- Clinical Analysis of Ventilator-associated Pneumonia (VAP) in Blunt-chest-trauma Patients
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Joong Hwan Oh, Il Hwan Park, Chun Sung Byun, Geum Suk Bae
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J Trauma Inj. 2013;26(4):291-296.
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 Abstract
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- PURPOSE
Prolonged ventilation leads to a higher incidence of ventilator-associated pneumonia (VAP), resulting in weaning failure and increased medical costs. The aim of this study was to analyze clinical results and prognostic factors of VAP in patients with blunt chest trauma.
METHODS
From 2007 to 2011, one hundred patients undergoing mechanical ventilation for more than 48 hours were divided into two groups: a VAP-negative group, (32 patients, mean age; 53 years, M:F=25:7) and a VAP-positive group, (68 patients, mean age; 60 years, M:F=56:12). VAP was diagnosed using clinical symptoms, radiologic findings and microorganisms. The injury severity score (ISS), shock, combined injuries, computerized tomographic pulmonary findings, transfusion, chronic obstructive lung disease (COPD), ventilation time, stay in intensive care unit (ICU) and hospital stays, complications such as sepsis or disseminated intravascular coagulation (DIC) and microorganisms were analyzed. Chi square, t-test, Mann-Whitney U test and logistic regression analysies were used with SPSS 18 software.
RESULTS
Age, sex, ISS, shock and combined injuries showed no differences between the VAP - negative group and - positive group (p>0.05), but ventilation time, ICU and hospital stays, blood transfusion and complications such as sepsis or DIC showed significant differencies (p<0.05). Four patients(13%) showed no clinical symptoms eventhough blood cultures were positive. Regardless of VAP, mortality-related factors were shock (p=0.036), transfusion (p=0.042), COPD (p=0.029), mechanical ventilation time (p=0.011), ICU stay (p=0.032), and sepsis (p=0.000). Microorgnisms were MRSA(43%), pseudomonas(24%), acinetobacter(16%), streptococcus(9%), klebsiela(4%), staphillococus aureus(4%). However there was no difference in mortality between the two groups.
CONCLUSION
VAP itself was not related with mortality. Consideration of mortality-related factors for VAP and its aggressive treatment play important roles in improving patient outcomes.
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Summary
- Comparison of Rib Fracture Location for Morbidity and Mortality in Flail Chest
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Chun Sung Byun, Il Hwan Park, Geum Suk Bae, Pil Yeong Jeong, Joong Hwan Oh
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J Trauma Inj. 2013;26(3):170-174.
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Abstract
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A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality.
METHODS
Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups.
RESULTS
Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was 19.08+/-10.57. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related morbidity (p=0.369) or mortality (p=0.189).
CONCLUSION
An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.
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Summary
- Traumatic Pericardial Rupture: A Case Report
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Il Hwan Park, Joong Hwan Oh, Seung Hoon Seong
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J Korean Soc Traumatol. 2009;22(1):116-118.
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Abstract
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- Pericardial rupture due to blunt trauma is very rare, but can lead to serious complications. It occurs mainly on the left, is found incidentally during surgery, and is seldom discovered radiologically unless accompanied by cardiac herniation. The following case describes a 53-year-old traffic-accident victim who received emergency pericardial repair and bleeding control via an exploratory thoracotomy and an exploratory laparatomy. The patient was discharged without any complication and remained healthy at six month after injury.
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Summary
- Clinical Analysis of Death in Trauma Patients
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Whan Sik Kim, Min Su Cho, Keum Seok Bae, Seong Joon Kang, Kang Hyun Lee, Keum Hwang, Jin Rok Oh, Il Hwan Park
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J Korean Soc Traumatol. 2007;20(2):96-100.
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Abstract
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Trauma is the 5th most common leading cause of death in Korea, but there has been no appropriate management system for patients until now. We analyzed the main causes of death in trauma patients by comparing the characteristics of those patients with the characteristics of patients who survived. We feel this analysis should have a positive effect on the development of an appropriate trauma management system in Korea.
METHODS
We retrospectively reviewed trauma patients who had been admitted to the Department of General Surgery from February 2002 to February 2007. We compared several expected risk factors between the mortality and the survival group. Data on the transportation, arrival time at the emergency center, amount of transfusion, initial shock index, cause of death, and initial physical condition according to RTS (Revised trauma score), ISS (Injury severity score) and TRISS (Trauma and Injury Severity Score) were collected. Patients with ISS lower than 12 were excluded.
RESULTS
Three hundred sixty-six(366) patients with multiple injuries were included. There were 40 patients in the mortality group and 326 patients in the survival group. The mean arrival time (minutes) to emergency center was longer in the mortality group (137.6 vs 93.6 p 0.04). The total amount of transfusion (ml) was larger in the mortality group (7139 vs 2470 p 0.01). The initial shock index was higher in the mortality group (1.45 vs 1.17 p<0.01). The RTS, ISS, and TRISS were not statistically different between the groups. In the multivariate analysis, mean arrival time and initial shock index were important factors for survival.
CONCLUSION
If the mortality rate of trauma patients is to be reduced , the arrival time at the emergency center should be minimized. Improvement of the emergency medical transfer service system is very important for achieving that.
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Summary
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