Percutaneous dilatational tracheostomy for ICU patients with severe brain injury / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To sum up our experience in percutaneous dilatational tracheostomy (PDT) in ICU patient with severe brain injury.</p><p><b>METHODS</b>Between November 2011 and April 2014, PDTs were performed on 32 severe brain injury patients in ICU by a team of physicians and intensivists. The success rate, efficacy, safety, and complications including stomal infection and bleeding, paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, as well as clinically significant tracheal stenosis were carefully monitored and recorded respectively.</p><p><b>RESULTS</b>The operations took 4-15 minutes (mean 9.1 minutes ± 4.2 minutes). Totally 4 cases suffered from complications in the operations: 3 cases of stomal bleeding, and 1 case of intratracheal bloody secretion, but none required intervention. Paratracheal insertion, pneumothorax, pneumomediastinum, tracheal laceration, or clinically significant tracheal stenosis were not found in PDT patients. There was no procedure-related death occurring during or after PDT.</p><p><b>CONCLUSION</b>Our study demonstrats that PDT is a safe, highly effective, and minimally invasive procedure. The appropriate sedation and airway management perioperatively help to reduce complication rates. PDT should be performed or supervised by a team of physicians with extensive experience in this procedure, and also an intensivist with experience in difficult airway management.</p>

Euthyroid sick syndrome in trauma patients with severe inflammatory response syndrome / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the alternations of thyroid hormone in traumatic patients with severe inflammatory response syndrome (SIRS).</p><p><b>METHODS</b>Fifty traumatic patients with severe SIRS were enrolled and divided into two groups according to whether they presented multiorgan dysfunction syndrome (MODS). Thyroid hormone measurements were taken, including total triiodothyronine (TT3), total thyroxine (TT4), free triiodothyronine (FT3), free thyroxine (FT4) and thyroid stimulating hormone (TSH). The acute physiology and chronic health evaluation II (APACHE II) score was calculated according to clinical data. The outcomes of recovery or deterioration were recorded, as well as the length of time from the onset of SIRS to the time thyroid hormones were measured.</p><p><b>RESULTS</b>Euthyroid sick syndrome (ESS) was presented in 45 cases. TT3 level was negatively correlated with APACHE II score (r = -0.330, P<0.05), and TT3/TT4 value was negatively correlated with the duration of SIRS( r = -0.316, P<0.05). TT3, TT4 and FT3 levels in MODS patients were significantly lower than those without MODS (P<0.05). MODS patients got low TT4 or FT4 level more frequently than those without MODS (P<0.05). Compared with the patients in normal TSH group, the patients with decreased TSH had lower T3, T4, recovery rate and higher APACHE II scores, MODS incidence, but there was no difference between two groups (P>0.05).</p><p><b>CONCLUSIONS</b>Trauma patients with severe SIRS have high possibility to get ESS, which occurs more frequently and severely in MODS patients. It shows the influences of SIRS on the thyroid axes. With the persistence and aggravation of SIRS, there is a progressive reduction of thyroid hormone.</p>

ICU management of patients with suspected positive findings of diagnostic peritoneal lavage following blunt abdominal trauma / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To explore the management for blunt abdominal trauma victims with probable positive diagnostic peritoneal lavage (DPL) findings.</p><p><b>METHODS</b>Data of 76 patients with probable positive DPL findings accepted to ICU in previous 10 years were reviewed. After admission, the patients were evaluated in a settled time according to the protocols of Advanced Trauma Life Support (ATLS). Vital signs were continuously monitored and DPL, ultrasound and/or CT scan were repeated when necessary.</p><p><b>RESULTS</b>Eighteen (24%) of 76 patients presented positive DPL findings after repeated DPL. Surgical findings confirmed 7 cases of spleen rupture, 3 hepatorrhexis (infra-Glisson capsule), 4 intestinal perforation, 2 gastric perforation, 1 colon perforation and 1 injured mesentery.</p><p><b>CONCLUSIONS</b>Patients with probable positive DPL findings were admitted to ICU with vital signs continuously monitored. Repeated DPL with supplemental ultrasound and/or CT scan can work together to increase the sensitivity and accuracy of the diagnosis, reduce the rate of exploratory laparotomy, ensure patients' safety and provide a reliable basis for therapeutic operations.</p>

Spontaneous diuresis and negative fluid balance predicting recovery and survival in patients with trauma-hemorragic shock / 中华创伤杂志(英文版)

Most patients with trauma-hemorragic shock, prior to ICU admission, have been resuscitated and stabilized in the emergency room (ER) and/or operation room (OR). Many of them suffer from systemic edema. This extra-vascular fluid is caused by massive infusion of fluid and blood for the maintenance of blood pressure. During the recovery stage, the patients exhibit spontaneous diuresis followed by negative fluid balance. Urine volumes of some patients are more than 10000 ml/d. Do we need to maintain a balance between daily input and output of water at this situation? There are many references in the medical literature and textbooks about fluid resuscitation and the principles in maintaining the balance between input and output of water, but rarely about when and how to restrict it, that is, when and how to permit a negative balance. In this retrospective review, we examined the resuscitation records of 205 patients with systemic edema after trauma-hemorragic shock.