Tendencias temporales de falla multiorgánica después de la lesión: todavía muchos recursos, morbosa, y letal.
Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal.
Sauaia A1, Moore EE, Johnson JL, Chin TL, Banerjee A, Sperry JL, Maier RV, Burlew CC.
J Trauma Acute Care Surg. 2014 Mar;76(3):582-92, discussion 592-3. doi: 10.1097/TA.0000000000000147.
Abstract
BACKGROUND:While the incidence of postinjury multiple-organ failure (MOF) has declined during the past decade, temporal trends of its morbidity, mortality, presentation patterns, and health care resources use have been inconsistent. The purpose of this study was to describe the evolvingepidemiology of postinjury MOF from 2003 to 2010 in multiple trauma centers sharing standard treatment protocols.METHODS:"Inflammation and Host Response to Injury Collaborative Program" institutions that enrolled more than 20 eligible patients per biennial during the 2003 to 2010 study period were included. The patients were aged 16 years to 90 years, sustained blunt torso trauma with hemorrhagic shock (systolic blood pressure < 90 mm Hg, base deficit ≥ 6 mEq/L, blood transfusion within the first 12 hours), but without severe head injury (motor Glasgow Coma Scale [GCS] score < 4). MOF temporal trends (Denver MOF score > 3) were adjusted for admission risk factors (age, sex, body max index, Injury Severity Score [ISS], systolic blood pressure, and base deficit) using survival analysis. RESULTS: A total of 1,643 patients from four institutions were evaluated. MOF incidence decreased over time (from 17% in 2003-2004 to 9.8% in 2009-2010). MOF-related death rate (33% in 2003-2004 to 36% in 2009-2010), intensive care unit stay, and mechanical ventilation duration did not change over the study period. Adjustment for admission risk factors confirmed the crude trends. MOF patients required much longer ventilation and intensive care unit stay, compared with non-MOF patients. Most of the MOF-related deaths occurred within 2 days of the MOF diagnosis. Lung and cardiac dysfunctions became less frequent (57.6% to 50.8%, 20.9% to 12.5%, respectively), but kidney and liver failure rates did not change (10.1% to 12.5%, 15.2% to 14.1%). CONCLUSION: Postinjury MOF remains a resource-intensive, morbid, and lethal condition. Lung injury is an enduring challenge and should be a research priority. The lack of outcome improvements suggests that reversing MOF is difficult and prevention is still the best strategy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116088/pdf/nihms593568.pdf
Epidemiología de lesiones medulares y factores de riesgo de lesiones completas en Guangdong, China
Epidemiology of spinal cord injuries and risk factors for complete injuries in Guangdong, China: a retrospective study.
Yang R, Guo L, Wang P, Huang L, Tang Y, Wang W, Chen K, Ye J, Lu C, Wu Y, Shen H.
PLoS One. 2014 Jan 28;9(1):e84733. doi: 10.1371/journal.pone.0084733. eCollection 2014.
Abstract
BACKGROUND: Spinal cord injuries are highly disabling and deadly injuries. Currently, few studies focus on non-traumatic spinal cord injuries, and there is little information regarding the risk factors for complete injuries. This study aims to describe the demographics and the injury characteristics for both traumatic and non-traumatic spinal cord injuries and to explore the risk factors for complete spinal cord injuries. METHODS: A retrospective study was performed by reviewing the medical records of 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals in Guangdong, China. The demographics and injury characteristics of the patients were described and compared between the different groups using the chi-square test. Logistic regression was conducted to analyze the risk factors for complete spinal cord injuries. RESULTS: The proportion of patients increased from 7.0% to 14.0% from 2003 to 2011. The male-to-female ratio was 3.0 ∶ 1. The major cause of spinal cord injuries was traffic accidents (21.7%). Many of the injured were workers (36.2%), peasants (22.8%), and unemployed people (13.9%); these occupations accounted for 72.9% of the total sample. A multivariate logistic regression model revealed that the OR (95% CI) for male gender compared to female gender was 1.25 (1.07-1.89), the OR (95%CI) for having a spinal fracture was 1.56 (1.35-2.60), the OR (95%CI) for having athoracic injury was 1.23 (1.10-2.00), and the OR (95%CI) for having complications was 2.47 (1.96-3.13). CONCLUSION: The proportion of males was higher than the proportion of females. Workers, peasants and the unemployed comprised the high-risk occupational categories. Male gender, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete injury. We recommend that preventive measures should focus on high-risk populations, such as young males.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904832/pdf/pone.0084733.pdf
Manejo anestésico del traumatismo craneoencefálico
Dr. Guillermo Becerra-Escobedo
Rev Mex de Anestesiol Vol. 31. Supl. 1, Abril-Junio 2008, pp S155-S157
http://www.medigraphic.com/pdfs/rma/cma-2008/cmas081ai.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
Temporal trends of postinjury multiple-organ failure: still resource intensive, morbid, and lethal.
Sauaia A1, Moore EE, Johnson JL, Chin TL, Banerjee A, Sperry JL, Maier RV, Burlew CC.
J Trauma Acute Care Surg. 2014 Mar;76(3):582-92, discussion 592-3. doi: 10.1097/TA.0000000000000147.
Abstract
BACKGROUND:While the incidence of postinjury multiple-organ failure (MOF) has declined during the past decade, temporal trends of its morbidity, mortality, presentation patterns, and health care resources use have been inconsistent. The purpose of this study was to describe the evolvingepidemiology of postinjury MOF from 2003 to 2010 in multiple trauma centers sharing standard treatment protocols.METHODS:"Inflammation and Host Response to Injury Collaborative Program" institutions that enrolled more than 20 eligible patients per biennial during the 2003 to 2010 study period were included. The patients were aged 16 years to 90 years, sustained blunt torso trauma with hemorrhagic shock (systolic blood pressure < 90 mm Hg, base deficit ≥ 6 mEq/L, blood transfusion within the first 12 hours), but without severe head injury (motor Glasgow Coma Scale [GCS] score < 4). MOF temporal trends (Denver MOF score > 3) were adjusted for admission risk factors (age, sex, body max index, Injury Severity Score [ISS], systolic blood pressure, and base deficit) using survival analysis. RESULTS: A total of 1,643 patients from four institutions were evaluated. MOF incidence decreased over time (from 17% in 2003-2004 to 9.8% in 2009-2010). MOF-related death rate (33% in 2003-2004 to 36% in 2009-2010), intensive care unit stay, and mechanical ventilation duration did not change over the study period. Adjustment for admission risk factors confirmed the crude trends. MOF patients required much longer ventilation and intensive care unit stay, compared with non-MOF patients. Most of the MOF-related deaths occurred within 2 days of the MOF diagnosis. Lung and cardiac dysfunctions became less frequent (57.6% to 50.8%, 20.9% to 12.5%, respectively), but kidney and liver failure rates did not change (10.1% to 12.5%, 15.2% to 14.1%). CONCLUSION: Postinjury MOF remains a resource-intensive, morbid, and lethal condition. Lung injury is an enduring challenge and should be a research priority. The lack of outcome improvements suggests that reversing MOF is difficult and prevention is still the best strategy.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4116088/pdf/nihms593568.pdf
Epidemiología de lesiones medulares y factores de riesgo de lesiones completas en Guangdong, China
Epidemiology of spinal cord injuries and risk factors for complete injuries in Guangdong, China: a retrospective study.
Yang R, Guo L, Wang P, Huang L, Tang Y, Wang W, Chen K, Ye J, Lu C, Wu Y, Shen H.
PLoS One. 2014 Jan 28;9(1):e84733. doi: 10.1371/journal.pone.0084733. eCollection 2014.
Abstract
BACKGROUND: Spinal cord injuries are highly disabling and deadly injuries. Currently, few studies focus on non-traumatic spinal cord injuries, and there is little information regarding the risk factors for complete injuries. This study aims to describe the demographics and the injury characteristics for both traumatic and non-traumatic spinal cord injuries and to explore the risk factors for complete spinal cord injuries. METHODS: A retrospective study was performed by reviewing the medical records of 3,832 patients with spinal cord injuries who were first admitted to the sampled hospitals in Guangdong, China. The demographics and injury characteristics of the patients were described and compared between the different groups using the chi-square test. Logistic regression was conducted to analyze the risk factors for complete spinal cord injuries. RESULTS: The proportion of patients increased from 7.0% to 14.0% from 2003 to 2011. The male-to-female ratio was 3.0 ∶ 1. The major cause of spinal cord injuries was traffic accidents (21.7%). Many of the injured were workers (36.2%), peasants (22.8%), and unemployed people (13.9%); these occupations accounted for 72.9% of the total sample. A multivariate logistic regression model revealed that the OR (95% CI) for male gender compared to female gender was 1.25 (1.07-1.89), the OR (95%CI) for having a spinal fracture was 1.56 (1.35-2.60), the OR (95%CI) for having athoracic injury was 1.23 (1.10-2.00), and the OR (95%CI) for having complications was 2.47 (1.96-3.13). CONCLUSION: The proportion of males was higher than the proportion of females. Workers, peasants and the unemployed comprised the high-risk occupational categories. Male gender, having a spinal fracture, having a thoracic injury, and having complications were the major risk factors for a complete injury. We recommend that preventive measures should focus on high-risk populations, such as young males.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3904832/pdf/pone.0084733.pdf
Manejo anestésico del traumatismo craneoencefálico
Dr. Guillermo Becerra-Escobedo
Rev Mex de Anestesiol Vol. 31. Supl. 1, Abril-Junio 2008, pp S155-S157
http://www.medigraphic.com/pdfs/rma/cma-2008/cmas081ai.pdf
Atentamente
Anestesiología y Medicina del Dolor
www.anestesia-dolor.org
No hay comentarios:
Publicar un comentario