Document Detail


Low incidence of multiple organ failure after major trauma.
MedLine Citation:
PMID:  17572416     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: In major trauma patients, multiple organ failure (MOF) is considered a leading cause of death. Acute lung injury is deemed a "pacemaker" of MOF. The purpose of this study was to determine if incidence of organ failure and mortality in multiple trauma patients can be reduced by implementation of lung-protective strategies. METHODS: All critically ill multiple trauma patients admitted to the ICU of a major trauma center in Berlin, Germany from January 1999 to December 2002 were analyzed retrospectively. Patients were ventilated pressure controlled with low tidal volumes and adequate PEEP. RESULTS: n=287 patients were included. The most frequent injuries were traumatic brain injury (TBI-68%), chest trauma (68%), and lung contusions (55%). Injury severity score (ISS) was 32+/-19 (mean+/-standard deviation), polytraumaschluessel (PTS) 34+/-19, and APACHE II 14+/-7. During their ICU-stay 16 patients died, 9 (56%) from TBI. Single-organ-failure occurred in n=69 patients (24%, mortality 5%), two-organ-failure in n=22 (8%, mortality 14%), and MOF in n=9 (3%, mortality 13%); one patient died from MOF 14 days after trauma. The number of days on mechanical ventilation increased depending on the number of organs failed (R=0.618, p<0.001). Seven patients (2%) fulfilled ARDS criteria for longer than 24h despite optimized ventilatory settings, one died of irreversible shock. Patients with MOF had a significantly increased ICU-LOS (35+/-15 days) compared to patients without organ failure (11+/-11 days; p<0.001). CONCLUSION: The low incidence of MOF in our series of trauma patients suggests that MOF may be prevented in some patients by implementation of lung-protective strategies. The improved outcome was associated with an increased ICU-LOS.
Authors:
Sven Laudi; Bernd Donaubauer; Thilo Busch; Thoralf Kerner; Sven Bercker; Hermann Bail; Aarne Feldheiser; Norbert Haas; Udo Kaisers
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Publication Detail:
Type:  Journal Article     Date:  2007-06-18
Journal Detail:
Title:  Injury     Volume:  38     ISSN:  0020-1383     ISO Abbreviation:  Injury     Publication Date:  2007 Sep 
Date Detail:
Created Date:  2007-08-24     Completed Date:  2008-03-03     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0226040     Medline TA:  Injury     Country:  Netherlands    
Other Details:
Languages:  eng     Pagination:  1052-8     Citation Subset:  IM    
Affiliation:
Department of Anesthesiology and Intensive Care Medicine, University of Leipzig Medical Faculty, 04103 Leipzig, Germany.
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Female
Humans
Injury Severity Score
Male
Middle Aged
Multiple Organ Failure / mortality*,  prevention & control,  therapy
Multiple Trauma / mortality*,  prevention & control,  therapy
Positive-Pressure Respiration / methods
Respiration, Artificial / methods*
Retrospective Studies
Trauma Centers

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