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Biomedical subjects

J A Sturm

Publications and source records attributed to J A Sturm.

At least 19 recordsLinked to original sources
PubMed2002

[Algorithm for prehospital blunt trauma management].

Clinical algorithms can divide sophisticated treatment concepts for blunt trauma care into logical, systematic and easy to follow sequences. The presented algorithm for prehospital management of major and suspected blunt trauma will assure appropriate trauma care within narrow time windows. The risk of over- or undertreatment is reduced for both, the suspected and confirmed diagnosis of polytrauma. Due to the lack of evident data the algorithm was confirmed via consent expert opinion of trauma surgeons, incorporating the ABC priorities and also the concept of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.

Algorithms↗
PubMed2002

[Algorithm for extrication and medical care in vehicular trauma].

The rescue and treatment of trapped persons in car accidents requires a close cooperation and coordination between firefighters and medical personnel. Priorities of medical care as well as aspects of extrication should be considered equally. Procedures on scene should follow a sequence securing life support and careful rescue of the trapped patient.The developed algorithm allows for prioritized and coordinated management and represents a transparent guide for both teams, during training as well as practical application. The concept incorporates the ABC priorities for polytrauma management and also the structure of the ATLS((R))-programme. The algorithm was validated in simulated scenarios and was by affirmed by the German Trauma Surgeons Task Force on Emergency Care under the regulations of a nominal group process via resolution.

Accidents, Traffic↗
PubMed1997

[Polytrauma and the hospital structure].

Hospital standards for the care of multiple traumatized patients include certain clinical capabilities, special logistics (appraisal of structure), and--even more important--algorithms for simultaneous activities in diagnosis and therapy (assessment of process). The main goal in the trauma system should be definitive, specialized care for the injured in the shortest possible time. Economically there is no way of creating a tight network of highly developed trauma centers close to every patient. Also primary air-transport by helicopters over some distances in every case is not realistic (darkness, weather conditions). Therefore, an algorithm that is dependent on regional conditions is needed for primary care and stabilization of multiple trauma patients in smaller hospitals followed by early transfer to trauma centers. The effectivity of this stepwise approach must be compared with primary care in a trauma center. Trauma registers are necessary to plan for the future. Quality improvement programs (education, system evaluation) should be installed, especially for smaller hospitals bound into the trauma system. Financial support is essential for hospitals designated for care of multiple traumatized patients in rural areas.

Algorithms↗
PubMed1996

Pattern of organ failure following severe trauma.

Multiple organ failure (MOF) is considered to be the leading cause of death after severe trauma. Although there is extensive literature on MOF, little is known about the pattern, sequence, and onset of this clinical syndrome. The first goal of this clinical study was to define MOF; the second was to assess the typical onset, sequence, and pattern of MOF; and the third was to define certain risk factors for the development of MOF in 342 multiple trauma patients. Patients with an Injury Severity Score (ISS): > 20 (mean 35.7) were included. Three well established MOF scoring methods were used to give strict definitions of MOF: 11.4% of the total patient population developed MOF, and 88.6% did not. Respiratory failure was most frequent in patients developing MOF (74.4%), and these patients had the highest mortality rate (65.5%) compared to patients with failure of other organ systems (liver, cardiovascular system). Generally, the lung is the first organ to fail after injury (failure after 3.7 +/- 2.8 days). Significant renal failure and the need for dialysis decreased to < 5%; other signs of organ dysfunction (gastric, central nervous system) are difficult to verify. Typical risk factors for the development of MOF after severe trauma are the severity, type, and distribution of injury as well as the indicators of prolonged hemorrhagic shock (elevated lactate levels). The main therapeutic efforts, therefore, should be the effective treatment of traumatic hemorrhagic shock during the initial phase, adequate resuscitation, optimal oxygenation, and early surgical treatment.

Adolescent↗
PubMed1995

[Effect of primary fracture management on craniocerebral trauma in polytrauma. An animal experiment study].

Severe head trauma (BI) associated with long bone fractures is present in about 60% of polytraumatized patients admitted to hospital. However, there is no consensus regarding early fracture stabilization in such patients. In an experimental sheep study, the influence of intramedullary nailing of the femur (IMNF) on a cold-induced, vasogenic brain edema (method of Klatzo) in combination with traumatic hemorrhagic shock (THS) was investigated. Three animal groups (n = 6) were explored: group A, only BI; group B, BI and THS; group C, BI, THS and IMNF. The animals remained intubated, on controlled ventilation, sedated and received analgesia during the whole experiment. For a period of 6 h after the cold-induced brain injury the hemodynamic changes were measured and the intracranial pressure (ICP) was recorded in the left and the right hemisphere continuously. The hemorrhagic shock (MAP = 60 mm Hg) was maintained over 1.5 h. At the end of the reperfusion period (2 h) the nailing of the femur was performed. The animals were killed and the percentage water content of the brain was determined and compared with the brain water content of a control group (n = 6). There were no significant differences in ICP between groups A, B and C before or after IMNF, but in group C the ICP increased significantly after nailing. Brain water content in group C was significantly higher than in the control group and slightly significantly higher than in groups A and B. Brain edema and ICP are increased by IMNF.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Increased gut permeability after multiple trauma.

Gut permeability was studied in multiply injured patients with respect to the development of multiple organ failure (MOF). Two groups were defined according to MOF score (threshold 10 points) as to whether MOF developed (group 1; n = 11, four deaths) or did not (group 2; n = 21, no death). Gut permeability was determined from the ratio of urinary excretion of enterally administered lactulose and mannitol. Serum elastase concentrations were also determined. Mean(s.e.m.) gut permeability was abnormal during the entire study (day 1: group 1--5.1(2.1) versus group 2--10.6(4.1) (P not significant; P < 0.001 versus normal volunteers, 0.56(0.24)). An increase on days 3 and 5 correlated with serum elastase levels only in patients in group 1 (rs = 0.71, P < 0.01). Severe injury leads to increased intestinal permeability, which is related to a systemic inflammatory response.

Adult↗
PubMed1994

The effect of kinetic positioning on lung function and pulmonary haemodynamics in posttraumatic ARDS: a clinical study.

In the treatment of adult respiratory distress syndrome (ARDS) no breakthrough has been achieved so far. In several cases of severe ARDS in multiply injured patients we have seen improvements of lung function by means of continuous body positioning. We therefore compared the effect of kinetic positioning (KIN) on lung function and haemodynamics in ARDS patients with conventional (CON) supine positioning. Pulmonary and systemic haemodynamics were determined on the basis of pulmonary artery catheter measurements. On a daily basis oxygenation ratio (PaO2/FiO2) and pulmonary shunt (Os/Ot. per cent) were calculated. Extravascular lung water (EVLW, ml/kg BW) was determined by the double indicator thermodilution technique. Twenty-two patients were included: KIN, N = 11, CON, N = 11. Mortality from ARDS in KIN patients was 18.2 per cent (N = 2): in CON patients it was 63.6 per cent (N = 7). The oxygenation ratio (PaO2/FiO2) increased significantly in KIN patients from 140 + 45 (day 0) to 237 + 40 (P < 0.05) (day 5); in CON patients no improvement was seen (143 + 48 (day 0). 133 + 44 (day 5); n.s. between groups at day 0: P < 0.05 between groups at day 5). Pulmonary shunt decreased significantly from 26.6 + 4 per cent (day 0) to 12.5 + 2 per cent (day 5) (P < 0.05) in KIN patients and was 36.6 + 6 per cent at day 0 and 31.4 + 2 per cent at day 5 in CON patients (P < 0.05 between groups at day 5).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1994

Does the reamer type influence the degree of lung dysfunction after femoral nailing following severe trauma? An animal study.

In multiple trauma patients with lung contusion, pulmonary complications have been reported that were attributed to intramedullary stabilization of the femur. The reaming procedure of the medullary canal is thought to play a major role. We investigated whether different types of reamers might exert different amounts of fat mobilization into the vascular system and different degrees of pulmonary dysfunction. Adult female Merino sheep were submitted to hemorrhagic shock (2 h, 50 mm Hg) and a unilateral lung contusion; in addition, a lung lymph fistula was created. Pulmonary capillary permeability, central venous triglyceride levels, 11-dehydro-thromboxane B2 (dh-TXB2) levels, and pulmonary artery pressure were determined. After recovery, animals were randomly assigned to intramedullary femoral nailing using several types of reamers: group A, AO reamer (n = 8); group B, Biomet reamer (n = 7); group H, Howmedica reamer (n = 6); group C, controls, no reaming (n = 4). Intramedullary reaming caused a significant (p < 0.05) increase in pulmonary artery pressure in groups A and B; dh-TXB2 levels increased in all groups. Statistically significant (p < 0.05) pulmonary capillary permeability damage was measured in group A only. Intramedullary femoral nailing can cause transient pulmonary hemodynamic and mediator effects as well as increased pulmonary capillary permeability. In the present study, this effect was evident in group A reamer systems only, which may be due to reamer construction.

Animals↗
PubMed1993

Primary intramedullary femur fixation in multiple trauma patients with associated lung contusion--a cause of posttraumatic ARDS?

We investigated whether primary (< 24 hours) intramedullary stabilization of femoral shaft fractures in multiple trauma patients with severe thoracic injury might be associated with an increased incidence of adult respiratory distress syndrome (ARDS). A total of 766 patients with multiple trauma admitted to Hannover Medical School between January 1, 1982, and December 31, 1991, were investigated retrospectively. Of these, 106 patients met the inclusion criteria: Injury Severity Score > 18, femoral midshaft fracture treated by intramedullary nailing, primary admission or referral within 8 hours after injury, and no death from head injury or hemorrhagic shock. Two groups were differentiated according to the presence or absence of chest trauma (severe chest trauma = AIS thorax > or =, group T; no severe chest trauma = AIS thorax < 2, group N). Selection of subgroups according to the time of femur stabilization was group I < 24 hours after trauma, group II > 24 hours after trauma. Injury Severity Scores in the four groups were TI: 29.4 (n = 24); TII 31.4 (n = 26); NI 20.1 (n = 33); NII 25.4 (n = 23). In patients without thoracic trauma the ICU time (NI: 7.3 days; NII: 18.0 days) and intubation time (NI: 5.5 days; NII: 11.0 days) were lower in the patients treated primarily (p < 0.05). In patients with severe chest trauma there was a higher incidence of posttraumatic ARDS (33% versus 7.7%) and mortality (21% versus 4%) when early intramedullary femoral nailing was done. In the absence of severe chest trauma primary intramedullary femoral nailing is beneficial.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1993

Influences of different methods of intramedullary femoral nailing on lung function in patients with multiple trauma.

We investigated the effects of primary (< or = 24 h) intramedullary femoral nailing on lung function and pulmonary hemodynamics in patients with multiple trauma. Two groups were separated: the group with primary femoral nailing with reaming (group RFN) was submitted to femoral nailing after reaming of the medullary canal; in the group with unreamed femoral nailing (group UFN) a small-diameter solid nail was inserted without reaming. Lung function was assessed by oxygenation ratio (PaO2/FIO2), and pulmonary hemodynamics by intraoperative pulmonary artery catheter measurements. Central venous blood concentrations of elastase and the platelet count were determined during and 3 days after surgery. Lung function was stable in UFN patients (n = 14), but deteriorated in RFN patients (n = 17) from 353 +/- 24 (PaO2/FIO2 preoperatively) to 260 +/- 28 (PaO2/FIO2 postoperatively) (p < 0.05) and improved only after 48 hours. Pulmonary artery pressure (PAP) did not change during surgery in UFN patients; in RFN patients PAP increased from 27.2 +/- 3.1 mm Hg (preoperatively) to 36.3 +/- 4.1 mm Hg (p < 0.05) upon reaming and normalized 1 hour after insertion of the nail. Femoral nailing after reaming represents a potential risk with respect to lung function disturbances. This might trigger the development of adult respiratory distress syndrome (ARDS), especially in patients at extra risk of this complication (additional lung contusion, "borderline patient"). In these cases unreamed femoral nailing might offer an alternative by allowing primary intramedullary stabilization without the risk of adverse effects to the lung.

Adult↗
PubMed1993

[Rehabilitation and reintegration of polytraumatized patients].

In this randomized study we attempt to verify treatment results, rehabilitation and social reintegration of multiple trauma patients. Two to 4 years after the accident a clinical follow-up examination was carried out on 104 multiple trauma patients with an average age of 29.5 years who had 7.7 single injuries. Patients with injuries of the central nervous system still showed neurological disorders in 32%. The initially determined Glasgow Coma Scale did not correlate with the long-term prognosis of neurological disorders. Only 4 of 38 thoracic injuries had functional disorders-these patients had required long-term ventilation therapy (> 3 weeks). Former abdominal injuries showed no objective disorders in the follow-up. Most of the injuries to the extremities (79.7%) healed without functional disorder. Only patients with lower limb injuries still had complaints. At the time of the checkup 6.7% had still not been able to work (for more than 24 months) and 26.9% for more than 12 months. The disability rate was less than 20% in 64.3%, 7.2% more than 50% and 9.6% more than 80%. Most of these patients had severe head injuries. There was a relationship between reintegration at work and the age of the patients: 49.2% of patients younger than 25 years were working in their previous profession, 26.9% had here re-educated, and only 7.9% were unemployed. However, in the age group older than 25 years, only 29.2% worked in their previous profession and 12.2% had been re-educated. This follow-up study shows that in multiple trauma patients reintegration at work and in social life is possible.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

Pulmonary damage after intramedullary femoral nailing in traumatized sheep--is there an effect from different nailing methods?

Stabilization of femoral shaft fractures is a controversial issue in the management of patients with multiple trauma. Intramedullary nailing usually is preferred primarily; in recent years, however, pulmonary complications (e.g., ARDS) have been reported that were attributed to the reaming procedure. To study the effects of different nailing methods in a model of severe trauma, hemorrhagic shock and lung contusion were created at day 1 in sheep prepared by the method described by Staub. After recuperation (day 3) the animals in the study group (group 1) underwent intramedullary nailing of a closed femur without prior reaming; group 2 was treated with reaming and nailing according to AO standards. The reaming procedure led to an acute increase of pulmonary arterial pressure only in group 2 (19.8 +/- 2.1 to 31.0 +/- 4.6 mm Hg). Pulmonary triglyceride levels increased at parallel time points from 18.27 +/- 2.3 to 33.04 +/- 7.37 mg/dL only in group 2. Stimulatory capacity of polymorphonuclear leukocytes (PMNL) increased in the study group and decreased in controls (group 1: 2.652 +/- 0.23 x 10(6) cpm to 3.387 +/- 1.34 x 10(6) cpm; group 2: 2.699 +/- 0.34 x 10(6) cpm to 2.460 +/- 0.187 x 10(6) cpm). Intramedullary nailing caused an increase of lung capillary permeability in both groups; in the study group less damage was seen (group 1: 0.390 +/- 0.0006 to 0.354 +/- 0.011; group 2: 0.391 +/- 0.0004 to 0.336 +/- 0.015; p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Acetylglucosaminidase↗
PubMed1992

Effect of recurrent endotoxemia on hemodynamics, lung function and neutrophil activation in sheep.

The aim of the study was to find out in which way lung permeability and polymorphonuclear leukocyte (PMNL) functions are modulated under recurrent endotoxin challenge, as it might occur in clinical septic patients. In a sheep model with chronic lung lymph fistula, performing bronchoalveolar lavage (BAL), we investigated the relationship between PMNL function and endothelial as well as epithelial damage in the lung in a sepsis syndrome, using a protocol of recurrent endotoxemia induced by 1 microgram/kg body weight Escherichia coli endotoxin treatment every 12 h over a 5-day period. Pulmonary response showed constantly increased pulmonary arterial pressure at mean values of 24-30 mm Hg. Also, lymph flow did not return to baseline, but remained on a level of 6-9 ml/30 min, after an increase to 12-15 ml/30 min following each endotoxin injection. In contrast, a lower increase in protein clearance was noted upon subsequent endotoxin administration. After initial values of 7-8 ml/30 min following the first endotoxin injection, almost baseline values were measured on the 5th day (3-4 ml/30 min). In systemic hemodynamics, we noted a decrease in cardiac output to 3.0 l/min after the first endotoxin injection, followed by a significant increase to 7 l/min under subsequent endotoxin administration. In PMNL function, we observed an attenuation of the acute response of the decrease in PMNL count, in vitro chemiluminescence response and plasma beta-N-acetylglucosaminidase level. The plasma urea concentration revealed a transient reduction in kidney function. In the epithelial lining fluid (ELF) of the alveoli, total cell count did not change significantly, but the fraction of PMNL increased from 2 to 20% during the 5 days. The ELF/plasma ratios of albumin and total protein did not change significantly. In conclusion, recurrent endotoxemia in a sheep model can produce a hyperdynamic state like in a sepsis syndrome which is further characterized by an initial leakage of the endothelial barrier, only minor affection of the epithelial barrier and by an exhaustion of PMNL function.

Animals↗
PubMed1992

[Effects of different intramedullary stabilizing procedures of the femur on lung function in polytrauma].

We investigated the effects of primary (< 24 h) intramedullary femoral nailing on lung function and pulmonary hemodynamics in multiple trauma patients. The standard procedure following reaming of the medullary canal (AFN) was compared with a new procedure using a small, solid nail without prior reaming (UFN). Pulmonary hemodynamics were determined using a pulmonary artery catheter. Global lung function was assessed by means of the oxygenation ratio (PaO2/FiO2). Concentrations of elastase and the platelet count as a general parameter of the clinical course were determined from central venous blood during and 3 days after surgery. The lung function was stable in UFN patients (n = 6), but decreased significantly in AFN patients (n = 10) from 353 +/- 24 (PaO2/FiO2 preoperative) to 260 +/- 28 (PaO2/FiO2 postoperative) and did not improve until 48 h later. Pulmonary artery pressure (Pap) remained within normal limits in UFN patients, whereas in AFN patients Pap increased from 27.4 +/- 3 mm Hg (preoperative) to 37 +/- 3 mm Hg during reaming and did not normalize until 1 h after insertion of the nail. The platelet count remained unchanged in UFN patients and dropped in AFN patients from 143 +/- 25 x 1000 cells/ml blood (preoperative) to 87.5 +/- 15 x 1000 cells/ml blood 2 days after surgery. Our measurements did not show an increase in central venous triglycerides in the AFN group, probably because bone marrow does not become immediately soluble. There was no significant difference between the increase of elactase levels in the two groups. The femoral nailing procedure with reaming in multiple trauma patients involves a potential risk to the lung.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Can post-traumatic renal failure be modified therapeutically?].

Acute renal failure in the late phase after severe trauma is particularly dangerous, since it is resistant to therapy and contributes to the development of post-traumatic multiple organ failure. We have studied different treatment regimes in order to establish whether late renal failure can be prevented (study A: colloidal and crystalloid solutions; study B greater than: crystalloid solutions and dopamine; continuous infusion 3 micrograms/kg body weight). Renal function was assessed by means of the score by Goris as well as by creatinine clearance over a period of 14 days. Haemodynamics and cardiac function were determined on a daily basis. The demographic parameters were comparable in both groups. In group A 37 of 61 patients died (60.6%), and in group B 17 of 38 patients (44.7%) (P less than 0.05). The incidence of impairment of renal function was comparable; in group A there was significantly more severe damage (18%) compared to group B (2.6%). This coincided with significantly higher mortality in group A (group A: 60.65%; group B: 44.7%). In group A a lesser volume was given during the preclinical and clinical course, even after correcting for the volume-saving effect of colloidal solutions. In addition, cardiac index was higher in group B (day 9: 5.9 +/- 0.61 l/min) than in group A (day 9: 4.4 +/- 0.5 l/min) and pulmonary capillary wedge pressure (PCWP) was lower and systemic vascular resistance (SVR) higher over the whole period. Also, the arterio-venous oxygen difference (AvDO2) was higher following day 9 in patients in group A, but creatinine clearance was better in group B patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗