ABSTRACT
OBJECTIVE: To determine the predictive factors of nebulized morphine (nMOR) failure in patients with chest trauma. RESEARCH DESIGN AND METHODS: This was an interventional clinical study. Patients admitted with isolated chest trauma with a pain visual analog score > 4 were included. Each patient received 10 mg nMOR. If pain was still > 4 after 10 minutes of nebulization, the latter was repeated every 10 minutes until pain was relieved (i.e. ≤ 4). If pain was > 4 at 30 minutes, nMOR was considered a failure. Patients were divided into two groups: MOR (+) and MOR (-) (good response to and nMOR failure, respectively). RESULTS: Seventy-five patients were included. Analysis of the risk factors revealed that road traffic accidents (relative risk (RR): 0.117 [0.031-0.443]; p = 0.002), number of fractured ribs > 4 (RR: 0.317 [0.092-0.543]; p = 0.006), bilateral injury (RR: 0.114 [0.037-0.349]; p < 0.001), flail chest (RR: 0.120 [0.037-0.386]; p < 0.001), hemothorax (RR: 0.203 [0.062-0.660]; p = 0.008), pulmonary contusion (RR: 0.202 [0.069-0.589]; p = 0.003), and pain at admission > 7 (RR: 0.363 [0.147-0.579]; p = 0.004) were predictors of nMOR failure. CONCLUSION: Our results can help optimize the analgesic management of chest trauma patients by identifying the most eligible patients to benefit from nMOR. CLINICAL TRIAL REGISTRATION: www.clinicaltrials.gov identifier is NCT03580187.
Subject(s)
Morphine , Pain , Humans , Morphine/adverse effects , Pilot Projects , Prospective Studies , Pain/etiology , HospitalizationABSTRACT
Described as a potentially lethal condition that occurs in undernourished patients, refeeding syndrome (RFD) is a severe electrolyte disturbance that includes low intracellular serum concentrations of phosphor, magnesium and potassium in patients undergoing inappropriate oral or parenteral renutrition. We report a case of RFD in a 50-year-old male patient that occurs 22 days after a radical cystoprostatectomy. The patient was anorexic after the surgery, the body mass index decreased to 12,36 kg/m2. The concentrations of albumin, magnesium, phosphor, and calcium were low. The Patient was admitted into the intensive care unit for severe cachexia and poor general condition 24 after introduction of parenteral nutrition (1500 Kcal/day). The evolution was lethal with multiple organ failure.
Subject(s)
Chylous Ascites/complications , Peritonitis/etiology , Acute Disease , Child , Chylous Ascites/diagnosis , Humans , Male , Peritonitis/diagnosisABSTRACT
BACKGROUND: Mesh- based hernioplasties became the reference in inguinal hernia repair. AIM: To evaluate the results of combining a conic Plug to the Lichtenstein Mesh for inguinal hernia repair. METHODS: Between January 2007 and January 2009 we included 50 patients with primary or recurrent inguinal hernia in a prospective comparative randomized controlled trial. The randomization concerned the association of the conic Plug to the Lichtenstein Mesh. The primary objectives were to establish if any differences in operation time, postoperative pain response and/or postoperative recovery time, chronic pain and recurrence could be detected between the 2 groups. All patients were seen and data were collected after 2 weeks, 6 months and 2 years. RESULTS: Twenty two patients were treated by Lichtenstein Mesh (group A) and we associated the conic Plug to 28 patients (group B). The mean age was 56 years. Forty three patients were discharged after 24 hours. The postoperative pain was low with visual analogue scores ≤ 5 for 48 patients. One patient had residual pain treated efficiency with medical treatment. No recurrence in the 2 groups in 2 years outcome. There were no significant differences between the 2 groups. CONCLUSION: Results of the Lichtenstein plus Plug technique are similar to the Lichtenstein results. There were no significant differences between the 2 groups concerning early or late complications. The recurrence will be revaluated after 5 and 10 years outcome.
