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“Dr. Josip Benčević” General Hospital, Slavonski Brod

“Dr. Josip Benčević” General Hospital, Slavonski Brod Department of Aensthesiology, Reanimatology and Intensive Care. POLYTRAUMA CARE IN ICU. I. Matić, M. Jurjević, B. Hrečkovski, I. Lučić. Definition.

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“Dr. Josip Benčević” General Hospital, Slavonski Brod

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  1. “Dr. Josip Benčević” General Hospital, Slavonski Brod Department of Aensthesiology, Reanimatology and Intensive Care POLYTRAUMA CARE IN ICU I. Matić, M. Jurjević, B. Hrečkovski, I. Lučić

  2. Definition • Polytrauma is defined as two or more injuries to physical regions or organ systems, one of which may be life threatening • A syndrome of multiple injuries of defined severity [injury severity score (ISS) ≥ 16] with consecutive systemic reactions, which may lead to dysfunction of remote organs Champion HR. J Trauma. 1990 R. Lefering. European Journal of Trauma 2002

  3. Clinical prognosis Improved survival using ATLS Improved clinical outcome using advanced treatment methods Zander et al. 1992.

  4. Importance • Leading cause of death • Quality of treatment – best indicator od medical care in a specific region • High mortality, long-lasting treatment and rehabilitation with substantial expenses • High incidence of invalidity McKeown DW. Intensive Care Britain 1994

  5. Goals of polytrauma care • Mortality reduction through increased quality and reduced diagnostic time, improved surgical technique and shock treatment, using precise algorithms and adequate therapy and monitoring. Russel R. J Trauma. 2004 Edwin A. CCM. 2006

  6. Scoring systems • based on exact numbering of specific injuries • assesment of injury severity • different injuries combined in a single score • used as a language for communication in literature • results are comparable • prognosis – survival probability for a specific score result

  7. Scoring systems • GCS (Glasgow Coma Score) – eye opening, best motorical and verbal response • RTS (Revised Trauma Score) – physiological score. Sum of GCS, systolic BP and respiratory frequency • ISS (Injury Severity Score) – anatomical score. Based on the AIS (Abbreviated Injury Scale) The 3 most severely injured body regions have their score squared and added together to produce the ISS score . • TRISS = RTS + ISS • NISS – new ISS – three most severe injuries squared regardless of the body region Senkowski CK et al. J Am Call Surg 1999 Aharonson DL. J Trauma. 2006

  8. Patients and methods • Retrospective study • ICU - “Dr. J. Benčević” General Hospital, Sl. Brod • Multi-disciplinary ICU, total 560 patients • 67 (11,96%) polytrauma patients

  9. Patients and methods Monitoring: • GCS • ECG, RR, pulse-oksimetry • Blood gases, ventilation parameters • Blood samples, microbiology cultures • diuresis • Ultrasound, RTG, CT • Central venous catheter, arterial line,PICCO … • ICP, IAP

  10. Patients and methods • General data (sex, age) • Time from injury to ICU admittance • Procedures performed before ICU arrival (venous access, intubation, cardio-pulmonary resuscitation) • Procedures performed immediately on ICU arrival

  11. Patients and methods Severity of injury was assesed using: • GCS, RTS, ISS, TRISS and NISS • Based on ISS and NISS score patients were divided in 4 groups (0-15, 16-26, 27-44, >45 points).

  12. Patients and methods ICU treatment: • Number of surgicaly treated patients • Time from ICU arrival to surgery • Patients that had to be transferred to a tertiary centre for treatment continuation • Application of mechanical ventilation (MV) as well as total MV duration • Incidence of hospital pneumonia and life-threathening complications • Need for tracheostomy • ICU mortality • Time spent in ICU

  13. Results

  14. Results Age – 39.4 (5-94) years

  15. Results

  16. Results

  17. Results

  18. Mortality rates in 3 age groups for diff. ISS (35.827 patients in a retrospective study, 10 hospitals, 5 years) J Trauma. 2006

  19. Discussion German Surgery Congress 2001.: • 5353 polytrauma patients (median age - 38 years) • ISS 24.8 • Time to MD arrival 22.4 min, stay 32.9 min, transport 18.3 min • intubated 58.3 % • Hospital stay 31.1 dan

  20. Conclusion • Polytrauma patients require long-lasting treatment and substantial financial resources • Mortality and invalidity reduction can be achieved only through application of specific algorithms, quality diagnostic and monitoring and a multidisciplinary therapeutic approach.

  21. Thank you

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