Occult Hypoperfusion Is Associated with Increased Morbidity in Patients Undergoing Early Femur Fracture Fixation

Crowl, Adam C.; Young, Jeffrey S.; Kahler, David M.; Claridge, Jeffrey A.; Chrzanowski, David S.; Pomphrey, Michelle

doi:10.1097/00005373-200002000-00011

Cited by 125 publications

(66 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Its prognostic value in hemorrhagic shock was established in terms of identifying the risk of death as well as in predicting infectious complications and multiorgan failure [61,62]. Several authors have shown that the early clearance of the lactic acidosis correlates with a better chance of survival.…”

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

View full text Add to dashboard Cite

Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year. It has been calculated by the World Health Organization that in 2002 there occurred 1.6 million violent deaths [1] and 1.2 million deaths from traffic injury [2], for a combined mortality of 48 deaths per 100,000 population per year.Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals [3]. These deaths could be prevented by optimization of trauma care. Preventability of trauma deaths has been reported as high as 76% [4] and as low as 1% in mature trauma systems [5,6].Prehospitalization procedures, elapsed time to hospital arrival are, of course, vital to the whole trauma scenario, but errors made in the in-hospital phase of care are responsible for one third to two thirds of the reported by different authors [7,8]. Of these, intensive care unit (ICU) errors are among the most frequent and significant. Errors in the ICU management of trauma patients were studied by Duke and colleagues [9]. They reported 165 ICU trauma deaths. Two hundred fifty-eight errors occurred in 81 patients (52%), and 134 of them contributed to death in 52 patients (34%). ICU errors were classified as management errors (82%), diagnostic (9%), technique (5%), and system inadequacies (4%). Davis and colleagues [10] identified critical care errors in 30% of 125 trauma deaths with errors. These errors contributed to 48% of all preventable deaths.The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions [9,10].It is imperative for the general surgeon who takes care of trauma patients to know how to deal with these critical aspects, to reduce preventable morbidity and mortality. In the next segment, the situations in which the participation of the surgeon is crucial, during the initial phases of reanimation and stabilization of the critically traumatized patient will be discussed. Airway and ventilation managementAirway and respiratory management errors are the most common of those identified by several authors [9][10][11] The cardinal manifestation is a sudden or a rapidly progressing desaturation, frequently accompanied by tachycardia and arrhytmias, and occasionally by agitation. Hypertension announces the cardiovascular collapse, and bradicardia appears immediately after the total collapse [12]. The symptoms should not be attributed to agitation when it is present, and other possible causes must be ruled out before. Diagnosing the complication involves a directed physical examination, the analysis of the airway pressures and ventilator volumes, chest radiographs, and sometimes the measurement of arterial blood gases (ABG), and the urinary bladder pressure ( Table 1).The emergency conditions in which the access to the airways must be gained, the displacement to diagnosis areas or operating room and the agitation, often present, make the critical...

show abstract

Section: Nih-pa Author Manuscriptmentioning

confidence: 99%

Critical Care Issues in the Early Management of Severe Trauma

García

2006

Surgical Clinics of North America

View full text Add to dashboard Cite

show abstract

“…Several observational studies [1][2][3][4][5][6][7][8] and one randomized study 9 have suggested that early stabilization of major long-bone fracturesthose of the shaft of the femur being most common-is associated with clinical benefits in terms of reducing the incidence of pulmonary complications and mortality. Other studies have suggested that internal fixation of long-bone fractures, either with intramedullary nailing or plate osteosynthesis, may have potentially deleterious effects in the acute setting, when systemic hypoperfusion 10 and inflammation [11][12][13] may increase susceptibility to end-organ injury and increase morbidity. A meta-analysis 14 demonstrated a large relative risk reduction (relative risk, 0.30; 95% confidence interval, 0.22 to 0.40) in respiratory complications in association with early operative fixation (usually within twenty-four hours), whereas two systematic reviews 15,16 demonstrated no difference in morbidity or mortality between early operative treatment (usually at less than twenty-four hours) and late operative treatment of femoral shaft fractures, either overall or within subgroups of patients with associated head injuries or thoracic injuries.…”

mentioning

confidence: 99%

Delayed Internal Fixation of Femoral Shaft Fracture Reduces Mortality Among Patients with Multisystem Trauma

Morshed

Miclau

Bembom

et al. 2009

The Journal of Bone and Joint Surgery-American Volume

129

View full text Add to dashboard Cite

“…This form of extreme physiological instability is comparatively rare after musculoskeletal trauma. A larger proportion of patients, however, may have clinically occult tissue hypoxia or hypoperfusion, despite an apparently successful initial resuscitation, 89,90 as has been increasingly recognised with the use of more invasive forms of monitoring. Many of these patients also have evidence of SIRS and concerns have been raised about the safety of early reamed nailing because the procedure may act as a secondary 'hit', which may trigger the development of ARDS.…”

Section: 84-86mentioning

confidence: 99%

“…Many of these patients also have evidence of SIRS and concerns have been raised about the safety of early reamed nailing because the procedure may act as a secondary 'hit', which may trigger the development of ARDS. 9,19,20,89 Modifications to the basic protocol of early reamed nailing have been examined including the use of temporary external fixation until the inflammatory response has settled or resuscitation is complete, 88,91 the employment of different methods of fixation such as unreamed nails 78,92,93 or compression plates, 94,95 or of techniques designed to reduce fat embolisation during reamed nailing including venting, 96 lavage of the medullary canal 86 or an altered design of reamer.…”

Section: 84-86mentioning

confidence: 99%

“…31,[98][99][100][101] There is some evidence to suggest that patients who have been incompletely resuscitated have a higher incidence of pulmonary complications when the operation is carried out early, 89,102 although it is possible that such patients have a greater initial severity of injury, which is responsible for their poor prognosis. 103 If delayed fixation is used, it is still not clear how long the delay should be, since reliable laboratory markers of the inflammation or occult tissue hypoperfusion are not generally available.…”

Section: 84-86mentioning

confidence: 99%

See 1 more Smart Citation