Development Of Respiratory Complications Research Articles

Right sided congenital diaphragmatic hernia

Introduction: Congenital diaphragmatic hernia is a rare affection, has been classified as posterolateral, anterior or central. The posterolateral defect occurs on the left side (85%), although it may involve the right side (13%) or be bilateral (2%). Patients and methods: We report the evolution after surgical treatment of right diaphragmatic hernia in one case. Results: A male neonate, born via uncomplicated vaginal delivery at a gestational age of 10 days, weighed 3.8 kg at birth and initially presented with weak crying and a dusky skin tone. He required intubation and was placed on a ventilator. Subsequent imaging studies including chest radiography and CT scan revealed a right congenital diaphragmatic hernia, while ultrasound confirmed the presence of pulmonary hypertension. Following stabilization, the newborn underwent thoracotomy surgery, during which intraoperative exploration revealed the entire liver within the thoracic cavity along with intestinal loops. The liver was challenging to maneuver but was successfully relocated into the abdomen, and the intestinal loops were reduced. Repair of the diaphragmatic defect was accomplished using non-absorbable sutures. Following surgery, the neonate was transferred to the neonatal intensive care unit (NICU), where a postoperative chest radiograph on the fourth day showed expansion of the right lung. Over the subsequent two years, the patient's condition remained stable without the development of respiratory complications or worsening symptoms. Conclusion: Success in this difficult case is optimized by close cooperation between the neonatologist, anesthesiologist, and pediatric surgeon. Although the hospital stay was prolonged, the survival outcome is excellent in this high-risk case.

Viruses in the Respiratory Tract in Elective Cardiac Surgery Patients

Objectives: Acute respiratory distress syndrome after cardiac surgery is a severe complication that is associated with high morbidity and mortality. The presence of viruses in the respiratory tract is postulated to be one of multiple factors attributing to development of Acute Respiratory Distress Syndrome (ARDS), but studies report conflicting results. Since this possible risk factor can potentially be influenced by screening or vaccination, we aimed to further investigate the role of viruses in the development of ARDS after cardiac surgery. Methods: We conducted an explorative prospective cohort study in 49 randomly chosen asymptomatic adult elective cardiac surgery patients. On four different time points, non-fiberscopic mini-broncho alveolar lavages (miniBAL) were collected and analysed with multiplex PCR testing for 11 types of respiratory viruses. Results and Conclusions: Various (merely low pathogenic) respiratory viruses were detected in 12% of our study population. Respiratory viruses were present both within and out of the influenza-like-illness- season. 19 (39%) of all patients developed acute respiratory distress syndrome. No relationship of viral presence with major pulmonary outcomes (PaO2/FiO2 ratio, development of acute respiratory distress syndrome or mechanical ventilation time) could be demonstrated, though events were too few to allow multivariate analyses. Conclusion: Asymptomatic elective cardiac surgery patients do carry respiratory viruses, though not associated with development of respiratory complications. Further research is warranted, in particular research into the (more pathogenic) diverse subtypes of the respiratory viruses, the relevance of virus load (cycle threshold-values) and even into the diagnostic method (throat swab versus deeper material).

The Reproducibility of 3D power Doppler in Intrauterine Growth Restriction

Objective: it is to examine the reproducibility of 3D power Doppler in the management of intrauterine growth restriction compared with the conventional 2d Doppler. Patients and Methods: This study was performed between Jan 2021 and Feb 2022 and included 100 pregnant women recruited from outpatient clinic at Elgalaa Teaching Hospital, 3D power Doppler US was done for assessment of IUGR and compare the findings with 2D Doppler. Results: it is found that 3D Power Doppler parameters were significant in prediction of poor neonatal outcome regarding development of respiratory complications, neurological complications and IUFD as complications to IUGR comparing to 2D colour Doppler parameters which were non-significant in these cases. Our results also showed that the only parameter of 2D Colour Doppler that showed significance and positive correlation to birth weight among these cases was Middle Cerebral Artery Pulpability Index. Conclusion: 2D Doppler flow-velocity waveforms are of limited value in the prediction of poor neonatal outcome in IUGR except for MCAPI. 3D power Doppler was superior in the diagnosis and prediction of neonatal outcome.

The association between erector spinae plane block timing and reduced rib fracture related respiratory complications: A cohort study

Is erector spinae plane (ESP) catheter insertion within 24h of hospital admission for rib fractures associated with a lower incidence of respiratory complications compared to those having an ESP within 48h or after 48h of admission. Retrospective cohort study. Hospital. 199 patients admitted for rib fractures, who received an ESP catheter. Timing of ESP performance was assessed by dividing the study cohort into three subgroups: prompt block within 24h, early block within 48h and late block after 48h of admission. The primary outcome of interest was the development of respiratory complications. This included pneumonia, pulmonary embolism and respiratory failure. Secondary outcomes included intensive care unit (ICU) length of stay and hospital length of stay. A prompt ESP within 24h was performed in 14.5% (n=29) of patients, 47% (n=95) received an early block within 48h and 37% (n=75) of patients received a late block after 48h from admission. There was a significantly higher rate of respiratory complications (p=0.005) with late block. A late block was associated with a significantly longer ICU length of stay (7.82±5.2days) compared to patients who received an early block (5.84±2.8days; p=0.044). There was no significant association with hospital length of stay (p=0.06). There were no differences between the prompt (within 24h) and early (within 48h) block groups for any outcome. The performance of an ESP block after 48h of admission was associated with an increased incidence of respiratory complications and ICU length of stay. There appears to be no added benefit associated with the provision of a prompt ESP within 24h.

INFLUENCE OF RESPIRATORY SYSTEM PROTECTION ON THE TREATMENT OF PATIENTS WITH CRANIOCEREBRAL TRAUMA

Introduction. Craniocerebral trauma (CCT) results in disorders of pharyngeal reflex, deglutition, breathing rhythm and frequency. All the mentioned conditions cause the development of respiratory complications. Whereas they become independent factors of negative therapeutic consequences in such category of patients.
 Aim of a paper. The research aims at evaluating protection/treatment possibilities of the respiratory system concerning the course of craniocerebral trauma in injured patients.
 Materials and methods. We examined 237 patients with CCT who underwent urgent surgical interventions in the form of a decompressive cranial trepanation and the removal of both subdural and epidural hematomata. All patients required prolonged mechanical ventilation of the lungs. The patients were retrospectively divided into two groups, namely: the first group (132 patients) – the patients with tracheostomy on the 5th-6th days of admission to the clinics of anesthesiology and intensive care; the second group (105 patients) – the patients with tracheostomy on the 1st-2nd days of hospitalization. Patients of both groups were not differentiated by gender, the severity of CCT and general condition. In addition to general clinical and biochemical blood markers, culturing of the secretion in the tracheostomy tube (at the moment of tracheostomy and further every 3-4 days), blood and urine were performed in all patients. Simultaneously we controlled the leucocyte count in the peripheral blood, number of immature forms, levels of CRP and procalcitonin. The evaluation of a neurological status of patients was carried out by the Glasgow and Richmond Agitation-Sedation Scale (RASS). The severity of CCT was visualized with the help of CT.
 Research results. Even at the moment of tracheostomy the frequency of colonization of tracheobronchial tree was significantly higher in the first group of patients compared to the second one. Such tendency was monitored in further stages as well. The phenomena of tracheobronchitis and pneumonia were detected more frequently in the group of patients with tracheostomy on the 5th-6th days of postoperative period in contrast to the patients with tracheostomy on the 1st-2nd days of postoperative period. Microorganisms of Enterobacteriaceae with the extended spectrum of ß-lactamase and non-fermenting Gram-negative bacteria were detected more frequently in the first group.
 Conclusion. Early tracheostomy in patients with CCT results in both the decrease in the frequency of positive culturing of secretions from the tracheobronchial tree and the reduction in a detection frequency of nosocomial pneumonia.

A STUDY ON RESPIRATORY COMPLICATIONS AND ITS OUTCOME IN ACUTE PANCREATITIS

Background: Respiratory complications are frequent in acute pancreatitis, and respiratory dysfunction, presenting as Acute lung injury (ALI) or Acute Respiratory Distress Syndrome (ARDS), is a major component of multiple organ dysfunction syndrome (MODS), with a frequent need for ventilator support, which contributes to early death in severe acute pancreatitis. The current study was done with the objective of assessing the morbidity and mortality of acute pancreatitis cases with respiratory complications and to find out whether there is any association between the aetiology of acute pancreatitis and respiratory complications.
 Methodology: It was a prospective observational study conducted in a tertiary care centre in Kerala. All participants admitted with symptoms suggestive of acute pancreatitis were screened for potential enrolment. The inclusion criteria employed were that the patients should be aged above 18 years, and presenting with the first episode of pancreatitis, irrespective of aetiology. All the patients who were admitted were monitored daily for the worsening of any respiratory complications and provided with adequate respiratory supports.
 Results: Out of the 101 participants recruited, males were 84.2%. Mean (SD) age was 42.1 (11.4) years. Majority of cases (61%) had alcoholic aetiology. Fourteen patients required high flow nasal oxygen support, four patients were given face mask support, five patients required ventilator support and three patients required tracheostomy support. Respiratory complications and requirement of support were found to be associated with higher morbidity as well as mortality. Respiratory complications were higher in those with alcoholic etiology but this was not significant in univariate analysis.
 Conclusion: Respiratory complications pose challenges in clinical course of acute pancreatitis in terms of morbidity as well as mortality. Aetiology did not seem to play a major role in development of respiratory complications.

Iatrogenic esophageal and tracheal perforation with tracheoesophageal fistula following emergency intubation.

Iatrogenic tracheoesophageal fistula (TEF) through direct penetration of esophageal and tracheal walls is exceedingly rare. Body tissues sealing around the tube may result in delayed development of respiratory complications and diagnosis. Pneumomediastinum and pneumothorax may be absent. Maintaining the airway through TEF until tracheostomy resulted in a satisfactory outcome.

The Role of Intrapleural Lymphotropic Blockades in the Incidence of Respiratory Complications after Surgical Treatment of Lung Cancer

The development of respiratory complications in patients after surgical treatment of lung cancer remains a serious problem, far from being resolved today. Pain remains the main factor that leads to a decrease in respiratory function in the postoperative period.The aim of this study is to evaluate the effect of intrapleural lymphotropic blockades on the incidence of respiratory complications in the postoperative period in patients undergoing surgical treatment of lung cancer.Materials and methods. 103 patients with operable forms of lung cancer, who underwent anatomical lung resection or pneumonectomy, were treated in the Oncology Department of the Tomsk Regional Oncology Center. The patients were divided in two groups. The first group included 52 patients, who were supplemented with intrapleural lymphotropic blockades. The second group consisted of 51 patients who received a standard multimodal scheme of analgesia in the postoperative period. In the postoperative period, we assessed severity of pain in patients, and the frequency and types of respiratory disorders.Results. The analysis of the results revealed a significant decrease in the intensity of pain syndrome the first 12 hours after surgery in the group of patients, who underwent lymphotropic blockade. The analysis of the frequency of respiratory disorders in the study groups also revealed significant reduction in the number of complications in patients in the group with lymphotropic blockade. Acute postoperative pain, that prevents full natural ventilation, plays one of the key roles in the pathogenesis of respiratory complications in patients after surgical treatment of lung cancer.Conclusion. The use of multimodal analgesia of intrapleural lymphotropic blockade in the complex allows to reduce the pain syndrome and provide psycho-emotional comfort of the patient in the early postoperative period, thereby reducing the risk of respiratory disorders.

Study of respiratory complications and outcome in meconium stained deliveries

Background: To study the development of respiratory complications in the form of meconium aspiration syndrome (MAS), persistent pulmonary hypertension of newborn (PPHN), pulmonary hemorrhage and pneumothorax in neonates born through meconium stained liquor.Methods: It was a prospective study conducted during the period of February to October 2018. All live babies associated with meconium stained liquor were included.Results: Total 606 neonates with meconium stained amniotic fluid (MSAF) were enrolled. Chance of meconium passage was more after 37wk of gestation, in birth weight >2.5 kg and in AGA babies. The rate of LSCS was higher in MSAF group. MAS developed in 28% cases, out of which 42.9% expired. PPHN developed in 6.9% cases, out of which 80% expired. 100% mortality was there in babies with pulmonary hemorrhage. Apgar scores <7 is significantly associated with the development of respiratory complications. 22.8% of vigorous babies and all non-vigorous babies developed respiratory complications showing statistical significance with P-value of <0.00001. Mortality in MSAF was 12%. All babies who expired had severe meconium aspiration syndrome. 83.9% of the patients stayed for <7 days in the hospital. All of the expiry except one occurred within 7 days of life due to development of respiratory complications.Conclusions: MSAF is associated with the development of respiratory complications and mortality in neonates. Non-vigorous babies and the babies with Apgar scores <7 at birth are more prone to developing respiratory complications. Most of the MSAF babies were discharged and mortality was more in patients with respiratory complications.

Risk factors for respiratory complications in patients in the perioperative period

Diseases of the respiratory system (both acute and exacerbations of chronic ones) remain the most frequent non-surgical complications after surgical interventions of various sizes, increasing the duration of the patient»s hospital stay, increasing economic costs and the percentage of deaths. It was shown that respiratory complications developed after abdominal operations increased the risk of 30-day mortality by 10 times. The most common complications include: reintubation, acute respiratory failure, pulmonary edema, atelectasis and pneumonia. The development of respiratory complications is due to the pathology of the respiratory system and respiratory muscles. It is proved that the use of drugs that inhibit neuromuscular conduction in 75 % of cases provokes the development of atelectasis, respiratory muscle dysfunction and reduces respiratory volumes. Respiratory complications are most often caused by hypoxia or hypercapnia. Hypoxia is characterized by a decrease in the partial pressure of oxygen and is well corrected by additional oxygenation. In the first hours after surgery hypoxemia occurs in 50—55 % of cases with a decrease in saturation up to 80 %. Complete normalization of respiratory dysfunction usually occurs 4—6 hours after extubation. Hypercapnia, on the contrary, is characterized by an increase in the partial pressure of oxygen, the phenomena of hyperkalemia and respiratory acidosis. Correction of electrolyte and buffer disturbances is necessary. It is important for the Clinician to remember the need to identify possible risk factors for respiratory complications (modifiable and unmodified) and ways to correct them. Examination of the patient by a therapist before the planned operation, including possible preoperative preparation in the therapeutic departments of a multidisciplinary hospital helps to reduce the frequency of postoperative complications. In this article the authors describe recommendations for evaluation, prevention and diagnosis of respiratory complications in the perioperative period in patients with comorbid pathology.

Factors affecting bacterial culture positivity in specimens from bronchoscopy in patients with suspected lung cancer.

Bronchoscopy is important to diagnose lung cancer. However, some patients who undergo bronchoscopic procedures develop respiratory tract infections. Little is known about the proportion of pathogen-positive results in bacterial cultures from diagnostic bronchoscopy samples in patients with suspected lung cancer. This study aimed to determine the rate of positive bacterial cultures after diagnostic bronchoscopy in patients with suspected lung cancer and the relationship among culture results, clinical characteristics, and respiratory tract infections. We retrospectively reviewed the medical records of all immunocompetent patients who underwent bronchoscopy and had culture and histological samples for the diagnosis of peripheral pulmonary lesions from September 2012 to August 2014 at the National Cancer Center in Tokyo. We analyzed data and classified radiological lesions into the following categories: calcifications, cavitations, low-density areas, margin irregularities, and satellite nodules. The study population consisted of 328 patients (median age, 69 years). We found that 65.9% of patients had malignant lesions and 4.2% of patients had positive cultures for pathogenic bacteria. The number of calcifications (p = 0.002, 95% CI: 2.17-41.10) was significantly higher in patients with positive bacterial isolates, according to the multivariate analysis, and bacterial culture positivity was not associated with the development of respiratory complications after bronchoscopy. Of the three patients with respiratory complications, all presented with cavitations. Because of the low prevalence of positive bacterial cultures in patients with suspected lung cancer, bacterial culture may be limited to specific patients, such as those with calcifications. Lesions with cavitation warrant close monitoring.

The potential role of 13-valent pneumococcal conjugate vaccine in preventing respiratory complications in bacteraemic pneumococcal community-acquired pneumonia

IntroductionPneumococcal 13-valent vaccine (PCV-13) has a potential role in preventing bacteraemic pneumococcal pneumonia and its complications, but little is known about its ability to specifically prevent respiratory complications. Our aim were to analyse the pneumococcal serotypes associated with the development of respiratory complications and the potential role of PCV-13 in preventing respiratory complications in bacteraemic pneumococcal pneumonia. Material and methodsWe analysed demographic characteristics, comorbidities, antibiotic resistances and the outcomes of a cohort of 65 vaccine-naïve bacteraemic pneumococcal pneumonias, stratified by the pneumococcal serotypes included in PCV13 vs. those not included. Complications were clustered as follows: respiratory complications (hypoxemic respiratory failure; mechanical ventilation), systemic complications (septic shock; multiorgan failure), suppurative complications (empyema; pleural effusion; lung abscess). ResultsFrom a population of 65 CAP-SP, 47.7% of the isolates belonged to PCV-13 serotypes group. No differences in comorbidities or clinical manifestations were found between groups. With regard to biochemical parameters, we found more profound hypoxemia levels in PCV-13 serotypes group comparing to non-vaccine group [PaO2/FiO2 209 (63) vs. 268 (57); p=0.007]. Global complications were identified in 69.2% (45 patients), and the most frequent were respiratory complications, found in 47.7%. Respiratory complications were detected more frequently in PCV-13 groups compared to non-vaccine groups (61.3% vs. 35.3%; p=0.036). Overall 30-day mortality was 30.8%. Mortality was similar between both groups (25.8% vs. 35.3%; p=0.408). ConclusionsPneumococcal 13-valent conjugate vaccine includes the serotypes which cause more respiratory complications in our series; these serotypes were not associated with higher mortality in our series. PCV-13 may have a potential role in preventing respiratory complications due to bacteraemic pneumonoccal pneumonia.

Risk, monitoring, management development of respiratory complications in the postoperative period surgeries of esophagus

Risk, monitoring, management development of respiratory complications in the postoperative period surgeries of esophagus

Changes in Airway and Respiratory Tissue Mechanics After Cardiac Surgery

Because of the critical importance of the first postoperative week in the development of respiratory complications after cardiac surgery, the mechanical properties of the respiratory system in this period were followed up systematically. The input impedance of the respiratory system (Zrs) was measured during spontaneous breathing in patients (n=35) undergoing cardiac surgery on the day before surgery to establish the baseline, and for six days thereafter. The airway resistance was inferred from the average of the resistive component of Zrs, while the changes in respiratory elastance were assessed from the imaginary part of Zrs by model fitting. An assessment was made of the impact on the postoperative changes of factors characteristic of the patients (gender, age, smoking, and obesity) or the surgery duration and the need or not for a cardiopulmonary bypass. Airway resistance increased immediately after extubation (peak rise on day 1, evening: 48+/-10%) and subsequently gradually decreased to the initial level, the recovery proving prolonged in obese patients. Postoperative elevation in elastance peaked later (day 2, evening: 83+/-14%), lasted longer, and was affected by both cardiopulmonary bypass (p<0.05) and obesity (p<0.005). These findings demonstrate the need for particular attention in the postoperative management of patients after cardiac surgery in order to reduce the immediate airway symptoms, and to take steps to maintain the lungs open during the critical postoperative days 2 and 3, especially in obese patients and (or) if the surgery involves the use of cardiopulmonary bypass.

Respiratory complications after oesophageal surgery

The most frequent complications of oesophageal surgery are respiratory and these are associated with increased critical care stay, hospital stay and mortality. This review focuses on the risk factors associated with the development of respiratory complications after oesophageal surgery. An acceptable operative mortality, increased and improved quality of life can be gained in appropriately selected patients. When induction therapy is scheduled, smoking cessation is advised. The preoperative treatment of airway pathogens can reduce postoperative complications and this may be particularly relevant in patients who have received induction chemoradiotherapy. Nonrandomized studies suggest that thoracic epidural analgesia improves outcome. Minimally invasive surgery is increasingly used and appears safe but direct comparisons to open surgery in terms of respiratory complications are awaited. Few randomized studies are available to guide anaesthetic management but anaesthetists should aim to avoid hypoxaemia, hypotension, aspiration and limit blood and fluid administration. Postoperative aspiration is common and steps to reduce it are recommended. The multifactorial nature of respiratory complications after oesophageal surgery may mean that a number of interventions are needed to have a detectable influence on outcome, much like a care bundle strategy.

Hidatidosis pulmonar pediátrica: Reporte de 12 años de experiencia

Pulmonary hydatid (PH) disease in children is a frequent cause of referral at our hospital. Patients and Methods : A retrospective study was conducted in children hospitalized for PH disease in the period 1990-2002. Results: 33 children (39 hospitalizations) aged 4 to 13 years were studied. The diagnosis was based on the clinical picture and chest x-ray in 93% of cases. 26 children had complicated cysts. 20 were treated surgically and 14 solely received albendazole. The most common surgical technique was lobectomy. Post-operative complications were: atelectasis (6), bronchopleural fistulas (5) and pneumonia (4). The development of respiratory complications was significantly associated with complicated cysts or pulmonary resection (p < 0.05). Four patients experienced cyst rupture. Discharge within 2 weeks was registered in 24 patients. 19 patients (18 surgical) were free of PH disease upon discharge. Conclusions: Surgical treatment proved to be safe and effective, medical therapy could not be evaluated due to poor follow-up. Newer and future studies are needed to confirm our results.

Increased airway mucins after cardiopulmonary bypass associated with postoperative respiratory complications in children

ObjectiveAirway mucins may play an important role in the mechanism of respiratory complications after cardiopulmonary bypass in infants and children. Our aim was to measure airway mucin levels before and after cardiopulmonary bypass and to determine whether changes in mucin levels were associated with the development of respiratory complications. MethodsAirway glycoprotein and mucins (MUC5AC, MUC5B, and MUC2) in serial small-volume airway lavage samples from 39 young children who underwent cardiac operations with cardiopulmonary bypass were measured by slot-blot assay with specific antimucin peptide antibodies. The relationship between mucin changes and post–cardiopulmonary bypass respiratory complications was investigated. Airway lavage samples were also collected from 11 children before and after operation without cardiopulmonary bypass, and changes in mucin levels were compared with those in subjects who underwent cardiopulmonary bypass. Airway lavage sample DNA was also measured to investigate the relationship between mucin changes and lung injury. ResultsGlycoprotein, MUC5AC, and MUC5B levels were significantly increased after cardiopulmonary bypass (P < .001) whereas MUC2 level was not. Children with respiratory complications showed significantly higher glycoprotein and MUC5AC levels than did children without respiratory complications before and after cardiopulmonary bypass (P < .05). Increase of total mucin (MUC5AC, MUC5B, and MUC2) during cardiopulmonary bypass showed positive correlation with DNA increase during cardiopulmonary bypass (r = 0.73), Paco2 (r = 0.62) and alveolar-arterial oxygen difference (r = 0.55) immediately after cardiopulmonary bypass. Increase of total mucin was associated with postoperative respiratory complications and their severity. There were no significant changes detected in airway mucin during operations without cardiopulmonary bypass. ConclusionsAirway mucins were increased during cardiopulmonary bypass, and this increase was associated with markers of lung injury after cardiopulmonary bypass and with the development of postoperative respiratory complications.

The golden hour and the silver day: detection and correction of occult hypoperfusion within 24 hours improves outcome from major trauma.

The significance of occult hypoperfusion (OH) in the development of respiratory complications (RC), multiple system organ failure (MSOF), and death, and the effect of rapid identification and correction of OH in the severely injured trauma patient was investigated. A pilot retrospective study and the analysis of a prospective protocol to correct OH were performed. Pilot study: all trauma patients admitted to our Level I trauma center between February and December of 1995, who survived greater than 48 hours, had an Injury Severity Score greater than or equal to 20, and intensive care unit stays greater than 48 hours were evaluated. Prospective study: patients admitted between January 1, 1996, and April 30, 1997, who survived greater than 24 hours, with Injury Severity Score greater than or equal to 20, and who were hemodynamically stable (systolic blood pressure greater than 100, pulse rate less than 120, and urine output greater than 1 mL/kg per hour) were included. Serum lactic acid (LA) levels were measured at arrival and at proscribed intervals. In the pilot study, initial LA levels were examined in relation to outcome and complications. In the prospective study, patients with two consecutive LA levels greater than 2.5 mmol/L underwent invasive monitoring and vigorous resuscitation to correct their lactic acidosis. Among the 31 patients studied in the pilot study, there were 4 deaths, 6 cases of MSOF, and 13 patients with RC. Lactic acidosis and poor cardiac performance, as evidenced by low cardiac index (CI) with normal filling pressures, were seen in all cases of MSOF and RC, as well as in all deaths. From these results, the prospective study was performed. Eighty-five intensive care unit patients met criteria for inclusion in the study. Six additional patients were excluded because of severe, untreatable intracranial hypertension at admission to the intensive care unit. Fifty-eight of these patients had OH in the first 24 hours. Forty-four patients corrected their OH within 24 hours with vigorous resuscitation. There were no deaths, three cases of MSOF, and 10 cases of RC in those patients who corrected OH within 24 hours. Persistent OH (>24 hours) was seen in 14 patients, despite resuscitative efforts, 43% of whom died. MSOF and RC were present in 36% and 50% of cases, respectively (p<0.05). Initial lactic acidosis is associated with lower cardiac performance and higher morbidity and mortality. Persistent OH is associated with higher rates of RC, MSOF, and death after severe trauma. Early identification and aggressive resuscitation aimed at correcting continued elevation in serum lactate improves survival and reduces complications in severely injured trauma patients.

Cervical spinal cord injury: the correlations of initial clinical features and blood gas analyses with early prognosis

The predictive values of some early post-traumatic clinical symptoms and signs and laboratory tests on the problems, complications and prognosis of the initial treatment of tetraplegic patients were studied. The study was carried out by scrutinizing the files of 54 patients with a cervical spinal cord injury (40 of them complete and 14 incomplete). Most of the patients (n = 43) needed ventilatory support, the duration of which depended on the level and completeness of the spinal cord injury. Bradycardia, hypotonia and tachypnoea at admission occurred most frequently in those patients who later developed complications or died. In addition, the frequency of complications correlated with a patient's age, previous diseases and with the height and degree of the spinal cord injury. Tachypnoea on admission forecast the later development of respiratory complications. All 8 patients who died, 5 of them from pneumonia and 3 from pulmonary embolism, had their spinal cord injury at the level C4 to C5 and they were significantly older than those who survived.