 7 (70%), P = 0.467. CHG + MUP are ineffective in eradicating MRSA from the anterior nares but may reduce the incidence of infection. Subsequent invasive MRSA infections are typically caused by the endogenous colonization strain.

Early prediction of length of intensive care unit stay from inflammatory mediators in trauma patients

2011 ◽  
Vol 26 (2) ◽  
pp. e5-e6 ◽  
Author(s):  
Cordelia Ziraldo ◽  
Ali Ghuma ◽  
Rajaie Namas ◽  
Juan Ochoa ◽  
Timothy R. Billiar ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Inflammatory Mediators ◽  
Trauma Patients ◽  
Early Prediction

scholarly journals Treatment with a Broad-Spectrum Cephalosporin versus Piperacillin-Tazobactam and the Risk for Isolation of Broad-Spectrum Cephalosporin-Resistant Enterobacter Species

2003 ◽  
Vol 47 (6) ◽  
pp. 1882-1886 ◽  
Author(s):  
Mitchell J. Schwaber ◽  
Camilla S. Graham ◽  
Bruce E. Sands ◽  
Howard S. Gold ◽  
Yehuda Carmeli
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Broad Spectrum ◽  
Multivariable Analysis ◽  
Treatment Groups ◽  
Increased Risk ◽  
Enterobacter Species ◽  
Treatment Onset ◽  
Group 1

ABSTRACT Receipt of a broad-spectrum cephalosporin is a strong risk factor for isolation of broad-spectrum cephalosporin-resistant Enterobacter species, and yet the risk from other broad-spectrum β-lactams hydrolyzed by group 1 β-lactamases has not been well characterized. We compared the risk conferred by broad-spectrum cephalosporins to that conferred by piperacillin-tazobactam, alone or in combination with an aminoglycoside or a fluoroquinolone. A retrospective cohort was monitored from treatment onset until a broad-spectrum cephalosporin-resistant Enterobacter strain was isolated or the patient was discharged. There were 447 patients in the piperacillin-tazobactam group and 2,341 patients in the broad-spectrum cephalosporin group. Groups were similar in age (mean, 62.5 years). The piperacillin-tazobactam group had a smaller percentage of men (32% versus 44%, P < 0.001) and a lower rate of intensive care unit stay (25% versus 38%, P < 0.001) but a higher rate of surgery (41% versus 26%, P < 0.001). Groups differed in the distribution of comorbidities. Resistant Enterobacter strains were isolated from 62 patients, 2% in each group (hazard ratio [RR] = 1.02 [P = 0.95]). In multivariable analysis, risk was similar among treatment groups (RR = 0.71 [P = 0.32]). Intensive care unit stay and surgery were associated with increased risk (RR = 4.53 [P < 0.001] and RR = 1.97 [P = 0.015], respectively), fluoroquinolones were protective (RR = 0.24 [P = 0.003]), and aminoglycosides did not affect risk (RR = 0.98 [P = 0.95]). The protective effect of fluoroquinolones against isolation of broad-spectrum cephalosporin-resistant Enterobacter spp. and the equivalence in risk associated with piperacillin-tazobactam and broad-spectrum cephalosporins may have important clinical and epidemiologic implications.

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