Energy expenditure and severity of injury and illness indices in multiple trauma patients.

OBJECTIVE: To determine whether the energy expenditure of mechanically ventilated multiple trauma patients correlates with the severity of injury and illness indices before important systemic infection has complicated the clinical course, and to compare the energy expenditure with the energy expenditure expected from the Harris-Benedict equation adjusted with correction factors for trauma. DESIGN: Prospective, clinical study. SETTING: General intensive care unit of a university teaching hospital. PATIENTS: Immediate multiple trauma adult patients who required mechanical ventilation. INTERVENTIONS: Metabolic cart connected to the ventilator. MEASUREMENTS AND MAIN RESULTS: Data on admission to the emergency department and during the first 24 hrs of intensive care unit admission were collected for computation of severity of injury and illness indices, respectively. Resting and total energy expenditures were derived at least 48 hrs after intensive care unit admission by continuous indirect calorimetry. Predicted basal energy expenditure was obtained using the Harris-Benedict equation and predicted total energy expenditure was calculated using the Harris-Benedict value adjusted with correction factors for trauma. Twenty-six multiple trauma adult patients completed the study. No statistically significant correlations were observed between both the resting energy expenditure and the total energy expenditure and the Injury Severity Score, Revised Trauma Score, Simplified Acute Physiologic Score II, Acute Physiology and Chronic Health Evaluation II score, and Glasgow Coma Scale score. A regression model of total energy expenditure was developed with the following variables: Harris-Benedict equation, heart rate, and minute ventilation (p = .01; r2 = .74). The resting energy expenditure/predicted basal energy expenditure ratio was 1.17+/-0.2 and the total energy expenditure/predicted total energy expenditure ratio was 0.76+/-0.1. CONCLUSIONS: In mechanically ventilated multiple trauma patients the energy expenditure is not correlated to the severity of injury and illness indices but is dependent on the Harris-Benedict equation in addition to heart rate and minute ventilation. Furthermore, this patient population is characterized by a moderate state of hypermetabolism, and the Harris-Benedict prediction modified with correction factors for trauma systematically overestimates the total energy expenditure.

[Hemodynamic and hydroelectrolytic problems in the care of potential multiorgan donors]. / Problemi emodinamici ed idroelettrolitici nel mantenimento del potenziale donatore multiorgano.

Brain death condition involves haemodynamic and hydroelectrolytic unbalances which can lead to organ malfunction and perfusion impairment making their harvest for transplant not possible. Fluid infusion, based on an adequate haemodynamic and hydroelectrolytic monitoring, can restore imbalances enabling organ harvest. Authors here report their own experience in treating 30 multiorgan donors during 12 hours before organs harvest; the fluidotherapy they performed and the need of basing either the quantity and the sort of the infused liquids on a close monitoring are discussed.

[Accidental introduction of a naso-gastric tube into the cranial cavity in a patient with non-severe cranial and facial trauma]. / Accidentale introduzione di una sonda naso-gastrica in cavità cranica di un paziente colpito da trauma cranico e facciale di non grave entità.

The authors report the accidental insertion of a nose-gastric tube inside the brain-pan of a patient affected by a cranic-facial trauma. The wrong tubes positioning was performed at the Emergency Department of the authors' hospital; it was discovered a few minutes later when a cranic CT scan had been performed. In the meantime an important neurologic syndrome developed. The poor objective evidence of the injury, which, even though causing not very evident physical damage to the patient's face, produced a communication between the patient's nose-pharynx and brain-pan, made the case worth reporting. The aim of this report is to remember and to stress how in every case of craniofacial injury, although if of poor evidence, the insertion of a naso-gastric tube is exposed to its dislocation to the brain-pan. The tube positioning must then be performed only after a cranic CT scan showed no disruption of the anatomic structures dividing the nose-pharynx by the brain-pan. The simple skull X-ray is not sufficient.

[Evaluation of bacterial resistance to pefloxacine after prolonged use in resuscitation]. / Valutazione della comparsa di resistenza batterica alla pefloxacina dopo uso prolungato in rianimazione.

In an overall of the value of an antibiotic it is important to take into account the onset of bacterial resistance in addition to its immediate clinical effects since the former can render an otherwise efficacious antibiotic obsolete within a short space of time. We studied two groups of intubated patients with pneumonia infections during two different periods in 1990: January-June and October-December; each patient was treated with pefloxacin 400 mg twice a day i.v. for 6 days on the basis of an antibiogram carried out on tracheobronchial secretion; at the end of that period patients were clinically evaluated and a second bacteriological test was performed. It was found that the percentage of pefloxacin-resistant bacterial strains did not increase significantly after this antibiotic had been used for a year for pneumonia infections (from 27.5% to 33%). The appearance of bacterial resistance at the six-day treatment cycle was similar in both groups (19% and 22%). Of all the bacterial strains, Pseudomonas aeruginosa showed the greatest tendency to become resistant.