RESUMO
BACKGROUND: In trauma patients surviving their initial injuries, infectious complications and multiple organ failure represent the major causes of death after the first 72 hours. Critically injured trauma patients frequently have bacteria recoverable simultaneously from multiple culture sites; the clinical significance of this event is unknown. The objective of this study was to identify the association between growth patterns of multiple site cultures and mortality among critically injured trauma patients. METHODS: We performed a retrospective chart review collecting demographic and medical data on admissions to a state-designated Level I trauma center from April 2000 to December 2002. The inclusion criteria were age >17 years, admission to the trauma intensive care unit (TICU), and simultaneous sampling of blood, sputum, and urine in the setting of fever of undetermined origin or alteration in the white blood cell count. Four mutually exclusive groups were developed according to the number of positive culture sites. We used standard statistical analysis and multivariate logistic regression. RESULTS: During the study period, 3,402 patients were admitted to the trauma service of whom 124 met the inclusion criteria. Eighty percent of these (99) were male, and the average age was 41 years. The median TICU stay was 17 days. The mortality rate was 24.2% (30 nonsurvivors). The survivors and non-survivors were comparable in injury severity score (ISS), initial base deficit, initial hematocrit, initial blood pressure, and hospital length of stay (p > 0.05), whereas age (p = 0.03), female sex (p = 0.04), and TICU stay (p < 0.01) were higher among non-survivors. More non-survivors showed growth of microorganisms in simultaneous blood, sputum, and urine cultures (p = 0.02). By multivariate analysis, adjusting for age, sex, and TICU length of stay, patients with growth of microorganisms in simultaneous cultures (blood, sputum, and urine) had a 3-fold greater mortality rate (OR, 3.20; 95% CI 1.05, 9.73). CONCLUSIONS: In this group of patients, growth of bacteria in simultaneous cultures was associated with higher mortality-a factor that may be considered a poor prognostic indicator. This factor requires further studies to explore the relation with survival in critically injured patients.
Assuntos
Infecções Bacterianas/complicações , Estado Terminal/mortalidade , Ferimentos e Lesões/complicações , Adulto , Infecções Bacterianas/mortalidade , Sangue/microbiologia , Feminino , Febre , Humanos , Escala de Gravidade do Ferimento , Unidades de Terapia Intensiva , Contagem de Leucócitos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Estudos Retrospectivos , Escarro/microbiologia , Estatística como Assunto , Centros de Traumatologia , Urina/microbiologia , Ferimentos e Lesões/mortalidadeRESUMO
Temporary abdominal closure (TAC) has increasingly been employed in the management of severely injured patients to avoid abdominal compartment syndrome (ACS) and as part of damage control surgery (DCS). Although the use of TAC has received great interest, few data exist describing the morbidity and mortality associated with its use in trauma victims. The main goal of this study is to describe the incidence of surgical complications following the use of TAC as well as to define the mortality associated with this procedure. A retrospective review of patients admitted to a state-designated level 1 trauma center from April 2000 to February 2003 was performed. Inclusion criteria were age >18 years, traumatic injury, and need for exploratory laparotomy and use of TAC. A total of 120 patients were included in the study. The overall mortality of trauma patients requiring TAC was 59.2 per cent. The most common causes of death were acute inflammatory process (50.7%), followed by hypovolemic shock (43.7%). The incidence of surgical complications was 26.6 per cent. Intra-abdominal abscesses were the most frequent surgical complication (10%). After multiple logistic regression analysis, increasing age and a numerically greater initial base deficit were found to be independent predictors of mortality in trauma patients that require TAC.
Assuntos
Traumatismos Abdominais/mortalidade , Traumatismos Abdominais/cirurgia , Causas de Morte , Laparotomia/efeitos adversos , Complicações Pós-Operatórias/mortalidade , Traumatismos Abdominais/diagnóstico , Síndromes Compartimentais/prevenção & controle , Feminino , Humanos , Escala de Gravidade do Ferimento , Laparotomia/métodos , Modelos Logísticos , Masculino , Análise Multivariada , Complicações Pós-Operatórias/diagnóstico , Probabilidade , Prognóstico , Estudos Retrospectivos , Medição de Risco , Fatores de Tempo , Centros de TraumatologiaRESUMO
Presentamos el caso de un niño de 11 años de edad con hidrocefalia a quien se instaló sistema derivativo ventrículo-auricular V-A) y presentó como complicación ruptura de porción del catéter distal, con alojamiento en cavidades cardiacas derechas. Desarolló endocarditis bacteriana que se resolvió con tratamiento médico; para una cura definitiva se debió extraer el catéter no radio-opaco quirúrgicamente. La localización del catéter intracardiaco se realizó con ecocardiografía bidimensional