Biomedical subjects

Kimberly A Davis

Publications and source records attributed to Kimberly A Davis.

21 records · Page 2Linked to original sources

PubMed2002

Resuscitation in the pediatric trauma population: admission base deficit remains an important prognostic indicator.

BACKGROUND: Base deficit (BD), as an endpoint for trauma resuscitation, has been extensively studied in the adult trauma patient but not in the pediatric population. We proposed that admission BD would correlate with outcomes after trauma in a pediatric population. METHODS: This study was a retrospective review of all patients admitted to the pediatric intensive care unit in an adult trauma center with pediatric commitment in whom an admission BD was available, over the 5-year period ending June 2001. RESULTS: A total of 65 patients formed the study population. Overall mortality was 20%. Patients who died were younger (6 +/- 5 vs. 9 +/- 5 years; p = 0.009), had lower Glasgow Coma Scale scores at admission (7 +/- 5 vs. 10 +/- 5; p < 0.0001), had higher Injury Severity Scores (24 +/- 14 vs. 14 +/- 9; p < 0.0001), and had lower Pediatric Trauma Scores (7 +/- 4 vs. 10 +/- 2; p < 0.0001). No patient with a BD less negative than -5 died, whereas 13 of 37 patients with a BD of -5 or higher died (37%) (p < 0.0001). Of the 13 patients who died, 8 never cleared their BD and died within 33 +/- 18 hours of admission. Failure to clear BD was associated with 100% mortality. Five patients who normalized their BD died of isolated closed head injuries (time to death, 37 +/- 18 hours; p = not significant). All surviving patients normalized their BD within 43 +/- 41 hours of admission. Seventy-five percent of patients who survived (39 of 52) had a normal BD within 48 hours of admission. CONCLUSION: Admission BD in the pediatric trauma patient is a strong indicator of posttraumatic shock. An admission BD of < or = -5 is predictive of severe injury and of poor outcome, with a 37% mortality in this series. Failure to clear BD is an extremely poor prognostic indicator.

Acid-Base Imbalance↗

PubMedDate not supplied

Ventilator-associated pneumonia after combined burn and trauma is caused by associated injuries and not the burn wound.

An increased risk of ventilator-associated pneumonia (VAP) has previously been demonstrated in trauma patients urgently intubated in the prehospital (ie, field) and emergency department (ED) settings. This study investigated the impact of urgent intubation on subsequent VAP in patients who sustained both a burn injury and a traumatic injury. We undertook a retrospective review of both trauma registry data and medical records for all patients with combined thermal and traumatic injuries admitted to a single verified burn center and level I trauma center. Patients undergoing field or ED intubation during the 5-year period ending December 2002 were identified and studied. Data abstracted included admission demographics and vital signs, presence of inhalation injury, location at the time of intubation, presence of associated injury, percentage TBSA burn, hospital and intensive care unit length of stay, and hospital day of VAP diagnosis. Seventy-eight of the 3388 patients (2.3%) admitted during the study period sustained a combination of burn wounds and trauma and underwent urgent field or ED intubation. The majority of patients were men (71%), with a mean age of 46 +/- 24 years. There was one failed oral intubation, which required cricothyroidotomy. The location of the patient at the time of intubation was ED, 66%; burn center ED, 17%; and field, 17%. Eighty percent of all patients were diagnosed with an inhalation injury. VAP was diagnosed in 39 patients (50%), with a mean time to diagnosis of 10 +/- 9 days. TBSA burn, smoke inhalation, and time (in days) to diagnosis of VAP were not independent risk factors for the occurrence of pneumonia in any of the 3 groups. However, those intubated at the initial ED were more likely to develop VAP (P = .028) compared to those intubated in the field or in the burn center. The incidence of associated injuries was significantly greater (P < .0001) in the initial ED group. Only a small percentage of burn patients also sustain blunt trauma. VAP occurs in 50% of the patients requiring urgent intubation. Independent risk factors appear to be intubation at an initial ED before transfer and associated injuries.

Adult↗

PubMedDate not supplied

Ventilator-associated pneumonia: a review.

Ventilator-associated pneumonia is the most frequent intensive care unit (ICU)-related infection in patients requiring mechanical ventilation. In contrast to other ICU-related infections, which have a low mortality rate, the mortality rate for ventilator-associated pneumonia ranges from 20% to 50%. These clinically significant infections prolong duration of mechanical ventilation and ICU length of stay, underscoring the financial burden these infections impose on the health care system. The causes of ventilator-associated pneumonia are varied and differ across different patient populations and different types of ICUs. This varied presentation underscores the need for the intensivist treating the patient with ventilator-associated pneumonia to have a clear knowledge of the ambient microbiologic flora in their ICU. Prevention of this disease process is of paramount importance and requires a multifaceted approach. Once a diagnosis of ventilator-associated pneumonia is suspected, early broad-spectrum antibiotic administration decreases morbidity and mortality and should be based on knowledge of the sensitivities of common infecting organisms in the ICU. De-escalation of therapy, once final culture results are available, is necessary to minimize development of resistant pathogens. Duration of therapy should be based on the patient's clinical response, and every effort should be made to minimize duration of therapy, thus further minimizing the risk of resistance.

Anti-Bacterial Agents↗