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P156 The role of hypothermia in trauma resuscitation
Trauma, Pathophysiology, Electrotherapy, Drugs, Paediatrics, Brain, Complications
s15
P156
P158
The role ofhypothermia in trauma rmwcitation
RETICULOENDOTHELIAL SYSTEM FUNCTION AND ACTIVITY CIRCULTING NEUTROPHILS AFTER SEVERE TRAUMA
Andreas Seekamp. Ma-tin Grotz. Gerd Regel.Harald Tscbeme
H.C.Paoe. ‘A.Dwmzer. **JKotzerke. S.Ztddar. G. Renel Depts. of Traumatology, ‘Biochemistry and **Nuclear Medicine, Hamover Med School
Medtcd School Hanover, Konstxnty-Gutschow-Str 8.30625 Harmover me initial phase of treatment in lpolw patients is commonly characterized by a ig&im bvpotbamia The major role 0fbyQothermia in the onset of ponaaumatic contpltcmtotu is still under disuwsioa Retmapectively we bwe an&ed data of 782 polytrpurmtized pmiatts (IS-22) oftbe yea 1981-1992. Accordb@ to the Severity Of )allpaiatswaedividedintotbrez hypothllk(muuural~epmalbOdyampwnve groqw. Group A: T>345: (a= 203.26%). @uup 8: Tc34oC @=321,41%), @-sup C: Tc32’C (IF 125.16%). 55 patients (7%) d&d w beca”x ofa scydc bead ittj”ty md in 78 was not l-ecded. The l-ateofrtwltiple organ fare (wxrding to cesestkilttdel~ the ctiteda ofcoris) and lemthy lat.2lvere aralyd.
OF
PURPOSE lmpaimwtt of the stationary (reticuloendothelii system, RES) and the intravascular nonspecific immune system (palymor-phonuclear leukocytes, PMN) is said to contribute to the pathcgenesis of multiple organ failure (MOF) We therefore evaluated changes of these systems during the intensive care period in polytrauma patients. METHODS: 26 po1ytmumatized patients were studied pmsp@ively. Every second day the RES clearance capacity (K-value, invasion constant, normal range 0.6 - 0.8 min-l) was studied after i.v injection of 100 m8q 99mTc-buman serum albumin milliicrosphaes. Liw perfusion was calculated from these data. Total scntm hiliibin (pm&l) and the stimulatory capacity of Ph4N in whole blood (Chemilumiwwnce, CL, normal range: 2 6-3 2 x 106cpm/ 2x105 PMN) were determined Two groups were separated regarding MOF (+MOF, -MOF) according the MOF Score (GORlS). RESULTS Mean ISS +MOl? 35.1 (n=g), -MOF 28.3 (rig) Letality +MOF n=4: -MOF none STATISTICS U-Test, Wilcoxon, p
--
..~
..-
indicating cellular exhaustion. In -MOF~+nts extensive hypen&vity of PMN was present, indicating intact reaction to tnmma 4. In the presatce of wwessioti of cireulatinn nn;lropbils RES activation might be a comp-asatory
RES function,
multlple
trauma,
Immune response.
P3
PI57
BOUT URLY AFlER RESTORATIONOF SPGNTAREWS ClRCUlATlON DOES NOT CORRELATEWITN NEUROLGGtC OUTCOME AFTER CARDIACARREST
A HWERI’ENOIVE
THE INFLUENCE OF INITIAL TREATMENT OF MULTIPLE TRAUMA PATIENTS FOR THE DEVELOPMENT OF MULTIPLE ORGAN FAILURE M GROTZ, U LEHMANN, G REGEL. H.TSCHWU‘IE Unfallchinqiscbe Klinik, Medizinische Hocbschule Hammver, 30623 Hannover Introduction’ The initial treahnmt of m”Itiple truma patients seems influence to the development of multiple organ Failure(MOF) The aim of this study was to investigate criteria in the preclinical and early clinical treatment which lead to posttmwmtic organ f&Ire &I&Q& 762 multiple trauma patients (l982-92)(Hamwver Polytrauma Score (PTS) > 20); Exch&n criteria death < 24h alter trauma. Dwumentation of injury severity and -pattern methods of r-e (hdiiopter-lU?L. ambulance-AMB). rescue intervals (‘M: interval of no therapy. INT: interval from trauma to intubtation. RZ. interval Eiom trauma to arrival in hospital, REA time in resuscitation room, volume therepy (preclinicaU24h atIer trauma: CR-cristalloids, BU-Mood units, FFP&sh l&en plasma). catecbolamiwr (24h e&r trauma), cause and time of death (TZ. days after trauma). Patients were divided in +MOf (I 8%j! -MOF (82%) according to the MOV-Score (GORIS). Statistics ‘sign p
+MOF I9 53 58 101 3060’ 11260’ ISlO* 1070’ 7.11’ -MOF 21 57 60 104 2440 8930 IO80 570 2.59 /.e/k,liry~ 27.3 %. +MOF 68.6%. -MOF 18.2% tbure ofdmh:
4.95' 1.22' I.28 0 MOF 36.1%. TZ 16.7.
Head injury 26.9%. TZ 3.6. ARlX 6.4%. TZ. 10.3 Conclusions~ Despite optimal rescue conditions (helicopter, early intubation, short rescue intervals) signilicant differences in injury severity and -pattern cause early dysiimction (high demand m volume. catecholsmines) leading to late MOF Multiple trauma, initnd treatment. multiple organ failure
K.HEUWAGNER. FSTERZ. M.M~LLNER.I.KDRKCIYAN,HDOMANOVITS, M.HOL.?ER. CH.SITZWOHL.A.N.lAGGNER Eme~ency Deprtnwnt. UnNemHyHas#tsl Vienna.Ausbia STUDY OWECllVE: To deteenineI a brief hypertensb bout (systolic arledalpressure z-150mmHg) early ablerrestorattonof spmtaneous circulation(ROSC) correlates with neumkgic mdcmw (CPC) after Cardiacarrest (CA) PARTICIPANTS:PSthtS aRet CA with ROSC and dowmented art&al systo,lc blood pressure (SPB) for the flrsl2 ho”ls Bn0rROSC. &&k&l wem pallsntr with CA of preoumed“0” cardiac etiology and those who died w8hll2 how? sfler ROSC. METHODS: Pmspdive study. Patientswere groupedaccordingto SSP. Gmup 1 with SSP t 150 mmklg withinthe Rrst 5 min after ROSC (Hyper(enslve Soul).Group 2 with SSP 80 to 148 mmH8 and Group 3 with SBP < m “l”,Hg more than 10 mint&esduhg the 8rst 2 hours after ROSC. Bast reachedWC swre was evaluated&in the rirst S month aner ROSC. For anaiysisANOVA. Chb square te.b!eand KNskaCWallIIstatiific were used RESULTS:Oti of 332 patients(July 1881- Deamber 1893) 84 were elkkiM%.There was no significantdaferencein emergency medicalservica response time [Group 1: 3.8~8.8 min, Group 2. 4 8*4.8min. Group 3: 4.6f5.9 (p=O.9)]and epinephnneneededfar ROSC [Group 1: 212.8 ma Group 2:3.7*6.0 m&Group 3:5.9+10.6 mg (p=0.3)].Timeto achieve ROSC [Group 1.9.8f9.5 min. Gm”p 2: 16.2f14.8 min, Gmup 3: 29.6ti9.5 mm (p=O.Ot)] andcathecholammesneededafter ROSC [Gmup 1’ 28%, Gmup 2: Se%,Group 3: 86% (pO.OOlZ)] was signmcantdiflerentbetweengro”ps. but there was no slgnifcant dllerence in neumlcqic~Ulcomefp=O47). see table sert CPC Group1 Group2 Group3 04 month *BPprl rmnng SW et-149mmHp SBPIBOmmng “=I8 “=25 n=*, CPC! 1oew lll4m~ 6mm, WC2 O,OW 2,W I,l%, WC3 7@Xl II4T.j 1,5’1) 1~17%) 1,lSZ) WC. 5“WA, c?cs 1WX) 6w5+, 9,ux, CONCLUSION: A hypertensivebO”t wlhin in the first 5 minutesalter ROSC does not correlatewith neumlogicoutcomea6er CA Cardiac Arrest. Hypertensive BoJ. ROSC
s15
P156
P158
The role ofhypothermia in trauma rmwcitation
RETICULOENDOTHELIAL SYSTEM FUNCTION AND ACTIVITY CIRCULTING NEUTROPHILS AFTER SEVERE TRAUMA
Andreas Seekamp. Ma-tin Grotz. Gerd Regel.Harald Tscbeme
H.C.Paoe. ‘A.Dwmzer. **JKotzerke. S.Ztddar. G. Renel Depts. of Traumatology, ‘Biochemistry and **Nuclear Medicine, Hamover Med School
Medtcd School Hanover, Konstxnty-Gutschow-Str 8.30625 Harmover me initial phase of treatment in lpolw patients is commonly characterized by a ig&im bvpotbamia The major role 0fbyQothermia in the onset of ponaaumatic contpltcmtotu is still under disuwsioa Retmapectively we bwe an&ed data of 782 polytrpurmtized pmiatts (IS-22) oftbe yea 1981-1992. Accordb@ to the Severity Of )allpaiatswaedividedintotbrez hypothllk(muuural~epmalbOdyampwnve groqw. Group A: T>345: (a= 203.26%). @uup 8: Tc34oC @=321,41%), @-sup C: Tc32’C (IF 125.16%). 55 patients (7%) d&d w beca”x ofa scydc bead ittj”ty md in 78 was not l-ecded. The l-ateofrtwltiple organ fare (wxrding to cesestkilttdel~ the ctiteda ofcoris) and lemthy lat.2lvere aralyd.
OF
PURPOSE lmpaimwtt of the stationary (reticuloendothelii system, RES) and the intravascular nonspecific immune system (palymor-phonuclear leukocytes, PMN) is said to contribute to the pathcgenesis of multiple organ failure (MOF) We therefore evaluated changes of these systems during the intensive care period in polytrauma patients. METHODS: 26 po1ytmumatized patients were studied pmsp@ively. Every second day the RES clearance capacity (K-value, invasion constant, normal range 0.6 - 0.8 min-l) was studied after i.v injection of 100 m8q 99mTc-buman serum albumin milliicrosphaes. Liw perfusion was calculated from these data. Total scntm hiliibin (pm&l) and the stimulatory capacity of Ph4N in whole blood (Chemilumiwwnce, CL, normal range: 2 6-3 2 x 106cpm/ 2x105 PMN) were determined Two groups were separated regarding MOF (+MOF, -MOF) according the MOF Score (GORlS). RESULTS Mean ISS +MOl? 35.1 (n=g), -MOF 28.3 (rig) Letality +MOF n=4: -MOF none STATISTICS U-Test, Wilcoxon, p
--
..~
..-
indicating cellular exhaustion. In -MOF~+nts extensive hypen&vity of PMN was present, indicating intact reaction to tnmma 4. In the presatce of wwessioti of cireulatinn nn;lropbils RES activation might be a comp-asatory
RES function,
multlple
trauma,
Immune response.
P3
PI57
BOUT URLY AFlER RESTORATIONOF SPGNTAREWS ClRCUlATlON DOES NOT CORRELATEWITN NEUROLGGtC OUTCOME AFTER CARDIACARREST
A HWERI’ENOIVE
THE INFLUENCE OF INITIAL TREATMENT OF MULTIPLE TRAUMA PATIENTS FOR THE DEVELOPMENT OF MULTIPLE ORGAN FAILURE M GROTZ, U LEHMANN, G REGEL. H.TSCHWU‘IE Unfallchinqiscbe Klinik, Medizinische Hocbschule Hammver, 30623 Hannover Introduction’ The initial treahnmt of m”Itiple truma patients seems influence to the development of multiple organ Failure(MOF) The aim of this study was to investigate criteria in the preclinical and early clinical treatment which lead to posttmwmtic organ f&Ire &I&Q& 762 multiple trauma patients (l982-92)(Hamwver Polytrauma Score (PTS) > 20); Exch&n criteria death < 24h alter trauma. Dwumentation of injury severity and -pattern methods of r-e (hdiiopter-lU?L. ambulance-AMB). rescue intervals (‘M: interval of no therapy. INT: interval from trauma to intubtation. RZ. interval Eiom trauma to arrival in hospital, REA time in resuscitation room, volume therepy (preclinicaU24h atIer trauma: CR-cristalloids, BU-Mood units, FFP&sh l&en plasma). catecbolamiwr (24h e&r trauma), cause and time of death (TZ. days after trauma). Patients were divided in +MOf (I 8%j! -MOF (82%) according to the MOV-Score (GORIS). Statistics ‘sign p
+MOF I9 53 58 101 3060’ 11260’ ISlO* 1070’ 7.11’ -MOF 21 57 60 104 2440 8930 IO80 570 2.59 /.e/k,liry~ 27.3 %. +MOF 68.6%. -MOF 18.2% tbure ofdmh:
4.95' 1.22' I.28 0 MOF 36.1%. TZ 16.7.
Head injury 26.9%. TZ 3.6. ARlX 6.4%. TZ. 10.3 Conclusions~ Despite optimal rescue conditions (helicopter, early intubation, short rescue intervals) signilicant differences in injury severity and -pattern cause early dysiimction (high demand m volume. catecholsmines) leading to late MOF Multiple trauma, initnd treatment. multiple organ failure
K.HEUWAGNER. FSTERZ. M.M~LLNER.I.KDRKCIYAN,HDOMANOVITS, M.HOL.?ER. CH.SITZWOHL.A.N.lAGGNER Eme~ency Deprtnwnt. UnNemHyHas#tsl Vienna.Ausbia STUDY OWECllVE: To deteenineI a brief hypertensb bout (systolic arledalpressure z-150mmHg) early ablerrestorattonof spmtaneous circulation(ROSC) correlates with neumkgic mdcmw (CPC) after Cardiacarrest (CA) PARTICIPANTS:PSthtS aRet CA with ROSC and dowmented art&al systo,lc blood pressure (SPB) for the flrsl2 ho”ls Bn0rROSC. &&k&l wem pallsntr with CA of preoumed“0” cardiac etiology and those who died w8hll2 how? sfler ROSC. METHODS: Pmspdive study. Patientswere groupedaccordingto SSP. Gmup 1 with SSP t 150 mmklg withinthe Rrst 5 min after ROSC (Hyper(enslve Soul).Group 2 with SSP 80 to 148 mmH8 and Group 3 with SBP < m “l”,Hg more than 10 mint&esduhg the 8rst 2 hours after ROSC. Bast reachedWC swre was evaluated&in the rirst S month aner ROSC. For anaiysisANOVA. Chb square te.b!eand KNskaCWallIIstatiific were used RESULTS:Oti of 332 patients(July 1881- Deamber 1893) 84 were elkkiM%.There was no significantdaferencein emergency medicalservica response time [Group 1: 3.8~8.8 min, Group 2. 4 8*4.8min. Group 3: 4.6f5.9 (p=O.9)]and epinephnneneededfar ROSC [Group 1: 212.8 ma Group 2:3.7*6.0 m&Group 3:5.9+10.6 mg (p=0.3)].Timeto achieve ROSC [Group 1.9.8f9.5 min. Gm”p 2: 16.2f14.8 min, Gmup 3: 29.6ti9.5 mm (p=O.Ot)] andcathecholammesneededafter ROSC [Gmup 1’ 28%, Gmup 2: Se%,Group 3: 86% (pO.OOlZ)] was signmcantdiflerentbetweengro”ps. but there was no slgnifcant dllerence in neumlcqic~Ulcomefp=O47). see table sert CPC Group1 Group2 Group3 04 month *BPprl rmnng SW et-149mmHp SBPIBOmmng “=I8 “=25 n=*, CPC! 1oew lll4m~ 6mm, WC2 O,OW 2,W I,l%, WC3 7@Xl II4T.j 1,5’1) 1~17%) 1,lSZ) WC. 5“WA, c?cs 1WX) 6w5+, 9,ux, CONCLUSION: A hypertensivebO”t wlhin in the first 5 minutesalter ROSC does not correlatewith neumlogicoutcomea6er CA Cardiac Arrest. Hypertensive BoJ. ROSC