Retrospective study of the effectiveness of Intra-Aortic Balloon Occlusion (IABO) for traumatic haemorrhagic shock

[Introduction] Intra-aortic balloon occlusion (IABO) is useful for proximal vascular control, by clamping the descending aorta, in traumatic haemorrhagic shock. However, there are limited clinical studies regarding its effectiveness. This study aimed at investigating the effectiveness of IABO for traumatic haemorrhagic shock. [Methods] This retrospective, observational study included trauma patients who underwent IABO at the Emergency and Critical Care Center of Nippon Medical School Tama-Nagayama Hospital between January 2009 and March 2013. 14 patients were included to this study who were in shock on arrival (systolic blood pressure [SBP] <90 mmHg or shock index ≥1), underwent IABO for resuscitation and temporary haemostasis, and subsequently underwent haemostatic intervention (operation or transcatheter arterial embolization). Patient characteristics, physiological status, SBP, heart rate (HR), initial fluid and blood transfusion, time course, and total occlusion time were compared before and after IABO as well as between the survived (n = 5) and non-survived (n = 9) groups. [Results] The majority of patients experienced blunt injuries, with an average injury severity score of 29.5. The liver, pelvis, spleen, and mesenterium represented the majority of injured organs. SBP, but not HR, was significantly higher after IABO than before IABO (123.1 vs. 65.5 mmHg, P = 0.0001). The revised trauma score and probability of survival were significantly different between the survived and non-survived groups (both, P = 0.04). The survived group required significantly less blood transfusion volume than the non-survived group (20 vs. 33.7 red blood cell units, P = 0.04). In addition, the survived group required a significantly shorter total occlusion time than the non-survived group (46.2 vs. 224.1 min, P = 0.002). [Conclusions] IABO was used for relatively severe trauma patients. SBP was significantly higher after IABO, but was not related to survival. However, blood transfusion volume and total occlusion time were related to survival; therefore, it is important to reduce or shorten these parameters, i.e., immediate definitive haemostasis. IABO is effective for traumatic haemorrhagic shock; however, it is also important to consider these points and potential complications

Evaluation of clinical response to empirical antimicrobial therapy on day 7 and mortality in the intensive care unit: sub‐analysis of the DIANA study Japanese data

Aim It is not clear whether evaluating the clinical response to antibiotic use at day 7 among critically ill patients accurately predicts outcomes. We aimed to evaluate the relationship between clinical response to the initial empiric therapy on day 7 and mortality. Methods The determinants of antimicrobial use and de‐escalation in critical care (DIANA) study was an international, multicenter, observational study on antibiotic use in the intensive care unit (ICU). ICU patients ages over 18 years in whom an empiric antimicrobial regimen in Japan was initiated were included. We compared patients who were evaluated as cured or improved (“effective”) 7 days after starting antibiotic treatment with patients who were evaluated as deteriorated (“failure”). Results Overall, 217 (83%) patients were in the effective group, and 45 (17%) were in the failure group. Both the infection‐related mortality rate in the ICU and the in‐hospital infection‐related mortality rate in the effective group were lower than those in the failure group (0% versus 24.4%; P < 0.01 and 0.5% versus 28.9%; P < 0.01, respectively). Conclusion Assessment of efficacy of empiric antimicrobial treatment on day 7 may predict a favorable outcome among patients suffering from infection in the ICU

Elective Endovascular Stent-Graft Implantation for External Iliac Artery Injury after Blunt Pelvic Trauma

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Utility of a Compatibility Chart for Continuous Infusions in the Intensive Care Unit

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Recent trends in 30-day mortality in patients with blunt splenic injury: A nationwide trauma database study in Japan.

BACKGROUND:Splenic injury frequently occurs after blunt abdominal trauma; however, limited epidemiological data regarding mortality are available. We aimed to investigate mortality rate trends after blunt splenic injury in Japan. METHODS:We retrospectively identified 1,721 adults with blunt splenic injury (American Association for the Surgery of Trauma splenic injury scale grades III-V) from the 2004-2014 Japan Trauma Data Bank. We grouped the records of these patients into 3 time phases: phase I (2004-2008), phase II (2009-2012), and phase III (2013-2014). Over the 3 phases, we analysed 30-day mortality rates and investigated their association with the prevalence of certain initial interventions (Mantel-Haenszel trend test). We further performed multiple imputation and multivariable analyses for comparing the characteristics and outcomes of patients who underwent TAE or splenectomy/splenorrhaphy, adjusting for known potential confounders and for within-hospital clustering using generalised estimating equation. RESULTS:Over time, there was a significant decrease in 30-day mortality after splenic injury (p < 0.01). Logistic regression analysis revealed that mortality significantly decreased over time (from phase I to phase II, odds ratio: 0.39, 95% confidence interval: 0.22-0.67; from phase I to phase III, odds ratio: 0.34, 95% confidence interval: 0.19-0.62) for the overall cohort. While the 30-day mortality for splenectomy/splenorrhaphy diminished significantly over time (p = 0.01), there were no significant differences regarding mortality for non-operative management, with or without transcatheter arterial embolisation (p = 0.43, p = 0.29, respectively). CONCLUSIONS:In Japan, in-hospital 30-day mortality rates decreased significantly after splenic injury between 2004 and 2014, even after adjustment for within-hospital clustering and other factors independently associated with mortality. Over time, mortality rates decreased significantly after splenectomy/splenorrhaphy, but not after non-operative management. This information is useful for clinicians when making decisions about treatments for patients with blunt splenic injury

Comparison of 30-day mortality rates in patients with splenic injury, with or without associated injuries.

<p>Comparison of 30-day mortality rates in patients with splenic injury, with or without associated injuries.</p

30-day mortality of initial management strategy for splenic injury, stratified by time periods.

<p>30-day mortality of initial management strategy for splenic injury, stratified by time periods.</p