| 1. |
- Westman, Anton, et al.
(författare)
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Letters to the editor
- 2005
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Ingår i: Journal of Trauma. - Philadelphia : Lippincott Williams & Wilkins. - 0022-5282 .- 1529-8809. ; 69:2, s. 403-405
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Abu-Zidan, FM, et al.
(författare)
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Establishment of a teaching animal model for sonographic diagnosis of trauma
- 2004
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 56:1, s. 99-104
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Tidskriftsartikel (refereegranskat)abstract
- Background: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intraabdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Methods: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. Results: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. Conclusion: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.
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| 3. |
- Bak, Zoltan, et al.
(författare)
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Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula
- 2009
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 66:2, s. 329-336
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Parkland formula (2-4 mL/kg/burned area of total body surface area %) with urine output and mean arterial pressure (MAP) as endpoints; for the fluid resuscitation in burns is recommended all over the world. There has recently been a discussion on whether central circulatory endpoints should be used instead, and also whether volumes of fluid should be larger. Despite this, there are few central hemodynamic data available in the literature about the results when the formula is used correctly.Methods: Ten burned patients, admitted to our unit early, and with a burned area of >20% of total body sur-face area were investigated at 12, 24, and 36 hours after injury. Using transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution to monitor them, we evaluated the cardiovascular coupling when urinary output and MAP were used as endpoints.Results: Oxygen transport variables, heart rate, MAP, and left ventricular fractional area, did not change significantly during fluid resuscitation. Left ventricular end-systolic and end-diastolic area and global end-diastolic volume index increased from subnormal values at 12 hours to normal ranges at 24 hours after the burn. Extravascular lung intrathoracal blood volume ratio was increased 12 hours after the burn.Conclusions: Preload variables, global systolic function, and oxygen transport recorded simultaneously by three separate methods showed no need to increase the total fluid volume within 36 hours of a major burn. Early (12 hours) signs of central circulatory hypovolemia, however, support more rapid infusion of fluid at the beginning of treatment.
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| 4. |
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| 5. |
- Drobin, Dan, et al.
(författare)
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Tranexamic acid does not prevent rebleeding in an uncontrolled hemorrhage porcine model
- 2005
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Ingår i: Journal of Trauma. - : Lippincott Williams & Wilkins. - 0022-5282 .- 1529-8809. ; 59:4, s. 976-983
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Fluid resuscitation after uncontrolled hemorrhage might promote rebleeding and irreversible shock. Tranexamic acid is a procoagulant drug that limits blood loss after surgery of the hip, knee, and heart. We hypothesized that pretreatment with tranexamic acid reduces the rebleeding in uncontrolled hemorrhage and thereby allows safe administration of crystalloid fluid resuscitation.METHODS: A 120-minute intravenous infusion of 100 mL/kg of Ringer's solution was given to 24 pigs (mean weight, 20 kg) 10 minutes after lacerating the infrarenal aorta. The animals were randomized to receive an intravenous injection of 15 mg/kg of tranexamic acid or placebo just before starting the resuscitation. Rebleeding events were monitored by two ultrasonic probes positioned proximal and distal to the laceration.RESULTS: Tranexamic acid had no effect on the number of rebleeding events, bled volume, or mortality. The initial bleeding stopped within 4 minutes after the injury. The five animals that died suffered from 4.4 rebleeding events on average, which tripled the total blood loss, whereas the survivors had only 1.3 such events during fluid resuscitation (p < 0.02). At autopsy, death was associated with a larger total hemorrhage; the blood recovered from the abdomen weighed 1.4 kg (median) in nonsurvivors and 0.6 kg in survivors (p < 0.001), with the difference being attributable to rebleeding.CONCLUSION: Rebleeding events increased the amount of blood lost and the mortality in uncontrolled aortic hemorrhage. Tranexamic acid offered no benefit.
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| 6. |
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| 7. |
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| 8. |
- Metcalf, Kerstin, et al.
(författare)
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Nitric oxide does not cause extravasation in endotoxemic rats
- 2005
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Ingår i: Journal of Trauma. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5282 .- 1529-8809. ; 58:5, s. 1047-1054
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Tidskriftsartikel (refereegranskat)abstract
- Background: Nitric oxide (NO) formed from inducible NO synthase (iNOS) is assumed to promote vascular permeability in sepsis and endotoxemia.Methods: Thirty-seven anesthetized rats were examined for the effects of endotoxin. After randomization, 17 animals had lipopolysaccharide (LPS) administered and 20 rats served as controls and were given the corresponding volume of saline. The observation period was 5 hours after administration of endotoxin. Mean arterial blood pressure, heart rate, and hematocrit were recorded in all animals, and transcapillary exchange of albumin, tissue water content, immunohistochemistry for nitric oxide synthase, and blood gases were investigated in subsets of animals.Results: When anesthetized rats were studied for 5 hours after endotoxin (LPS), the sequestration of albumin decreased in the intestine (double-isotope method) and there was no increased water content (freeze-drying technique) when the elevated tissue plasma volume of the LPS-treated rats was corrected for. Immunohistochemical methods showed a similar distribution and intensity of staining for endothelial NOS and neuronal NOS in LPS and control groups. In the lung of the LPS-treated rats, there was a significantly larger number of infiltrating, inflammatory cells staining for iNOS. There was no iNOS demonstrated in vascular structures or heart.Conclusion: At 5 hours after LPS, there was no increased loss of water or albumin from the circulation. This challenges the notion that NO causes vascular damage in endotoxemia and extravasation as an obligatory sequela to endotoxemia.
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| 9. |
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| 10. |
- Nygren de Boussard, Catharina, et al.
(författare)
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Delayed Intracranial Complications After Concussion
- 2006
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Ingår i: Journal of Trauma. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5282 .- 1529-8809. ; 61:3, s. 577-581
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Tidskriftsartikel (refereegranskat)abstract
- Background and Methods: The incidence of readmissions because of delayed intracranial complications within 3 weeks after observation for the sole diagnosis of concussion was examined in a national cohort. A nested case-control design was used to analyze the association between clinical factors as well as early computed tomography (CT) scan examination and these complications. Results: Out of 100,784 patients hospitalized because of concussion during ten years, 127 (0.13%) patients were readmitted because of a delayed intracranial complication. High clinical severity grade (odds ratio [OR] 2.0, confidence interval [CI] 1.2-3.6), minor CT scan abnormalities (OR 1.7, CI 0.8-3.4) and male gender (OR 2.2, CI 1.4-3.5) were associated with an increased risk of delayed, intracranial complications. Conclusion: The incidence of delayed intracranial complications after primarily uncomplicated concussion was low. High clinical severity grade and male gender were risk factors. We failed to demonstrate an additional value of the acute CT scan examination to predict these complications.
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| 11. |
- Olofsson, Pia, 1962-, et al.
(författare)
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The effects of early rapid control of multiple bowel perforations after high-energy trauma to the abdomen : implications for damage control surgery
- 2006
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Ingår i: Journal of Trauma. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5282 .- 1529-8809. ; 61:1, s. 185-191
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study evaluates the effects of early rapid control of multiple bowel perforations on cardiovascular and pulmonary function in high-energy traumatic shock compared with conventional small bowel resection anastomosis. METHODS: Fifteen anesthetized pigs, 10 to 12 weeks old, were exposed to a reproducible high-energy trauma and were divided into two groups. In the first group, the resection anastomosis group (RA, n = 8), small-bowel injuries were treated with resection and anastomosis; in the second group, the multiple bowel ligation group (BL, n = 7), small-bowel injuries were treated by resection and ligation. Repeated measurement analysis of variance was used to study the within group change overtime, the between group difference, and the interaction between them. Mean outcome measures were intravascular pressures, cardiac output, vascular resistance, lactic acid, and blood gases. RESULTS: The high-energy injuries caused traumatic shock in both groups with reduced cardiac output (p < 0.001) and lactic acidemia (p < 0.001). The BL group had a trend for higher cardiac output (p = 0.06). The rise in systemic and pulmonary vascular resistance was significantly reduced in the BL group compared with the RA group (p < 0.05). The BL group had a strong trend for higher oxygen extraction ratio (p = 0.06). There was a trend for less oxygen consumption in the BL group (p = 0.07). There was no difference in the lactic acidemia between the two groups. CONCLUSIONS: Early rapid control of multiple bowel perforations after high-energy trauma resulted in less impairment of cardiovascular function than conventional resection anastomosis of the bowel.
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| 12. |
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| 13. |
- Robinson, Yohan, 1977, et al.
(författare)
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Erythropoiesis in multiply injured patients.
- 2006
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Ingår i: The Journal of trauma. - : Ovid Technologies (Wolters Kluwer Health). - 0022-5282 .- 1529-8809. ; 61:5, s. 1285-91
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Forskningsöversikt (refereegranskat)abstract
- Posttraumatic anemia in multiply injured patients is caused by hemorrhage, reduced red blood cell survival, and impaired erythropoiesis. Trauma-induced hyperinflammation causes impaired bone-marrow function by means of blunted erythropoietin (EPO) response, reduced iron availability, suppression and egress of erythroid progenitor cells. To treat posttraumatic anemia in severely injured patients, symptomatic therapy by blood transfusion is not sufficient. Furthermore, EPO, iron, and the use of red cell substitutes should be considered. The posttraumatic systemic inflammatory response syndrome (SIRS) induces posttraumatic anemia. Thus, a worsening of SIRS by a "second-hit" through blood transfusion ought to be avoided.
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| 14. |
- Sluys, Kerstin, 1956-, et al.
(författare)
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Outcome and quality of life 5 years after major trauma
- 2005
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Ingår i: Journal of Trauma. - Baltimore : Lippincott Williams & Wilkins. - 0022-5282 .- 1529-8809. ; 59:1, s. 223-232
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This study aimed to determine quality of life after injury and identify factors potentially associated with outcome.METHODS: Five years after injury from blunt or penetrating trauma, patients received a questionnaire based on the SF-36 Health Survey.RESULTS: Two hundred five patients (83%) replied. Most were men, median age 39 years, 93% injured by blunt energy, median Injury Severity Score 14 (range 9-57). Mean SF-36 scores were significantly lower than in a matched reference group. Poor outcome was associated with: in-hospital days, intensive care days, surgical procedures, in-hospital major complications, age, recurrent injury, and inadequate information. Subjects reported considerable physical (68%) and psychologic (41%) disabilities. Near half reported need of improved follow-up care. Injury severity did not predict poor health-related quality of life 5 years later.CONCLUSION: Adequate information, sufficient pain management and follow-up by trauma specialist teams are needed. Certain factors can help identify patients in need of additional help and support.
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| 15. |
- Sonden, A, et al.
(författare)
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Trauma attenuating backing improves protection against behind armor blunt trauma
- 2009
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 67:6, s. 1191-1199
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Tidskriftsartikel (refereegranskat)abstract
- Background: Body armor is used by military personnel, police officers, and security guards to protect them from fatal gunshot injuries to the thorax. The protection against high-velocity weapons may, however, be insufficient. Complementary trauma attenuating backings (TAB) have been suggested to prevent morbidity and mortality in high-velocity weapon trauma. Methods: Twenty-four Swedish landrace pigs, protected by a ceramid/aramid body armor without (n = 12) or with TAB (n = 12) were shot with a standard 7.62-mm assault rifle. Morphologic injuries, cardiorespiratory, and electroencephalogram changes as well as physical parameters were registered. Results: The bullet impact caused a reproducible behind armor blunt trauma (BABT) in both the groups. The TAB significantly decreased size of the lung contusion and prevented hemoptysis. The postimpact apnea, desaturation, hypotension, and rise in pulmonary artery pressure were significantly attenuated in the TAB group. Moreover, TAB reduced transient peak pressures in thorax by 91%. Conclusions: Our results indicate that ordinary body armor should be complemented by a TAB to prevent thoracic injuries when the threat is high-velocity weapons.
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| 16. |
- Sveen, Josefin, 1976-, et al.
(författare)
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A prospective longitudinal study of posttraumatic stress disorder symptom trajectories after burn injury
- 2011
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 71:6, s. 1808-1815
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Tidskriftsartikel (refereegranskat)abstract
- Background: Psychologic problems are common after burns, and symptoms of posttraumatic stress disorder (PTSD) are some of the most prevalent. Risk factors for PTSD have been identified, but little is known about the onset and course of these symptoms. The objective was to investigate whether there are different PTSD symptom trajectories after burns.Methods: Ninety-five adults with burns were enrolled in a prospective study from in-hospital treatment until 12 months after burn. Symptoms of PTSD were assessed with the Impact of Event Scale-Revised and scores at 3, 6, and 12 months after the burn were used in a cluster analysis to detect trajectories. The trajectories were compared regarding known risk factors for PTSD using non-parametric analysis of variance.Results: Four clusters were identified: (1) resilient, with low levels of PTSD symptoms that decreased over time; (2) recovery, with high levels of symptoms that gradually decreased; (3) delayed, with moderate symptoms that increased over time; and (4) chronic, with high levels of symptoms over time. The trajectories differed regarding several risk factors for PTSD including life events, premorbid psychiatric morbidity, personality traits, avoidant coping, in-hospital psychologic symptoms, and social support. The resilient trajectory consistently had fewer of the risk factors and differed the most from the chronic trajectory.Conclusions: There are subgroups among patients with burns that have different patterns of PTSD symptom development. These findings may have implications for clinical practice, such as the timing of assessment and the management of patients who present with these symptoms.
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| 17. |
- Wang, Jianpu, et al.
(författare)
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Administration of aerosolized terbutaline and budesonide reduces chlorine gas-induced acute lung injury
- 2004
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 56:4, s. 850-862
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Tidskriftsartikel (refereegranskat)abstract
- Background: The pathophysiology and treatment of chlorine gas-induced acute lung injury is poorly characterized and based on anecdotal data. This study aimed to assess the effects of aerosolized beta-2 adrenergic agonist and corticosteroid therapy on chlorine gas-induced lung injury.Methods: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million for 20 minutes), then assigned randomly 30 minutes later to receive aerosolized terbutaline, budesonide, terbutaline followed by budesonide or placebo (6 pigs in each group). Hemodynamics, gas exchange, and lung mechanics were evaluated for another 5 hours.Results: All the animals demonstrated an immediate increase in airway and pulmonary artery pressure as well as sharp drops in arterial oxygen tension (PaO2) and lung compliance (C L). Recovery of PaO2 and CL was greatest in the terbutaline plus budesonide group, but therapy with terbutaline and budesonide alone also was associated with significant improvement in PaO2 and CL, as compared with placebo.Conclusions. Treatment of acute chlorine gas lung injury with aerosolized terbutaline followed by aerosolized budesonide improved lung function. Combined treatment was more effective than treatment with either drug alone.
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| 18. |
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| 19. |
- Willebrand, Mimmie, et al.
(författare)
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A simplified domain structure of the Burn-Specific Health Scale-Brief (BSHS-B) : A tool to improve its value in routine clinical work
- 2008
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 64:6, s. 1581-1586
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Tidskriftsartikel (refereegranskat)abstract
- Background:Injury-specific instruments with good psychometric properties are valuable in the assessment of health status after trauma. Previous studies of burn-specific health have attempted to create broad domains such as physical and psychological health, but these domains have not been validated. In this study, burn-specific health domains were explored and validated by a factor analytic approach.Methods:Participants were 334 former burn patients injured between 1980 and 2000. Data were collected from medical charts and by a postal questionnaire, the Burn Specific Health Scale-Brief (BSHS-B). The nine subscales of the BSHS-B were subjected to second-order factor analysis. The sample was split into two subsamples that were equal with respect to burn severity.Results:The factor structure was well replicated in each of the subsamples and in the total sample. Three internally consistent and well separated domains were derived: affect and relations (BSHS-B subscales interpersonal relationships, affect, sexuality), function (simple abilities, hand function), and skin involvement (heat sensitivity, treatment regimens, body image). The work subscale of the BSHS-B was excluded from the analysis because of consistent double loadings. The three domains had intelligible associations with injury-specific and sociodemographic variables.Conclusion:The underlying structure of the BSHS-B comprises three clinically meaningful health domains. The work subscale is not part of these domains and can be considered a separate outcome domain. The domain scores increase the understanding of outcome after burn injury and could prove useful in clinical use of the BSHS-B.
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| 20. |
- Willebrand, Mimmie, et al.
(författare)
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Burn Specific Health up to 24 Months After the Burn : A Prospective Validation of the Simplified Model of the Burn Specific Health Scale-Brief
- 2011
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 71:1, s. 78-84
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Tidskriftsartikel (refereegranskat)abstract
- Background: Outcome after burn injury is a multidimensional concept, but few multidimensional, injury-specific outcome measures have been psychometrically evaluated. A recent cross-sectional study using the Burn Specific Health Scale-Brief (BSHS-B) found three psychometrically sound health domains: function, skin involvement, and affect and relations. The aim of this study was to reexamine the psychometric properties of the BSHS-B using a prospective study design. Methods: Ninety-four consecutive adult patients with burns were included and asked to fill in questionnaires, the BSHS-B, the Hospital Anxiety and Depression Scale, and the short-form 36 (SF-36), at 6 months, 12 months, and 24 months postburn. Results: The factor structure was replicated and the three domains, function, skin involvement, and affect and relations, had excellent internal consistency. Over time the scores of function and skin involvement increased, indicating health improvement, whereas the domain affect and relations did not change over time. At 6 months and 12 months postburn, all domains were associated with burn severity. The function domain was highly associated with the SF-36 subscales physical functioning and role-physical, the affect and relations domain was highly associated with the Hospital Anxiety and Depression Scale and the SF-36 subscales denoting psychological health, and the domain skin involvement was highly associated with subscales indicating role-concerns, social functioning, vitality, and mental health. Conclusion: The psychometric properties of the BSHS-B domains were excellent and they had intelligible concurrent associations with other measures. Thus, the simplified model of the BSHS-B is a reliable, valid, and useful tool in describing postburn health over time.
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| 21. |
- Willebrand, Mimmie, et al.
(författare)
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Prediction of psychological health after accidental burn
- 2004
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 57, s. 367--374
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Tidskriftsartikel (refereegranskat)abstract
- Background: Burn victims often display psychological symptoms that can impede recovery, but knowledge about risk factors for psychopathology is limited. The aim was to predict psychological health at three months post-burn from coping and trauma-related factors assessed early in hospitalization. Methods: Thirty-four burn patients were interviewed during hospitalization about the accident and coping. Questionnaires were administered during hospitalization and at three months post-burn, including the Impact of Event Scale-Revised for posttraumatic stress symptoms (intrusion, avoidance, arousal) and the Hospital Anxiety and Depression Scale for mood. Results: Anxiety, depressive and avoidant symptoms at three months were highly predicted by baseline levels of these symptoms, and avoidant coping. Life threat when being burned predicted intrusive and arousal symptoms, and coping by Self-control predicted less intrusive symptoms. Burn severity was not predictive of psychological health. Conclusions: Coping style, life threat during the accident and early symptomatology are strong predictors of post-burn psychopathology.
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| 22. |
- Öster, Caisa, et al.
(författare)
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Health-related quality of life 2 years to 7 years after a severe burn
- 2011
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Ingår i: Journal of Trauma. - 0022-5282 .- 1529-8809. ; 71:5, s. 1435-1441
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND:Knowledge concerning the trajectory andpredictors of health-related quality of life (HRQoL) years after burninjury is fragmentary and these factors were therefore assessed usingthe EQ-5D questionnaire.METHODS:Consecutive adult burnpatients were included during hospitalization and assessed at 3 months, 6months, and 12 months. In addition, an interview was performed at 2years to 7 years postburn. Data concerning injury characteristics,sociodemographic variables, psychiatric disorders, and HRQoL wereobtained.RESULTS:The EQ-5D dimension Mobility improvedbetween hospitalization and 3 months, while Anxiety/Depression improvedbetween 12 months and 2 years to 7 years. Other dimensions improvedgradually. At 2 years to 7 years, only the dimensions Pain/Discomfortand Usual activities were lower than in the general population. Inaddition, overall HRQoL was lower than in the general population whenmeasured by EQ VAS but not by EQ-5D index. EQ-5D index at 2 years to 7years was predicted by EQ-5D index at 12 months and concurrent workstatus and pain. EQ VAS at 2 years to 7 years was predicted by previousassessments of work status, posttraumatic stress disorder and EQ VAS,and concurrent work status and substance abuse. Total amount ofexplained variance ranged between 17% and 57%.CONCLUSIONS:HRQoLafter burn is conveniently screened by EQ VAS. Impairment after 2 yearsto 7 years is mainly reflected in the EQ dimensions Pain/Discomfort andUsual activities and can be predicted in part by information availablebefore or at 12 months.
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| 23. |
- Aberg, T, et al.
(författare)
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Cerebral function monitoring in rats with a critical hepatic injury treated with pneumatic antishock garment and infusion
- 1989
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Ingår i: Journal of Trauma. - 0022-5282. ; 29:2, s. 168-174
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Tidskriftsartikel (refereegranskat)abstract
- Twenty-nine rats were subjected to a severe standardized hepatic injury and divided into four groups. In addition to controls, the animals were treated with PASG inflated to 40 mm Hg, PASG and infusion of Ringer's acetate, or PASG and infusion of Ringer's acetate and Dextran 70 in combination. The aim of the infusion therapy was to stabilize the mean aortic blood pressure at 60 mm Hg. PASG significantly prolonged the survival time and the time during which a sensory evoked response could be observed. The PASG also prolonged the time before the EEG amplitude began to decrease or a burst-suppression pattern appeared in the EEG. Intravenous infusion of Ringer's acetate did not prolong these times compared to when PASG was used alone; when Dextran 70 was added to the infusion therapy these times were reduced. Changes in the EEG were recorded at a mean aortic pressure of 60 mm Hg when infusions were given, whereas the aortic pressure had to fall to 40 mm Hg before any changes could be observed when no infusions were used.
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| 24. |
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| 25. |
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| 26. |
- Bergqvist, D, et al.
(författare)
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Patients with abdominal trauma and fatal outcome: analysis of a 30-year series
- 1983
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Ingår i: Journal of Trauma. - 0022-5282. ; 23:6, s. 499-502
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Tidskriftsartikel (refereegranskat)abstract
- Patients with blunt abdominal trauma and fatal outcome during 30 years in a well-defined rural Swedish area have been analyzed. There were 127 patients. Several facts indicate that more severe trauma has been appearing more often during this period The mortality rate has, however, been stable, but the patients have become older. More patients die from pulmonary complications than from the trauma itself. One very important development is the significant decrease in mortality among children.
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| 27. |
- Björses, Katarina, et al.
(författare)
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Topical Haemostatics in Renal Trauma-An Evaluation of Four Different Substances in an Experimental Setting
- 2009
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Ingår i: Journal of Trauma. - 0022-5282. ; 66:3, s. 602-611
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Damage control is valuable in hemodynamically unstable trauma patients. To improve the hemostasis of packing, topical hemostatic agents have been suggested. The effects of such agents are unclear in trauma situations. The purpose of this study was to investigate the hemostatic capacity, and the stability of the hemostatic clot, of four substances with different mode of action in an experimental traumatic bleeding model. METHODS: A standardized heminefrectomy was performed in 180 heparinized and normotensive Sprauge-Dawley rats. Four different substances were studied (separately and in combinations) in a randomized fashion: gelatin (sponge and matrix), bovine thrombin, freeze-dried recombinant factor VIIa (rFVIIa), and microporous polysaccharide hemospheres. Eight treatment groups (15 animals/group) were considered, primary endpoint was hemostasis within 20 minutes of observation. The effective treatment groups were evaluated in a second set in the same experimental model, but with a prolonged observation time after hemostasis (60 minutes) to control the stability of the clot. RESULTS: Those animals treated with gelatin in the comparative study, with and without thrombin or rFVIIa, obtained hemostasis. Thrombin and rFVIIa alone did not have any hemostatic capacity. Only 20% to 25% of the animals obtained hemostasis with microporous polysaccharide hemospheres alone or in combination with rFVIIa. In the prolonged observation study, gelatin alone and in combination with thrombin or rFVIIa was studied. On average, 34% (20%-54%) of the animals rebled with no significant difference between the treatment groups. CONCLUSIONS: Gelatin-containing products provided a fast hemostasis in this experimental model. One third of the animals rebled, regardless of whether thrombin or rFVIIa was added. Further studies are demanded to confirm these results clinically.
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| 28. |
- Blomqvist, S, et al.
(författare)
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Early post-traumatic changes in hemodynamics and pulmonary ventilation in alcohol-pretreated pigs
- 1987
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Ingår i: Journal of Trauma. - 0022-5282. ; 27:1, s. 40-44
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Tidskriftsartikel (refereegranskat)abstract
- Time relations among trauma, pulmonary and systemic circulation, and lung function were studied in pigs. Eleven animals (b.w. 25-30 kg) were investigated under balanced anesthesia. Ventilation was mechanically controlled. Hemodynamics, pulmonary ventilation, and gas exchange were serially recorded. Seven animals were pretreated with 40% ethanol in saline and four with saline only. Ninety minutes after the ingestion of alcohol or saline, the animals were subjected to a standardized soft-tissue trauma. Cardiac output decreased significantly 2 minutes after trauma and remained low in both groups throughout the observation period of 30 minutes. Pulmonary vascular resistance was significantly increased in the alcohol-pretreated group but was virtually unchanged in the control animals. Systemic vascular resistance was similarly reduced in the two groups. Total compliance was somewhat lower in alcohol-pretreated animals and 10 minutes after the trauma arterial oxygen tension was significantly lower in the alcohol group than in control animals. Carbon dioxide elimination was reduced after trauma in both groups. It is concluded that pulmonary vascular response increased and that total pulmonary compliance is somewhat decreased shortly after trauma in the alcohol group while gas exchange is almost unchanged. The results indicate a negative interaction between alcohol and trauma
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| 29. |
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| 30. |
- Dubniks, Maris, et al.
(författare)
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Comparison of the plasma volume-expanding effects of 6% dextran 70, 5% albumin, and 6% HES 130/0.4 after hemorrhage in the guinea pig.
- 2009
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Ingår i: The Journal of trauma. - 1529-8809. ; 67:6, s. 1200-1204
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We still lack comparing data of the plasma volume (PV)-expanding effect of the most commonly used colloids including dextran 70. This study compares the PV-expanding effects of 6% dextran 70, 5% albumin, and 6% hydroxyethylstarch (HES) 130/0.4 after a standardized hemorrhage. METHODS: The prospective and randomized study on 33 anesthetized adult male guinea pigs involved three groups (n = 11 each); the dextran group, the albumin group, and the HES group. The left carotis artery was cannulated for blood pressure measurements and blood samples, and the right jugular vein was cannulated for infusions. After hemorrhage of 20 mL/kg for 8 minutes, the animals were transfused with 20 mL/kg of the colloid for 10 minutes. PV was determined with a I-albumin tracer dilution technique at baseline and 3 hours after the colloid infusion. The PV just after hemorrhage was calculated as the baseline value minus bled PV. Blood gases were measured at baseline, after hemorrhage, just after the colloid infusion and at the end of the experiment. RESULTS: The increase in PV 3 hours after the colloid infusion, including the 20 mL infused, was 36.3 mL/kg +/- 2.3 mL/kg in the dextran group, 26.4 mL/kg +/- 4.7 mL/kg in the albumin group, and 17.6 mL/kg +/- 3.5 mL/kg in the HES group. At the end of the experiment, hematocrit was lower in the dextran group than in the albumin and the HES groups. Urine production was higher in the HES group than in the dextran and the albumin groups. CONCLUSION: After hemorrhage, the PV-expanding capacity of 6% dextran 70 was better than that of 5% albumin, which was in turn better than that of HES 130/0.4 given in equal volumes.
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| 31. |
- Dyster-Aas, Johan, et al.
(författare)
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Major depression and posttraumatic stress disorder symptoms following severe burn injury in relation to lifetime psychiatric morbidity
- 2008
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Ingår i: Journal of Trauma - Injury, Infection and Critical Care. - 0022-5282. ; 64:5, s. 1349-1356
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Psychiatric history has been suggested to have an impact on long-term adjustment in burn survivors. A rigorous, prospective, longitudinal approach was used to study psychiatric history in a population-based burn sample and its impact on symptomatology of depression and posttraumatic stress disorder (PTSD) at a 12-month follow-up. METHODS: Seventy-three consecutive patients admitted to the Uppsala Burn Unit were assessed with the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition for psychiatric disorders, of whom 64 were also assessed after 12 months. RESULTS: Forty-eight patients (66%) presented with at least one lifetime psychiatric diagnosis; major depression (41%), alcohol abuse or dependence (32%), simple phobia (16%), and panic disorder (16%) were most prevalent. At 12-months postburn, 10 patients (16%) met criteria for major depression, 6 (9%) for PTSD, and 11 (17%) for subsyndromal PTSD. Patients with lifetime anxiety disorder and with lifetime psychiatric comorbidity were more likely to be depressed at 12 months, whereas those with lifetime affective disorder, substance use disorder and psychiatric comorbidity were more likely to have symptoms of PTSD. CONCLUSIONS: Two-thirds of burn survivors exhibit a history of lifetime psychiatric disorders. Those with a psychiatric history have a higher risk of postburn psychiatric problems.
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| 35. |
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| 39. |
- Hansbrough, John, et al.
(författare)
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Effects of recombinant bactericidal/permeability-increasing protein (rBPI23) on neutrophil activity in burned rats
- 1996
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Ingår i: Journal of Trauma. - 0022-5282. ; 40:6, s. 886-892
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Tidskriftsartikel (refereegranskat)abstract
- Bactericidal/permeability-increasing protein (BPI) is a neutrophil granule protein with potent bactericidal and lipopolysaccharide (LPS)-neutralizing activities. The purpose of this study was to determine if a human recombinant BPI product, rBPI23, would influence neutrophil (PMN) sequestration into various tissues in a rat burn injury model. Leukosequestration may produce local tissue injury from proteases and high-energy oxygen species released from PMNs. Rats received tracheostomy and venous cannulation, then received 17 to 20% total body surface area full-thickness contact burns and resuscitation with 20 ml, of intraperitoneal saline. Ten mg/kg body weight rBPI23 in saline was given by intravenous injection immediately after burn injury, followed by intravenous doses of 2 mg/kg at 2 and 4 hours. Control animals received intravenous saline only. PMN retention in lung, liver, spleen, gut, skin, muscle, kidney, and brain tissues was determined by removing (before burn injury) and differentially radiolabeling PMNs (111In) and erythrocytes (51Cr), reinfusing cells 4.5 hours after burn injury, and measuring tissue radioactivity 30 minutes later. Edema was estimated by measuring extravasated 125I-labeled albumin in the various tissues, 30 minutes after injection. Peripheral blood PMNS were analyzed for intracellular H2O2 content by flow cytometry using a fluorescent dye that reacts with H2O2. Radioisotope studies demonstrated significant (p < 0.05) leukosequestration into lung, liver, gut, kidney, and skin tissues at 5 hours after burn injury. Tissue edema, manifested by radiolabeled albumin retention, was not observed in any tissues. Postburn PMN deposition in lungs and skin was decreased (p < 0.05) by the immediate administration of rBPI23 after burn injury. Flow cytometry showed increased intracellular H2O2 content in peripheral blood PMNs 5 hours after burn injury (p < 0.05), which was unaffected by administration of rBPI23. Since sequestration of metabolically active PMNs may induce tissue injury, therapies that block leukosequestration after burn injury may improve clinical outcomes by limiting remote tissue injury.
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| 40. |
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| 41. |
- Jungner, Mårten, et al.
(författare)
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Prostacyclin reduces elevation of intracranial pressure and plasma volume loss in lipopolysaccharide-induced meningitis in the cat.
- 2009
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Ingår i: The Journal of trauma. - 1529-8809. ; 67:6, s. 1345-1351
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Severe meningitis may compromise cerebral perfusion through increases in intracranial pressure (ICP) and through hypovolemia caused by a general inflammation with systemic plasma leakage. From its antiaggregative/antiadhesive and permeability-reducing properties, prostacyclin (PGI2) is a potential adjuvant treatment in meningitis, but previously published data have been ambiguous. The objective of this study was to evaluate the effects of PGI2 on meningitis on ICP, plasma volume, blood pressure, and cerebral oxidative metabolism. METHODS: Meningitis was induced by intrathecal injection of lipopolysaccharide (LPS, 0.8 x 10 units/kg) in cats. Four hours after the injection, the animals were randomized to intravenous treatment with either low-dose PGI2 (1 ng/kg/min) or the vehicle for 6 hours (n = 7 in each group). No LPS and no PGI2 or vehicle was given to three cats (sham group). Effects of treatment on ICP, mean arterial pressure, plasma volume (I-albumin technique), and brain tissue lactate/pyruvate ratio (microdialysis technique) were evaluated. RESULTS: ICP increased from 10.0 mm Hg +/- 1.3 mm Hg and 10.8 mm Hg +/- 1.7 mm Hg to 19.9 mm Hg +/- 1.7 mm Hg and 19.6 mm Hg +/- 3.3 mm Hg in the PGI2 and the vehicle group, respectively, 4 hours after the LPS injection (not significant). ICP increased further to 21.8 mm Hg +/- 4.5 mm Hg and to 25.8 mm Hg +/- 6.0 mm Hg after treatment for 6 hours with PGI2 or vehicle, respectively (p < 0.05). There was no significant difference in arterial pressure between groups. Plasma volume loss was less in the PGI2 group than in the vehicle group at the end of the experiment and urine production and arterial oxygenation was higher in the PGI2 group. Lactate/pyruvate ratio was within the normal range in all groups. CONCLUSION: Low-dose PGI2 may be a beneficial adjuvant therapy for meningitis by reducing elevation of ICP and plasma volume loss.
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| 42. |
- Kakar, Sanjeev, et al.
(författare)
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Technical considerations in the operative management of femoral neck fractures in elderly patients : a multinational survey.
- 2007
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Ingår i: The Journal of trauma, injury, infection, and critical care. - : Ovid Technologies (Wolters Kluwer Health). - 1079-6061 .- 0022-5282. ; 63:3, s. 641-646
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To identify current opinions among orthopedic traumatologists relating to technical aspects of internal fixation and arthroplasty for patients with femoral neck fractures. METHODS: We developed and administered a survey to orthopedic surgeons who were members of the Orthopedic Trauma Association and European clinics affiliated with AO International (Davos, Switzerland). Surgeons reported preferences in specific aspects of the surgical technique for internal fixation as well as arthroplasty. Each surgeon received either a mailed package (7-page survey, a personalized cover letter, and a stamped return envelope) or an email with a link to the same survey on the Internet with an identification code. At 6 weeks, 12 weeks, and 18 weeks after the initial mailing, we remailed the questionnaire to all nonresponders. RESULTS: Of the 442 surgeons who were sent the questionnaire, 298 (68%) responded. The typical respondent was a North American aged more than 40 years, in academic practice, supervised residents, had fellowship training in trauma, and worked in a low-volume center. Among surgeons who treated displaced femoral neck fractures with arthroplasty, significant disparities existed in terms of the type of anesthesia (51% preferring general anesthesia), surgical approach (47% used posterior approach), and placement of unipolar implants (50%). Surgeons tended to agree on the use of cement fixation (69%), repairing the capsule (80%), and not using a drain postoperatively (68%). Surgeons who preferentially treated hip fractures with internal fixation tended to have a lack of consensus in terms of what constituted acceptable surgical delays (43% allowing greater than 48 hours) and which screw configuration to use, with more than half using a triangle with base inferior construct. Surgeons tended to agree on the use of closed fracture reduction techniques (69%), three cannulated screws (73%), and did not routinely perform a capsulotomy (80%) or aspirate the fracture hematoma (90%). Within both treatment groups (internal fixation and arthroplasty), surgeons tended to agree on the use of perioperative antibiotics (>92%), thromboprophylaxis (98%), and postoperative weight bearing status (>87%). CONCLUSIONS: A general lack of consensus exists among orthopedic trauma surgeons in the management of displaced femoral neck fractures. With an ever-growing emphasis upon the practice of evidence-based medicine, we have demonstrated several disparities in the technical aspects of fixation and perioperative care likely caused by a general lack of available evidence. We recommend the need for future research and large collaborative efforts.
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| 43. |
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| 44. |
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| 46. |
- Ljungqvist, Olle, 1954-, et al.
(författare)
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Evidence of increased gluconeogenesis during hemorrhage in fed and 24-hour food-deprived rats
- 1989
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Ingår i: Journal of Trauma and Acute Care Surgery. - : Lippincott Williams & Wilkins. - 2163-0755 .- 2163-0763. ; 29:1, s. 87-90
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Tidskriftsartikel (refereegranskat)abstract
- Food withdrawal 24 hr before hemorrhage has been shown to increase experimental post-hemorrhage mortality, and survival is associated with the degree of hyperglycemia. Lack of hyperglycemic response has been attributed to depleted glycogen reserves after 24-hr food withdrawal. To investigate the effect of short-term food deprivation on glucose metabolism during hemorrhagic stress, glucose production (rate of appearance, Ra), glucose uptake (rate of disappearance, Rd), glucose clearance, and glucose recycling were investigated in fed and 24-hr food-deprived rats under basal conditions, and during hemorrhagic hypotension using 3-H3-U-C14-glucose. During hemorrhage, blood glucose levels were higher in fed rats. Hemorrhage induced a decrease in glucose clearance irrespective of nutritional state in both 24-hr starved animals and rats in the postprandial state. Calculated glucose recycling increased in both groups after hemorrhage. The results indicate that hemorrhagic stress induces a rapid increase in gluconeogenesis, as reflected by increased glucose recycling.
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| 47. |
- Lönn, Lars, 1956, et al.
(författare)
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Should blunt arterial trauma to the extremities be treated with endovascular techniques?
- 2005
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Ingår i: The Journal of trauma. - 0022-5282. ; 59:5, s. 1224-7
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Tidskriftsartikel (refereegranskat)abstract
- Endovascular techniques are making progress in most aspects of vascular disease. Penetrating or blunt trauma to large arteries can in many cases be managed elegantly with endovascular techniques. However when it comes to arterial trauma of the extremities things are more complicated. There are no reports hitherto in the literature on endovascular treatment of blunt injuries to the arteries of the extremities. In the present report we describe two cases of blunt trauma to the brachial artery treated with balloon angioplasty (PTA) to fixate the dissected intima to the vessel wall. The "glueing" was effective in giving a long lasting patency.We anticipate that there may be a role, though limited, for using PTA as a means of "glueing" the intima. More advanced techniques such as insertion of stents or stent-grafts in traumatized extremity arteries would rarely be indicated.
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| 48. |
- Muller, K, et al.
(författare)
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Mild head injuries: Impact of a national strategy for implementation of management guidelines
- 2003
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Ingår i: Journal of Trauma. - 0022-5282. ; 55:6, s. 1029-1034
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Tidskriftsartikel (refereegranskat)abstract
- Background. A national survey in 1996 showed insufficient routines for management of patients with mild head injuries in Norwegian hospitals. Since then, the Scandinavian Guidelines for Management of Mild Head Injuries have been published. Methods. A cross-sectional questionnaire survey of management practice was performed in all 59 hospitals in 2002. We compared the results with figures from 1996 and evaluated guideline compliance. Results. The proportion of noncompliant hospitals was reduced (p = 0.02) from 52% to 31%. The proportion assessing the patient's level of consciousness according to the Glasgow Coma Scale increased (p = 0.001) from 49% to 80%. The proportion requiring a normal computed tomographic scan if a patient with a history of loss of consciousness was to be sent home from the accident and emergency department increased (p < 0.001) from 1 (2%) to 13 (19%). Conclusion. The Scandinavian Guidelines for Management of Mild Head Injuries have had a significant impact on management practice in Norwegian hospitals.
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| 49. |
- Muller, Kay, et al.
(författare)
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S100B serum level predicts computed tomography findings after minor head injury
- 2007
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Ingår i: Journal of Trauma. - 0022-5282. ; 62:6, s. 1452-1456
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mild head injury (MHI) implies a risk for traumatic brain injury and even a small risk for development of an intracranial hematoma. Head computed tomography (CT) is recommended for early detection of such pathologic findings. The present multicenter study was performed to investigate whether determination of protein S100B in serum could contribute to the selection of patients for CT scanning. Methods: We included 226 patients with a history of head injury and a Glasgow Coma Scale (GCS) score of 13 to 15 at admission to hospital. Blood samples for S100B analysis and head CT were obtained within 12 hours after the injury. The diagnostic properties of S100B measurements for prediction of intracranial injury revealed by CT were tested with receiver operating characteristic (ROC) analysis and cross-table analysis at different cut-off levels. We also included analysis of S100B levels normalized to correspond to blood sampling I hour after the injury. Results: CT showed intracranial injury in 21 (9.3%) patients. S100B levels were significantly (p < 0.001) elevated in patients with intracranial injury (mean, 0.36; 95% CI, 0.21-0.50 mu g/L) compared with those in patients without intracranial injury (mean, 0.18; 95% CI, 0.16-0.20 mu g/L). ROC curve analysis showed a significant (p = 0.001) area under the curve (0.73; 95% CI, 0.62-0.84). Cross-table analysis showed that 20 of 21 (sensitivity 0.95) patients with intracranial injury were detected at a cut-off level of 0.10 mu g/L, but 141 of 205 (specificity 0.31) patients with no such injury also had a S100B level above this limit. Exclusion of cases with blood samples collected more than 3 hours after injury or normalization did not improve the diagnostic properties. Conclusion: Determination of serum S100B cannot replace the clinical examination or use of CT for patients with minor head injury, but adding S100B measurement to the clinical evaluation might support selection of patients for CT scanning.
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| 50. |
- Mätzsch, Thomas, et al.
(författare)
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Moped and motorcycle accidents--similarities and discrepancies
- 1986
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Ingår i: Journal of Trauma. - 0022-5282. ; 26:6, s. 538-543
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Tidskriftsartikel (refereegranskat)abstract
- Injury patterns and epidemiologic data from 211 moped accident victims and 214 motorcycle accident casualties admitted to hospital over a 5-year period (1977-1981) have been analyzed and compared. The number of those injured in motorcycle accidents tripled; the number of moped accident victims slightly decreased in the period studied. Differences in injury pattern, sex ratio, cause of accident, and age distribution were noted. Among mopedists, head injuries were more common but these injuries decreased significantly after the adoption of helmet use laws for mopedists also in 1978. There were more females involved in moped accidents and the mean age was considerably higher among mopedists. Of those injured in moped accidents, 21% were 60 years old or older and accounted for 56% of fatalities in this group. The most frequent cause of moped accidents was collision with a car, and over turning or running off the road in motorcycle accidents. The difference in injury severity was unexpectedly small, although there was a tendency toward more severe injuries in motorcyclists. Moped accidents are so similar to motorcycle accidents that it seems unjustified to regard mopeds as harmless 'bicycles with a helper motor.' The need for formal registration, driving license, and helmet use laws for mopeds is apparent.
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