Relationship between a High-inspired Oxygen Concentration and Dorsal Atelectasis in High-energy Trauma Patients.

We performed a retrospective cohort study of 911 high-energy trauma patients who underwent chest CT scans at least twice after admission. We hypothesized that in high-energy trauma patients, a high-inspired oxygen concentration delivered after admission results in dorsal atelectasis. The study's primary outcome was dorsal atelectasis formation diagnosed based on CT images. We defined dorsal atelectasis as the presence of atelectasis at ≥ 10 mm thick on CT images. We defined high-inspired oxygen concentration as >60% oxygen delivered between two CT scans. Four hundred sixty-five patients (51.0%) developed atelectasis according to the second CT scan, and 338 (37.1%) received a high-inspired oxygen concentration. A univariate analysis showed that the rate of the high-inspired oxygen concentration in the atelectasis group was significantly higher than that in the non-atelectasis group (43.4% vs. 30.1%, p<0.001). However, a logistic regression analysis showed that there was no significant relationship between the oxygen concentration and the formation of dorsal atelectasis (OR: 1.197, 95%CI: 0.852-1.683, p=0.30). Age, the Injury Severity Score, BMI, and smoking were found to be risk factors of dorsal atelectasis formation in high-energy trauma patients. There was no relationship between the oxygen concentration and atelectasis formation in our series of high-energy trauma patients.

The clinical relevance of plasma potassium abnormalities on admission in trauma patients: a retrospective observational study.

BACKGROUND: Abnormalities in potassium levels can lead to several clinical difficulties in trauma patients admitted to the ICU. However, the significance of potassium abnormalities soon after admission in trauma patients has not yet been clearly delineated. The objective of this study was to describe the plasma potassium abnormalities in trauma patients on admission and to examine the clinical outcomes associated with these abnormalities. METHODS: We performed a retrospective observational study of plasma potassium levels in trauma patients admitted to the Fukuyama City Hospital between January 1, 2010 and December 31, 2013. Five hundred twenty consecutive trauma patients were included and categorized into six groups according to their plasma potassium level on admission (<3.0, 3.0-<3.5, 3.5-<4.0, 4.0-<4.5, 4.5-<5.0, and ≥5.0 mEq/L). After adjusting for covariates, including age, gender, the Revised Trauma Score, and the Injury Severity Score, logistic regression analysis was used to examine the association between plasma potassium levels and outcomes, including life-saving interventions and in-hospital mortality. RESULTS: Two hundred twenty-seven patients (43.7 %) presented with hypokalemia (<3.5 mEq/L), while seven patients (1.3 %) presented with hyperkalemia (≥5.0 mEq/L). Patients in the lowest potassium group (<3.0 mEq/L, n = 36 [6.9 %]) were significantly associated with craniotomy (adjusted odds ratio 5.25 [95 % confidence interval 2.06-13.40]; p < 0.001) and showed an increased trend toward in-hospital mortality. In the second lowest potassium group (3.0-< 3.5 mEq/L, n = 191 [36.7 %]), the adjusted odds ratio for craniotomy was significantly higher (2.03 [95 % confidence interval 1.01-4.07]; p = 0.048) compared to the reference group. CONCLUSIONS: Trauma patients presenting with hypokalemia (<3.5 mEq/L) on admission may be associated with severe head trauma requiring life-saving craniotomy.

Hemodynamic effects of intravenous calcium administration on septic shock patients: a retrospective study.

We evaluated the hemodynamics and outcomes of septic shock (SS) patients who did not respond to fluid resuscitation, after treatment with or without intravenous calcium. We retrospectively collected information on 154 eligible SS patients who were admitted to Fukuyama City Hospital Emergency Medical Center and did not respond to fluid resuscitation. To compare their degree of hemodynamic impairment, we compared the changes in the vasoactive-inotropic score (VIS) in the calcium-treated group (n＝112) and the noncalcium-treated group (n＝42). We compared the length of stay in the intensive care unit (ICU) and hospital, in-hospital deaths, 28-day deaths, and changes in the Sequential Organ Failure Assessment score within 72h of ICU admission between the 2 groups. Changes in the VIS at 1h after the baseline time were significantly greater in the calcium-treated group than in the noncalcium-treated group (1.41 vs. －1.25, respectively;p＜0.001). However, the changes in the VIS at 3, 6, 24, 48, and 72h did not differ between the 2 groups. The secondary outcomes also did not differ between the groups. Our findings indicate that calcium administered to SS patients might reduce their hemodynamic stabilization, but only for a short time after its administration.

Computed tomography fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures.

OBJECTIVE: The purpose of this study was to evaluate retrospectively the safety and effectiveness of the computed tomography (CT) fluoroscopy-guided placement of iliosacral screws in patients with unstable posterior pelvic fractures. MATERIALS AND METHODS: Six patients (four women and two men; mean age 55.8 years; range 35-77 years) with unstable posterior pelvic fractures underwent iliosacral screw placement under CT fluoroscopy guidance between November 2007 and August 2008. Unstable pelvic ring injury (AO types B and C) was the indication for this procedure. RESULTS: In all the six patients except one, CT fluoroscopy-guided placement had been technically successful. In one patient, a second screw had been inserted, with a tilt to the caudal site, and slightly advanced into the extrasacral body; afterward, it could be exchanged safely for a shorter screw. Five patients and one patient underwent placement of two screws and one screw, respectively. The mean duration of the procedure was 15.0 min (range 9-30 min) per screw; the duration was 12.3 min and 18.2 min for the first and second screws, respectively. No complications requiring treatment occurred during or after the procedure. The mean clinical and radiologic follow-up period was 14 months (range 6-21 months). All pelvic injuries had healed satisfactorily, without complication, and all patients are now doing well clinically and can walk. CONCLUSION: CT fluoroscopy-guided placement of iliosacral screws is a safe and effective treatment in patients with unstable posterior pelvic fractures.