RESUMEN

PURPOSE: To identify high risk groups for infectious pulmonary complications (IPC) in patients with severe polytrauma, depending on the severity of the damage and the volume of acute blood loss in intensive care units in the early stages of the injury. MATERIAL AND METHODS: We studied 410 patients with severe polytrauma and IPC. Severity of injury was calculated according to ISS scale. ROC-curve was made in order to assess the prognostic significance of the impact of the severity of injury and the volume of acute blood loss on the development of IPC. RESULTS: To evaluate the effect of injury severity on the incidence of IPC, patients were divided into 2 groups: I--185 (ISS < 30) and group II--225 (ISS ≥ 30). In group I, prolonged mechanical ventilation was required in 4 patients (2.2%), pneumonia occurred in 9 patients (4.9%), no one died In group II--prolonged mechanical ventilation was performed in 120 (47.6%), pneumonia occurred in 158 (70.2%), sepsis--in 14 (6.2%), 37 (16.4%) patients died. Depending on the volume of blood loss into two groups: I group--179 patients (blood loss < 2000 ml) and group II--231 (blood loss ≥ 2000 ml). Prolonged mechanical ventilation was required 14 (7.6%) patients in group I and at 110 (47.6%)--II group, pneumonia developed in 14 (7.6%) and 153 (66.2%), respectively. Sepsis was developed in 14 patients of group II, whereas in patients of group I it was not registered also differed the number of deaths in the early period: in group 14 (2.2%) patients died, in II--33 (14.3%). CONCLUSIONS: Comparative statistical analysis revealed important criteriafor the prognosis of the IPC in patients with severe polytrauma: the severity of damage on a ISS ≥ 30 points and the volume of acute blood loss ≥ 2000 ml.

Asunto(s)

RESUMEN

Excessive activation of the innate immune system often leads to fatal consequences and can be considered as one of the phenoptotic events. After traumatic injury, various components of mitochondria are released into the circulation and stimulate myeloid cells of the innate immunity. Presumably, mitochondrial DNA (mtDNA) might activate immune cells (Zhang, Q., et al. (2010) Nature, 464, 104-107). In the present study, we investigated the role of mtDNA as a direct activator of human neutrophils, as well as a prognostic marker in patients with severe trauma. Quantitative determination of mtDNA in the plasma of these patients revealed its significant increase (p < 0.02) in the group of survivors compared to non-survivors. Highly purified mtDNA was not able to induce activation of human neutrophils, thus possibly indicating the existence of additional factor(s) ensuring the recognition of mtDNA as a damage-associated molecular pattern.

Asunto(s)

RESUMEN

GOAL OF THE STUDY: To define a relation between the selenium level and the risk of the development of nosocomial pneumonia in patients with severe multiple trauma depending on the trauma severity and the volume of blood loss. MATERIALS AND METHODS: We measured serum selenium concentration in 40 patients with severe multiple trauma. The ISS score was used to estimate the trauma severity. Patients were divided into 2 groups: group I--25 patients without pneumonia, group II--15 patients with pneumonia. The volume of blood loss was estimated in each group. The oxidative stress was estimated by means of the antioxidant index. RESULTS: For selected groups the significant difference (P < 0.05) in the volume of blood loss was detected. It was shown the significant decrease of selenium concentration (P < 0.05) in both groups in comparison with control for all testing time points (the 6-12 hrs, 24 hrs, 3 and 5-7 days). The mean of selenium concentration in group II was significantly lower in comparison to the group I. A significant difference of selenium concentrations (P < 0.05) between groups were detected on the 6-12 hrs and day 3 from the trauma onset. The antioxidant index was significantly lower in the group II within the 6-12 hrs, 12-24 hrs and 5-7 days (P < 0.05) in comparison to group I. CONCLUSIONS: The severe multiple trauma and severe blood loss lead to a selenium deficiency in the blood serum starting with the first hours from the trauma onset, which leads to the critical level of selenium concentration by the Ist day's end after trauma. It also leads to a pronounced oxidative stress that is reflected in the antioxidant index dynamics. Thus serum selenium concentration may be included in the set of the early prognostic detectors to detect infectious pulmonary complications development at severe multiple trauma, and it could be the basis for the decision to take early prophylaxis using selenium medications.

Asunto(s)

RESUMEN

Microscopy of gram-stained impression smears is used for the rapid diagnosis of microorganisms in the wound. The shin tissues of patient P. with suspected gas gangrene of lower extremity soft tissues were microscopically found to have gram-positive spore-forming bacteria that were morphologically similar to C. bifermentans that were identified as C. septicum on cultural diagnosis. The pathogenic C. septicum strain spores were likely to be formed in the macroorganism upon exposure of the pathogen to a patient's defense factors and to a package of therapeutic measures. Microbiological data should be used only in combination with clinical and instrumental findings and the results of other laboratory studies when the optimal technology is chosen to treat gas infection. By keeping in mind that there may be clostridial gangrene in the patients and the experience of clinicians and bacteriologists may be insufficient in diagnosing this pathology, it is necessary to strengthen the training of physicians in the diagnosis of this pathology.

Asunto(s)

RESUMEN

Resuscitative bronchofibroscopy in victims with severe injury and aspiration has been shown to be both a method for diagnosing damages to the bronchus and lung and that for recovering airway patency in them. The most common involvement (47% of cases) in chest injury has been noted to be the lower lung with the development of pyoinflammatory processes caused by etiologically significant microorganisms, such as Staphylococcus aureus and types of Enterobacteriacea, in most cases (more than 50%).

Asunto(s)

RESUMEN

Patients with polytrauma were divided into two groups according to injury severity score (ISS). Group I (10 subjects) consisted of patients who scored less than 25; group II included patients who scored 25 to 49. The study demonstrated a significant increase in NO(x) and MDA levels, as well as ACE activity in groups I and II. NO(x) level displayed a positive correlation with ISS in both groups. The same was demonstrated for ACE activity. In the control group (21 donors) NO(x) level positively correlated with serum ACE activity. However, while NO(x) level positively correlated with ACE activity in group I, this correlation was not observed in group II, suggesting an impairment of conjugated vascular tone regulation caused by imbalance between NO(x) and ACE in patients with more severe injuries. The multifold increase in the level of MDA, the main oxidative stress parameter, in group I and II, indicates the necessity to include antioxidants in complex therapy of patients with polytrauma.

Asunto(s)

RESUMEN

How intensive rehabilitation influences external respiration function, central and peripheral hemodynamics in the injured with a severe multitrauma was investigated in 71 injured. Intensive rehabilitation in combined treatment is shown to improve external respiration function, central hemodynamics, tissue blood flow, sleep, appetite, healing of bedsores, to enhance cough reflex.

Asunto(s)

RESUMEN

Blood linear velocity in inferior cava vein was measured in 74 persons (men and women) aged from 18 to 55 years including 29 healthy volunteers and 45 patients with various severity of trauma and different assessment of its severity by APACHE-2 scale. Correlation between APACHE-2 index and changes of ratio of blood linear velocities in inferior cava vein was demonstrated. It is concluded that ratio of blood linear velocities in inferior cava vein can be used as a criterion of treatment efficacy in patients with combined trauma in early postoperative period.

Asunto(s)

Asunto(s)