Download Adult Respiratory Distress Syndrome: An Aspect of Multiple by J. A. Sturm (auth.), Professor Dr. J. A. Sturm (eds.) PDF

By J. A. Sturm (auth.), Professor Dr. J. A. Sturm (eds.)

l. A. STURM In glossy society, trauma is still the number 1 reason behind demise in humans lower than 50 years, yet, regardless of this, little or no cognizance has been paid to trauma care in comparison with different ailments corresponding to malignancy or myocardial infarction (Table 1). The efforts which were made in therapy, in spite of the fact that, have confirmed a few luck; for instance even if the frequency of site visitors injuries within the Federal Republic of Germany has remained consistent through the years, the variety of deaths due to them has diminished (Fig. 1). the result of advancements in rescue structures, surgical ideas, and extensive care are obvious, as proven through a evaluation of the statistics of approximately 3000 a number of trauma sufferers taken care of within the final 15 years on the trauma de­ partment of Hannover scientific university which displays the growth that has been made in remedy. After the matter posed through posttraumatic kidney failure have been solved within the Nineteen Sixties and Seventies, the grownup breathing misery syndrome (ARDS) grew to become the most important challenge within the Seventies and Nineteen Eighties (Fig. 2). ARDS as a unmarried entity disappeared within the literature within the early Eighties and was once changed via the so-called a number of organ failure (MOF) syndrome. among 1985 and 1990 35% of the sufferers in our in depth care unit built MOF, and 70% of them died. total MOF mortality has remained consistent for the reason that 1985 at approximately 20% (Fig. 3).

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1, from 0 (= normal pulmonary function) to 1 (= complete ARDS). The mean value of the daily classification was used as a criterion to differentiate between two groups of patients, on one hand those with ARDS and on the other hand those with MPD (minimal pulmonary dysfunction) (Fig. 2). 6. 6 Fig. 2. Subjective classification of "severity of pulmonary failure" from 0 to 1 Development of a Linear Scoring System 27 Table 1. Chest X-ray score [5] Score Chest roentgenogram o Normal Moderately increased interstitial marking Markedly increased interstitial marking Patchy air-space consolidation Extensive air-space consolidation 1 2 3 4 stepwise multifactor regressive analysis of all the parameters describing the pulmonary function and mechanical ventilation was performed.

The methods of operative treatment even of bone fractures were similar in both centers. The main difference was the preference for intramedullary nailing for femur or lower leg fractures in Hannover in comparison with the usual plate fixation at Essen. The complication rate of operative treatment showed no major differences between the two groups of patients. - E 60 Q) E (;j ~ Q) > 40 ~ Cii a. 0% 20 ;2 0 15t 2nd 1-2 3-7 >7 operative stage day Fig. 1. 2% ~ C 60 Ql E (ij ~ 40 Ql > ~ Ql a. 0 (1j 20 (5 f- 0 1st 2nd 3rd 1-2 3-7 >7 operative stage day Fig.

28 U. Obertacke et al. 0 e? 2 Fig. 3. Correlation between ARDS score and severity of pulmonary failure in the Essen group Considering the first two questions we were able to demonstrate that the model had sufficient stability: No more than four. patients were classified differently by ARDS/MPD using the scoring system with a smaller number of patients or shorter periods (2::48 h) for the observation. For the third question we tested the model with the group of patients from Hannover. 76 (Fig. 4).

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