Acute and Critical Care

Original Articles

Trauma
Comparison of admission GCS score to admission GCS-P and FOUR scores for prediction of outcomes among patients with traumatic brain injury in the intensive care unit in India: Nishant Agrawal, Shivakumar S Iyer, Vishwanath Patil, Sampada Kulkarni, Jignesh N Shah, Prashant Jedge; Acute Crit Care. 2023;38(2):226-233. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00570

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Abstract PDF: Background
Traumatic brain injury (TBI) is a major contributor to trauma-related mortality and morbidity. Various scoring models have been proposed to evaluate the level of consciousness. The primary objective of this study was to measure the ability of the Full Outline of Unresponsiveness (FOUR) score and the Glasgow Coma Scale Pupil (GCS-P) score in predicting outcomes among TBI patients in terms of the Glasgow Outcome Scale (GOS) at 1 month and 6 months of follow-up.
Methods
Our study was a prospective observational study carried out over a period of 15 months that enrolled 50 patients admitted with TBI to the intensive care unit who fulfilled our inclusion criteria. Pearson’s correlation coefficient was used to correlate coma scales and outcome measures, and the predictive value of these scales was established by receiver operating characteristic (ROC) curve by calculating the area under the ROC curve with 99% confidence interval. All hypotheses were constructed as two-tailed, and P<0.01 was considered significant.
Results
In the present study, the GCS-P and FOUR scores among all patients on admission as well as in the subset of patients who were mechanically ventilated were statistically significant and strongly correlated with patient outcomes. The correlation coefficient of the GCS score compared to GCS-P and FOUR scores was higher and statistically significant. The areas under the ROC curve for the GCS, GCS-P, and FOUR scores and the number of computed tomography abnormalities were 0.912, 0.905, 0.937, and 0.324, respectively.
Conclusions
The GCS, GCS-P, and FOUR scores are all excellent predictors with a strong positive linear correlation with final outcome prediction. In particular, the GCS score has the best correlation with final outcome.

Nephrology
Epidemiology and outcome of an acute kidney injuries in the polytrauma victims admitted at the apex trauma center in Dubai: Bhushan Sudhakar Wankhade, Zeyad Faoor Alrais, Ghaya Zeyad Alrais, Ammar Mohamed Abdel Hadi, Gopala Arun Kumar Naidu, Mohammed Shahid Abbas, Ahmed Tarek Youssef Aboul Kheir, Hasan Hadad, Sundareswaran Sharma, Mohammad Sait; Acute Crit Care. 2023;38(2):217-225. Published online May 25, 2023; DOI: https://doi.org/10.4266/acc.2023.00388

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Abstract PDF: Background
Polytrauma due to road traffic accidents is one of the common causes of hospital admissions and deaths. Acute kidney injury (AKI) is frequently observed in polytrauma victims. It has a significant impact on patient’s outcomes after polytraumas.
Methods
This is a single-center, retrospective, and observation study done at a tertiary health care center in the state. Polytrauma victims with an Injury Severity Score (ISS) of more than 25 were included in the study.
Results
The incidence of AKI in polytrauma victims is 30.5%. It is common in patients with a higher Carlson comorbidity index (P=0.021). It is more common in patients with higher ISS (P=0.001). On logistic regression, there is good regression between ISS value and AKI (odds ratio [OR], 1.191; 95% confidence interval [CI], 1.150–1.233; P<0.05). The main causes of trauma-induced AKI are hemorrhagic shock (P=0.001), need for massive transfusion (P<0.00), rhabdomyolysis (P=0.001), and abdominal compartment syndrome (ACS; P<0.001). On multivariate logistic regression AKI can be predicated by higher ISS (OR, 1.08; 95% CI, 1.00–1.17; P=0.05) and low mixed venous saturation (OR, 1.13; 95% CI, 1.05–1.22; P<0.001). The development of AKI after polytrauma increases length of stay (LOS)-hospital (P=0.006), LOS-intensive care unit (ICU; P=0.003), need for mechanical ventilation (MV) (P<0.001), ventilator days (P=0.001), and mortality (P<0.001).
Conclusions
The incidence of AKI after polytrauma is about 30.5%. It is more common in a patient with preexisting comorbidities. The frequent causes of AKI after polytrauma are hemorrhagic shock, massive blood transfusion, rhabdomyolysis, and ACS. Although the AKI after polytrauma increases LOS-hospital, LOS-ICU, the need for MV, ventilator days, and mortality, this association may be related to more severe injuries in the AKI group.

Trauma
Selection of appropriate reference creatinine estimate for acute kidney injury diagnosis in patients with severe trauma: Kangho Lee, Dongyeon Ryu, Hohyun Kim, Sungjin Park, Sangbong Lee, Chanik Park, Gilhwan Kim, Sunhyun Kim, Nahyeon Lee; Acute Crit Care. 2023;38(1):95-103. Published online February 27, 2023; DOI: https://doi.org/10.4266/acc.2022.01046

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Abstract PDF: Background
In patients with severe trauma, the diagnosis of acute kidney injury (AKI) is important because it is a predictive factor for poor prognosis and can affect patient care. The diagnosis and staging of AKI are based on change in serum creatinine (SCr) levels from baseline. However, baseline creatinine levels in patients with traumatic injuries are often unknown, making the diagnosis of AKI in trauma patients difficult. This study aimed to enhance the accuracy of AKI diagnosis in trauma patients by presenting an appropriate reference creatinine estimate (RCE). Methods: We reviewed adult patients with severe trauma requiring intensive care unit admission between 2015 and 2019 (n=3,228) at a single regional trauma center in South Korea. AKI was diagnosed based on the current guideline published by the Kidney Disease: Improving Global Outcomes organization. AKI was determined using the following RCEs: estimated SCr75-modification of diet in renal disease (MDRD), trauma MDRD (TMDRD), admission creatinine level, and first-day creatinine nadir. We assessed inclusivity, prognostic ability, and incrementality using the different RCEs. Results: The incidence of AKI varied from 15% to 46% according to the RCE used. The receiver operating characteristic curve of TMDRD used to predict mortality and the need for renal replacement therapy (RRT) had the highest value and was statistically significant (0.797, P<0.001; 0.890, P=0.002, respectively). In addition, the use of TMDRD resulted in a mortality prognostic ability and the need for RRT was incremental with AKI stage. Conclusions: In this study, TMDRD was feasible as a RCE, resulting in optimal post-traumatic AKI diagnosis and prognosis.

Case Report

Neurosurgery
Use of droxidopa for blood pressure augmentation after acute spinal cord injury: case reports: Christopher S. Hong, Muhammad K. Effendi, Abdalla A. Ammar, Kent A. Owusu, Mahmoud A. Ammar, Andrew B. Koo, Layton A. Lamsam, Aladine A. Elsamadicy, Gregory A. Kuzmik, Maxwell Laurans, Michael L. DiLuna, Mark L. Landreneau; Received December 3, 2021 Accepted September 14, 2022 Published online December 7, 2022; DOI: https://doi.org/10.4266/acc.2021.01662 [Epub ahead of print]

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Abstract PDF: Hypotension secondary to autonomic dysfunction is a common complication of acute spinal cord injury (SCI) that may worsen neurologic outcomes. Midodrine, an enteral α-1 agonist, is often used to facilitate weaning intravenous (IV) vasopressors, but its use can be limited by reflex bradycardia. Alternative enteral agents to facilitate this wean in the acute post-SCI setting have not been described. We aim to describe novel application of droxidopa, an enteral precursor of norepinephrine that is approved to treat neurogenic orthostatic hypotension, in the acute post-SCI setting. Droxidopa may be an alternative enteral therapy for those intolerant of midodrine due to reflex bradycardia. We describe two patients suffering traumatic cervical SCI who were successfully weaned off IV vasopressors with droxidopa after failing with midodrine. The first patient was a 64-year-old male who underwent C3–6 laminectomies and fusion after a ten-foot fall resulting in quadriparesis. Post-operatively, the addition of midodrine in an attempt to wean off IV vasopressors resulted in significant reflexive bradycardia. Treatment with droxidopa facilitated rapidly weaning IV vasopressors and transfer to a lower level of care within 72 hours of treatment initiation. The second patient was a 73-year-old male who underwent C3–5 laminectomies and fusion for a traumatic hyperflexion injury causing paraplegia. The addition of midodrine resulted in severe bradycardia, prompting consideration of pacemaker placement. However, with the addition of droxidopa, this was avoided, and the patient was weaned off IV vasopressors on dual oral therapy with midodrine and droxidopa. Droxidopa may be a viable enteral therapy to treat hypotension in patients after acute SCI who are otherwise not tolerating midodrine in order to wean off IV vasopressors. This strategy may avoid pacemaker placement and facilitate shorter stays in the intensive care unit, particularly for patients who are stable but require continued intensive care unit admission for IV vasopressors, which can be cost ineffective and human resource depleting.

Review Article

Neurosurgery
Target temperature management in traumatic brain injury with a focus on adverse events, recognition, and prevention: Kwang Wook Jo; Acute Crit Care. 2022;37(4):483-490. Published online November 10, 2022; DOI: https://doi.org/10.4266/acc.2022.01291

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Abstract PDF: Traumatic brain injury (TBI) is a critical cause of disability and death worldwide. Many studies have been conducted aimed at achieving favorable neurologic outcomes by reducing secondary brain injury in TBI patients. However, ground-breaking outcomes are still insufficient so far. Because mild-to-moderate hypothermia (32°C–35°C) has been confirmed to help neurological recovery for recovered patients after circulatory arrest, it has been recognized as a major neuroprotective treatment plan for TBI patients. Thereafter, many clinical studies about the effect of therapeutic hypothermia (TH) on severe TBI have been conducted. However, efficacy and safety have not been demonstrated in many large-scale randomized controlled studies. Rather, some studies have demonstrated an increase in mortality rate due to complications such as pneumonia, so it is not highly recommended for severe TBI patients. Recently, some studies have shown results suggesting TH may help reperfusion/ischemic injury prevention after surgery in the case of mass lesions, such as acute subdural hematoma, and it has also been shown to be effective in intracranial pressure control. In conclusion, TH is still at the center of neuroprotective therapeutic studies regarding TBI. If proper measures can be taken to mitigate the many adverse events that may occur during the course of treatment, more positive efficacy can be confirmed. In this review, we look into adverse events that may occur during the process of the induction, maintenance, and rewarming of targeted temperature management and consider ways to prevent and address them.

Original Articles

Trauma
C-reactive protein-albumin ratio and procalcitonin in predicting intensive care unit mortality in traumatic brain injury: Canan Gürsoy, Güven Gürsoy, Semra Gümüş Demirbilek; Acute Crit Care. 2022;37(3):462-467. Published online August 5, 2022; DOI: https://doi.org/10.4266/acc.2022.00052

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Abstract PDF: Background
Prediction of intensive care unit (ICU) mortality in traumatic brain injury (TBI), which is a common cause of death in children and young adults, is important for injury management. Neuroinflammation is responsible for both primary and secondary brain injury, and C-reactive protein-albumin ratio (CAR) has allowed use of biomarkers such as procalcitonin (PCT) in predicting mortality. Here, we compared the performance of CAR and PCT in predicting ICU mortality in TBI.
Methods
Adults with TBI were enrolled in our study. The medical records of 82 isolated TBI patients were reviewed retrospectively.
Results
The mean patient age was 49.0 ± 22.69 years; 59 of all patients (72%) were discharged, and 23 (28%) died. There was a statistically significant difference between PCT and CAR values according to mortality (P<0.05). The area under the curve (AUC) was 0.646 with 0.071 standard error for PCT and 0.642 with 0.066 standard error for CAR. The PCT showed a similar AUC of the receiver operating characteristic to CAR.
Conclusions
This study shows that CAR and PCT are usable biomarkers to predict ICU mortality in TBI. When the determined cut-off values are used to predict the course of the disease, the CAR and PCT biomarkers will provide more effective information for treatment planning and for preparation of the family for the treatment process and to manage their outcome expectations.

Neurosurgery
Development and internal validation of a nomogram for predicting outcomes in children with traumatic subdural hematoma: Anukoon Kaewborisutsakul, Thara Tunthanathip; Acute Crit Care. 2022;37(3):429-437. Published online June 23, 2022; DOI: https://doi.org/10.4266/acc.2021.01795

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2 Citations

Abstract PDF

Background
A subdural hematoma (SDH) following a traumatic brain injury (TBI) in children can lead to unexpected death or disability. The nomogram is a clinical prediction tool used by physicians to provide prognosis advice to parents for making decisions regarding treatment. In the present study, a nomogram for predicting outcomes was developed and validated. In addition, the predictors associated with outcomes in children with traumatic SDH were determined.
Methods
In this retrospective study, 103 children with SDH after TBI were evaluated. According to the King’s Outcome Scale for Childhood Head Injury classification, the functional outcomes were assessed at hospital discharge and categorized into favorable and unfavorable. The predictors associated with the unfavorable outcomes were analyzed using binary logistic regression. Subsequently, a two-dimensional nomogram was developed for presentation of the predictive model.
Results
The predictive model with the lowest level of Akaike information criterion consisted of hypotension (odds ratio [OR], 9.4; 95% confidence interval [CI], 2.0–42.9), Glasgow coma scale scores of 3–8 (OR, 8.2; 95% CI, 1.7–38.9), fixed pupil in one eye (OR, 4.8; 95% CI, 2.6–8.8), and fixed pupils in both eyes (OR, 3.5; 95% CI, 1.6–7.1). A midline shift ≥5 mm (OR, 1.1; 95% CI, 0.62–10.73) and co-existing intraventricular hemorrhage (OR, 6.5; 95% CI, 0.003–26.1) were also included.
Conclusions
SDH in pediatric TBI can lead to mortality and disability. The predictability level of the nomogram in the present study was excellent, and external validation should be conducted to confirm the performance of the clinical prediction tool.

Citations

Citations to this article as recorded by

Development and internal validation of a nomogram to predict massive blood transfusions in neurosurgical operations
Kanisorn Sungkaro, Chin Taweesomboonyat, Anukoon Kaewborisutsakul
Journal of Neurosciences in Rural Practice.2022; 13: 711. CrossRef
Prediction of massive transfusions in neurosurgical operations using machine learning
Chin Taweesomboonyat, Anukoon Kaewborisutsakul, Kanisorn Sungkaro
Asian Journal of Transfusion Science.2022;[Epub] CrossRef

Review Article

Neurosurgery
Brain-lung interaction: a vicious cycle in traumatic brain injury: Ariana Alejandra Chacón-Aponte, Érika Andrea Durán-Vargas, Jaime Adolfo Arévalo-Carrillo, Iván David Lozada-Martínez, Maria Paz Bolaño-Romero, Luis Rafael Moscote-Salazar, Pedro Grille, Tariq Janjua; Acute Crit Care. 2022;37(1):35-44. Published online February 11, 2022; DOI: https://doi.org/10.4266/acc.2021.01193

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Abstract PDF

The brain-lung interaction can seriously affect patients with traumatic brain injury, triggering a vicious cycle that worsens patient prognosis. Although the mechanisms of the interaction are not fully elucidated, several hypotheses, notably the “blast injury” theory or “double hit” model, have been proposed and constitute the basis of its development and progression. The brain and lungs strongly interact via complex pathways from the brain to the lungs but also from the lungs to the brain. The main pulmonary disorders that occur after brain injuries are neurogenic pulmonary edema, acute respiratory distress syndrome, and ventilator-associated pneumonia, and the principal brain disorders after lung injuries include brain hypoxia and intracranial hypertension. All of these conditions are key considerations for management therapies after traumatic brain injury and need exceptional case-by-case monitoring to avoid neurological or pulmonary complications. This review aims to describe the history, pathophysiology, risk factors, characteristics, and complications of brain-lung and lung-brain interactions and the impact of different old and recent modalities of treatment in the context of traumatic brain injury.

Citations

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Ventilatory targets following brain injury
Shaurya Taran, Sarah Wahlster, Chiara Robba
Current Opinion in Critical Care.2023; 29(2): 41. CrossRef
Uncertainty in Neurocritical Care: Recognizing Its Relevance for Clinical Decision Making
Luis Rafael Moscote-Salazar, William A. Florez-Perdomo, Tariq Janjua
Indian Journal of Neurotrauma.2023;[Epub] CrossRef
The role of cardiac dysfunction and post-traumatic pulmonary embolism in brain-lung interactions following traumatic brain injury
Mabrouk Bahloul, Karama Bouchaala, Najeh Baccouche, Kamilia Chtara, Hedi Chelly, Mounir Bouaziz
Acute and Critical Care.2022; 37(2): 266. CrossRef
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Mapping brain endophenotypes associated with idiopathic pulmonary fibrosis genetic risk
Ali-Reza Mohammadi-Nejad, Richard J. Allen, Luke M. Kraven, Olivia C. Leavy, R. Gisli Jenkins, Louise V. Wain, Dorothee P. Auer, Stamatios N. Sotiropoulos
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Revista Investigación en Salud Universidad de Boyacá.2022;[Epub] CrossRef

Original Articles

Basic science and research
A machine learning model for predicting favorable outcome in severe traumatic brain injury patients after 6 months: Mehdi Nourelahi, Fardad Dadboud, Hosseinali Khalili, Amin Niakan, Hossein Parsaei; Acute Crit Care. 2022;37(1):45-52. Published online January 21, 2022; DOI: https://doi.org/10.4266/acc.2021.00486

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Abstract PDF

Background
Traumatic brain injury (TBI), which occurs commonly worldwide, is among the more costly of health and socioeconomic problems. Accurate prediction of favorable outcomes in severe TBI patients could assist with optimizing treatment procedures, predicting clinical outcomes, and result in substantial economic savings. Methods: In this study, we examined the capability of a machine learning-based model in predicting “favorable” or “unfavorable” outcomes after 6 months in severe TBI patients using only parameters measured on admission. Three models were developed using logistic regression, random forest, and support vector machines trained on parameters recorded from 2,381 severe TBI patients admitted to the neuro-intensive care unit of Rajaee (Emtiaz) Hospital (Shiraz, Iran) between 2015 and 2017. Model performance was evaluated using three indices: sensitivity, specificity, and accuracy. A ten-fold cross-validation method was used to estimate these indices. Results: Overall, the developed models showed excellent performance with the area under the curve around 0.81, sensitivity and specificity of around 0.78. The top-three factors important in predicting 6-month post-trauma survival status in TBI patients are “Glasgow coma scale motor response,” “pupillary reactivity,” and “age.” Conclusions: Machine learning techniques might be used to predict the 6-month outcome in TBI patients using only the parameters measured on admission when the machine learning is trained using a large data set.

Citations

Citations to this article as recorded by

Science fiction or clinical reality: a review of the applications of artificial intelligence along the continuum of trauma care
Olivia F. Hunter, Frances Perry, Mina Salehi, Hubert Bandurski, Alan Hubbard, Chad G. Ball, S. Morad Hameed
World Journal of Emergency Surgery.2023;[Epub] CrossRef
Predicting Outcome in Patients with Brain Injury: Differences between Machine Learning versus Conventional Statistics
Antonio Cerasa, Gennaro Tartarisco, Roberta Bruschetta, Irene Ciancarelli, Giovanni Morone, Rocco Salvatore Calabrò, Giovanni Pioggia, Paolo Tonin, Marco Iosa
Biomedicines.2022; 10(9): 2267. CrossRef

Trauma
Prevalence and clinical impact of vitamin D deficiency in critically ill Korean patients with traumatic injuries: a single-center, prospective, observational study: Kyoung Hoon Lim, Jihoon Jang, Jinyoung Park; Acute Crit Care. 2021;36(2):92-98. Published online April 29, 2021; DOI: https://doi.org/10.4266/acc.2020.00801

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Abstract PDF: Background
This study investigated the prevalence and impact of 25-hydroxyvitamin D (25(OH) vitamin D) deficiency in critically ill Korean patients with traumatic injuries.
Methods
This prospective observational cohort study assessed the 25(OH) vitamin D status of consecutive trauma patients admitted to the trauma intensive care unit (TICU) of Kyungpook National University Hospital between January and December 2018. We analyzed the prevalence of 25(OH) vitamin D deficiency and its impact on clinical outcomes.
Results
There were no significant differences in the duration of mechanical ventilation (MV), lengths of TICU and hospital stays, and rates of nosocomial infection and mortality between patients with 25(OH) vitamin D <20 ng/ml and those with 25(OH) vitamin D ≥20 ng/ml within 24 hours of TICU admission. The duration of MV and lengths of TICU and hospital stays were shorter and the rate of nosocomial infection was lower in patients with 25(OH) vitamin D level ≥20 ng/ml on day 7 of hospitalization. The duration of MV, lengths of TICU and hospital stays, and nosocomial infection rate were significantly lower in patients with increased concentrations compared with those with decreased concentrations on day 7 of hospitalization, but the mortality rate did not differ significantly.
Conclusions
The 25(OH) vitamin D level measured within 24 hours after TICU admission was unrelated to clinical outcomes in critically ill patients with traumatic injuries. However, patients with increased 25(OH) vitamin D level after 7 days of hospitalization had better clinical outcomes than those with decreased levels.

Trauma
The association between the initial lactate level and need for massive transfusion in severe trauma patients with and without traumatic brain injury: Young Hoon Park, Dong Hyun Ryu, Byung Kook Lee, Dong Hun Lee; Acute Crit Care. 2019;34(4):255-262. Published online November 29, 2019; DOI: https://doi.org/10.4266/acc.2019.00640

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Abstract PDF: Background
Exsanguination is a major cause of death in severe trauma patients. The purpose of this study was to analyze the prognostic impact of the initial lactate level for massive transfusion (MT) in severe trauma. We divided patients according to subgroups of traumatic brain injury (TBI) and non-TBI.
Methods
This single-institution retrospective study was conducted on patients who were admitted to hospital for severe trauma between January 2016 and December 2017. TBI was defined by a head Abbreviated Injury Scale ≥3. Receiver operating characteristic analysis was used to analyze the prognostic impact of the lactate level. Multivariate analyses were performed to evaluate the relationship between the MT and lactate level. The primary outcome was MT.
Results
Of the 553 patients, MT was performed in 62 patients (11.2%). The area under the curve (AUC) for the lactate level for predicting MT was 0.779 (95% confidence interval [CI], 0.742 to 0.813). The AUCs for lactate level in the TBI and non-TBI patients were 0.690 (95% CI, 0.627 to 0.747) and 0.842 (95% CI, 0.796 to 0.881), respectively. In multivariate analyses, the lactate level was independently associated with the MT (odds ratio [OR], 1.179; 95% CI, 1.070 to 1.299). The lactate level was independently associated with MT in non-TBI patients (OR, 1.469; 95% CI, 1.262 to 1.710), but not in TBI patients.
Conclusions
The initial lactate level may be a possible prognostic factor for MT in severe trauma. In TBI patients, however, the initial lactate level was not suitable for predicting MT.

Trauma
Usefulness of Rotational Thromboelastometry as a Mortality Predictor of Hyperfibrinolysis in Patients with Severe Trauma: Ji Soo Kim, Il Jae Wang, Seok Ran Yeom, Suck Ju Cho, Jae Hun Kim, June Pill Seok, Seong Hwa Lee, Byung Gwan Bae, Mun Ki Min; Acute Crit Care. 2018;33(3):162-169. Published online August 31, 2018; DOI: https://doi.org/10.4266/acc.2018.00199

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4 Citations

Abstract PDF

Background
Hemorrhage is the major cause of traumatic death and the leading cause of preventable death. Hyperfibrinolysis is associated with trauma severity. Viscoelastic hemostatic assays show complete clot formation dynamics. The present study was designed to identify the relationship between hyperfibrinolysis and mortality, metabolic acidosis, and coagulopathy in patients with trauma.
Methods
Patients with severe trauma (injury severity score [ISS] of 15 or higher) who were assessed using rotational thromboelastometry (ROTEM) were included in the present study from January 2017 to December 2017. Variables were obtained from the Korea Trauma Database or the medical charts of the patients. To identify whether hyperfibrinolysis is an independent predictor of mortality, univariate and multivariate Cox regression analyses were performed.
Results
During the 1-year study period, 190 patients were enrolled. In total, 21 (11.1%) had hyperfibrinolysis according to the ROTEM analysis and 46 (24.2%) died. Patients with hyperfibrinolysis had a higher ISS (P=0.014) and mortality rate (P<0.001) than did those without hyperfibrinolysis. In multivariate Cox analysis, hyperfibrinolysis (hazard ratio [HR], 4.960; 95% confidence interval [CI], 2.447 to 10.053), age (HR, 1.033; 95% CI, 1.013 to 1.055), lactic acid level (HR, 1.085; 95% CI, 1.003 to 1.173), and ISS (HR, 1.037; 95% CI, 1.004 to 1.071) were independent predictors of mortality.
Conclusions
Hyperfibrinolysis is associated with increased mortality, worse metabolic acidosis, and severe coagulopathy and is an independent predictor of mortality in patients with trauma.

Citations

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Vittorio Pavoni, Lara Gianesello, Maddalena Pazzi, Pietro Dattolo, Domenico Prisco
Journal of Clinical Monitoring and Computing.2022; 36(1): 55. CrossRef
Clinical value of early assessment of hyperfibrinolysis by rotational thromboelastometry during postpartum hemorrhage for the prediction of severity of bleeding: A multicenter prospective cohort study in the Netherlands
Marije Tahitu, Paul I. Ramler, Ada Gillissen, Camila Caram‐Deelder, Dacia D. C. A. Henriquez, Moniek P. M. Maat, Johannes J. Duvekot, Jeroen Eikenboom, Kitty W. M. Bloemenkamp, Thomas Akker, Johanna G. Bom
Acta Obstetricia et Gynecologica Scandinavica.2022; 101(1): 145. CrossRef
ROTEM diagnostic capacity for measuring fibrinolysis in neonatal sepsis
Maria Lampridou, Rozeta Sokou, Andreas G. Tsantes, Martha Theodoraki, Aikaterini Konstantinidi, Georgios Ioakeimidis, Stefanos Bonovas, Marianna Politou, Serena Valsami, Zoe Iliodromiti, Theodora Boutsikou, Nicoletta Iacovidou, Georgios Nikolopoulos, Argi
Thrombosis Research.2020; 192: 103. CrossRef
The Immunologic Effect of Early Intravenous Two and Four Gram Bolus Dosing of Tranexamic Acid Compared to Placebo in Patients With Severe Traumatic Bleeding (TAMPITI): A Randomized, Double-Blind, Placebo-Controlled, Single-Center Trial
Philip C. Spinella, Kimberly A. Thomas, Isaiah R. Turnbull, Anja Fuchs, Kelly Bochicchio, Douglas Schuerer, Stacey Reese, Adrian A. Coleoglou Centeno, Christopher B. Horn, Jack Baty, Susan M. Shea, M. Adam Meledeo, Anthony E. Pusateri, Jerrold H. Levy, An
Frontiers in Immunology.2020;[Epub] CrossRef

Trauma
Acute Physiology and Chronic Health Evaluation II Score and Sequential Organ Failure Assessment Score as Predictors for Severe Trauma Patients in the Intensive Care Unit: Min A Lee, Kang Kook Choi, Byungchul Yu, Jae Jeong Park, Youngeun Park, Jihun Gwak, Jungnam Lee, Yang Bin Jeon, Dae Sung Ma, Gil Jae Lee; Korean J Crit Care Med. 2017;32(4):340-346. Published online November 30, 2017; DOI: https://doi.org/10.4266/kjccm.2017.00255

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Abstract PDF

Background
The Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Sequential Organ Failure Assessment (SOFA) scoring system are widely used for critically ill patients. We evaluated whether APACHE II score and SOFA score predict the outcome for trauma patients in the intensive care unit (ICU).
Methods
We retrospectively analyzed trauma patients admitted to the ICU in a single trauma center between January 2014 and December 2015. The APACHE II score was figured out based on the data acquired from the first 24 hours of admission; the SOFA score was evaluated based on the first 3 days in the ICU. A total of 241 patients were available for analysis. Injury Severity score, APACHE II score, and SOFA score were evaluated.
Results
The overall survival rate was 83.4%. The non-survival group had a significantly high APACHE II score (24.1 ± 8.1 vs. 12.3 ± 7.2, P < 0.001) and SOFA score (7.7 ± 1.7 vs. 4.3 ± 1.9, P < 0.001) at admission. SOFA score had the highest areas under the curve (0.904). During the first 3 days, SOFA score remained high in the non-survival group. In the non-survival group, cardiovascular system, neurological system, renal system, and coagulation system scores were significantly higher.
Conclusions
In ICU trauma patients, both SOFA and APACHE II scores were good predictors of outcome, with the SOFA score being the most effective. In trauma ICU patients, the trauma scoring system should be complemented, recognizing that multi-organ failure is an important factor for mortality.

Citations

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Sion Jo, Taeoh Jeong, Boyoung Park
The American Journal of Emergency Medicine.2022; 51: 98. CrossRef
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Zhejun Yu, Feng Xu, Du Chen
BMJ Open.2021; 11(3): e041882. CrossRef
Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties
Joseph D. Bozzay, Patrick F. Walker, David W. Schechtman, Faraz Shaikh, Laveta Stewart, M. Leigh Carson, David R. Tribble, Carlos J. Rodriguez, Matthew J. Bradley
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Case Reports

Trauma/Surgery
Secondary Abdominal Compartment Syndrome Recognized in Operating Room in Severely Injured Patients: Seok Hwa Youn, John Cook-Jong Lee, Kyoungwon Jung, Jonghwan Moon, Yo Huh, Younghwan Kim; Korean J Crit Care Med. 2016;31(1):58-62. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.58

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Abstract PDF: For trauma patients with severe shock, massive fluid resuscitation is necessary. However, shock and a large amount of fluid can cause bowel and retroperitoneal edema, which sometimes leads to abdominal compartment syndrome in patients without abdomino-pelvic injury. If other emergent operations except intraabdomen are needed, a distended abdomen is likely to be recognized late, leading to multiple organ dysfunction. Herein, we report two cases of a 23-year-old woman who was in a car accident and a 53-year old man who was pressed on his leg by a pressing machine; severe brain swelling and popliteal vessel injury were diagnosed, respectively. They were both in severe shock and massive fluid resuscitation was required in the emergency department. Distended abdomen was recognized in both the female and male patients immediately after neurosurgical operation and immediately before orthopaedic operation in the operating room, respectively. Decompressive laparotomy revealed massive ascites with retroperitoneal edema.

Cardiology/Thoracic Surgery
The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture: Ju-Hee Park, Junghyeon Lim, Jaejin Lee, Hee Sung Lee; Korean J Crit Care Med. 2016;31(1):54-57. Published online February 29, 2016; DOI: https://doi.org/10.4266/kjccm.2016.31.1.54

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Abstract PDF: Extracorporeal membrane oxygenation (ECMO) has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

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