Nihon Geka Gakkai zasshi
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Trauma patients who receive exsanguinating torso injuries often develop hypothermia, metabolic acidosis, and coagulopathy before death. A new strategy for trauma surgery has been developed to avoid the occurrence of these events and hence prevent trauma deaths. The strategy is called "damage control surgery" and consists of three maneuvers: a) damage control; b) restoration of physiologic stability; and c) definitive surgery. ⋯ Planned reoperation is usually possible within 36 hours after the initiation of intensive care. Some patients who undergo damage control develop abdominal compartment syndrome characterized by increased intraabdominal pressure, increased peak airway pressure, decreased urine output, and decreased cardiac output. Early decompression surgery should be considered in such patients.
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Acute respiratory distress syndrome (ARDS) and multiple organ failure (MOF) are the most common causes of death in surgical intensive care units. A variety of stimuli, such as major surgery, trauma, shock, thermal injury, acute pancreatitis, and ischemia-reperfusion injury, initiate a systemic inflammatory response that contributes to the development of these complications. ⋯ Recently, measurement of the adequacy of gut circulation has been demonstrated as an excellent tool for prediction of outcome in these patients. The emphasis of this review is on events associated with intestinal ischemia-reperfusion and subsequent distant organ injury.
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Reperfusion injury is recognized as a syndrome which impairs an ischemic organ as well as remote organs throughout the entire body. Previous research has revealed that the various inflammatory mediators, such as cytokines, platelet-activating factors, and free radicals, are involved and interact with each other in reperfusion injury. More recently, it has been demonstrated that neutrophils play an important role in the development of reperfusion injury. ⋯ The same systemic reaction is also observed in multiple organ failure (MOF) or systemic inflammatory response syndrome (SIRS), where organ failure is a major determinant factor for the prognosis of patients. Regarding the treatment of organ failure due to reperfusion injury, several approaches using monoclonal antibody of adhesion molecules or receptor antagonist for cytokines have been introduced. Despite the current accumulation of knowledge, however, prevention is still the regimen for reperfusion injury and concomitant organ failure.
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Multiple organ failure (MOF) is a critical condition developing in patients with overwhelming bodily injury resulting from major surgical insult, severe trauma, extensive burns, acute pancreatitis, and sepsis. It has recently become evident that the host response to such injury is the main pathogenetic factor contributing to the development of MOF. The proinflammatory cytokines tumor necrosis factor (TNF) and interleukin (IL)-1 are known to play a pivotal role in the pathogenetic mechanisms of MOF. ⋯ The resultant systemic inflammation may develop into MOF mainly through neutrophil-endothelial cell interaction when the primary injury is overwhelming or a second inflammatory insult such as sepsis triggers an exacerbated inflammation. It has recently been confirmed that the transcription factor NF-kappaB is involved in the up-regulation of a variety of proinflammatory genes and that cell-mediated immunity is down-regulated in the event of major bodily injury through a shift in the balance between T helper 1 (Th1) and Th2 cytokine response patterns. The molecular immunological mechanisms by which these factors participate in the development of MOF should be characterized.
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Nihon Geka Gakkai zasshi · Jan 1998
Review[Early treatment for body fluid shifts and circulatory derangement in patients with extensive burns].
The initial postburn period is characterized by body fluid shifts and circulatory derangement, or so-called burn shock. The fluid shifts are mainly due to a marked increase in capillary permeability. This loss of capillary integrity is so great that colloid including albumin, readily disperse into the extravascular space. ⋯ Therefore fluid resuscitation should be initiated immediately after injury. Currently a number of methods for achieving adequate volume replacement are available. In this paper we review fluid resuscitation methods for patients with extensive burns and also introduce recent topics on new regimens for resuscitation.