Fibrinogen in traumatic haemorrhage: A narrative review

Haemorrhage in the setting of severe trauma is associated with significant morbidity and mortality. There is increasing awareness of the important role fibrinogen plays in traumatic haemorrhage. Fibrinogen levels fall precipitously in severe trauma and the resultant hypofibrinogenaemia is associated with poor outcomes. Hence, it has been postulated that early fibrinogen replacement in severe traumatic haemorrhage may improve outcomes, although, to date there is a paucity of high quality evidence to support this hypothesis. In addition there is controversy regarding the optimal method for fibrinogen supplementation. We review the current evidence regarding the role of fibrinogen in trauma, the rationale behind fibrinogen supplementation and discuss current research.Griffith Health, School of Medical ScienceNo Full Tex

Early mobilization and recovery in mechanically ventilated patients in the ICU: a bi-national, multi-centre, prospective cohort study

Introduction: The aim of this study was to investigate current mobilization practice, strength at ICU discharge and functional recovery at 6 months among mechanically ventilated ICU patients. Method: This was a prospective, multi-centre, cohort study conducted in twelve ICUs in Australia and New Zealand. Patients were previously functionally independent and expected to be ventilated for >48 hours. We measured mobilization during invasive ventilation, sedation depth using the Richmond Agitation and Sedation Scale (RASS), co-interventions, duration of mechanical ventilation, ICU-acquired weakness (ICUAW) at ICU discharge, mortality at day 90, and 6-month functional recovery including return to work. Results: We studied 192 patients (mean age 58.1 ± 15.8 years; mean Acute Physiology and Chronic Health Evaluation (APACHE) (IQR) II score, 18.0 (14 to 24)). Mortality at day 90 was 26.6% (51/192). Over 1,351 study days, we collected information during 1,288 planned early mobilization episodes in patients on mechanical ventilation for the first 14 days or until extubation (whichever occurred first). We recorded the highest level of early mobilization. Despite the presence of dedicated physical therapy staff, no mobilization occurred in 1,079 (84%) of these episodes. Where mobilization occurred, the maximum levels of mobilization were exercises in bed (N = 94, 7%), standing at the bed side (N = 11, 0.9%) or walking (N = 26, 2%). On day three, all patients who were mobilized were mechanically ventilated via an endotracheal tube (N = 10), whereas by day five 50% of the patients mobilized were mechanically ventilated via a tracheostomy tube (N = 18). In 94 of the 156 ICU survivors, strength was assessed at ICU discharge and 48 (52%) had ICU-acquired weakness (Medical Research Council Manual Muscle Test Sum Score (MRC-SS) score <48/60). The MRC-SS score was higher in those patients who mobilized while mechanically ventilated (50.0 ± 11.2 versus 42.0 ± 10.8, P = 0.003). Patients who survived to ICU discharge but who had died by day 90 had a mean MRC score of 28.9 ± 13.2 compared with 44.9 ± 11.4 for day-90 survivors (P <0.0001). Conclusions: Early mobilization of patients receiving mechanical ventilation was uncommon. More than 50% of patients discharged from the ICU had developed ICU-acquired weakness, which was associated with death between ICU discharge and day-90

Georesistivity precursors to the Tangshan earthquake of 1976

Georesistivity precursors and corresponding coseismic effects to the Tangshan earthquake of 1976 are given as follows: 1) resistivity measurements with accuracies of 0.5% or better for over 20 years show that resistivity decreases of several percent, which began approximately 3 years prior to the Tangshan earthquake, were larger than the background fluctuations and hence statistically significant. An outstanding example of an intermediate-term resistivity precursor is given. 2) Georesistivity decreases of several percent observed simultaneously at 9 stations beginning 2-3 years prior to the 1976 Tangshan earthquake are such a pervasive phenomenon that the mean decrease, in percent, can be contoured on a map of the Beijing-Tianjin-Tangshan region. This shows the maximum decrease centered over the epicenter. 3) Corresponding coseismic resistivity changes, ∆ρc/ρc, during the M 7.8 Tangshan earthquake were observed at all 16 stations within 240 km from the epicentre. These observed ∆ρc/ρc are opposite in sense but similar in spatial distribution to corresponding georesistivity precursors. This observation suggests that the Tangshan earthquake is a rebound process. Calculation indicates that these georesistivity precursors could be represented by a virtual dislocation, of opposite sign to the real dislocation produced at the time of the Tangshan earthquake. These reported ∆ρc/ρc offer very convincing evidence for accepting corresponding anomalies prior to the earthquake as its precursors. 4) It is inferred from observed anisotropic decreases in georesistivity that before the Tangshan earthquake the crust was compressed and that the angle between the maximum principal stress σ1 and the earthquake fault was about 80° before the earthquake i.e., the fault was locked by the σ1 which is almost normal to the fault

Effects of saline or albumin resuscitation on standard coagulation tests

Aims: To explore whether fluid resuscitation with normal saline or 4% albumin is associated with differential changes in routine clinical coagulation tests

Agreement in electrocardiogram interpretation in patients with septic shock

Objective: The reliability of electrocardiogram interpretation to diagnose myocardial ischemia in critically ill patients is unclear. In adults with septic shock, we assessed intra-and inter-rater agreement of electrocardiogram interpretation, and the effect of knowledge of troponin values on these interpretations