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A Seekamp

Publications and source records attributed to A Seekamp.

At least 19 recordsLinked to original sources
PubMed2006

[The trauma surgeon's role in intensive care].

Severe injuries in patients of all ages and injuries in elderly multi-morbid subjects are a relevant medical and economic challenge. Optimal care of the polytraumatized patient can be best delivered by physicians specializing both in causal treatment of the injury or underlying disease and in intensive care. For care of critically ill injured patients, trauma surgeons with a certified specialty in intensive care medicine appear best suited. Of course, directing a surgical or trauma intensive care unit has to be full-time. Specialization of trauma surgeons (e.g., in the USA) has resulted in a considerable improvement in outcomes at least partly related to specialized trauma intensive care. Further improvement of trauma care relies on competent and innovative research not only in the fields of general intensive care, e.g., ventilation, but particularly in the complex aspects of the causality of the traumatic disease. An integrative view of the pathobiochemical, pathophysiological, and immunopathological sequelae of severe trauma under consideration of the various surgical and therapeutic strategies is the actual focus of research in surgical critical care medicine. Organ dysfunctions have to be modulated as they develop. Surgeons and trauma surgeons lead worldwide in this field of research. Obviously, competent research in polytrauma care requires competence in polytrauma intensive care.

Adult↗
PubMed2006

[Treatment of hypertrophic non union of the distal tibial shaft with percutaneously inserted locking plate Initial report on experience in 4 cases].

Hypertrophic nonunions of the distal, dia-/metaphyseal tibial shaft are still considered to be a problematic challenge. The use of a locking plate system (LCP) as an alternative treatment option was evaluated in these nonunions. This retrospective, nonrandomized study included four male patients (mean age 52.5 years) with hypertrophic nonunions of the distal dia-/metaphyseal tibial shaft treated with a locking compression plate (LCP) by percutaneous technique. The following parameters were evaluated: fracture type (AO), primary fracture care, operation technique of the nonunion, healing of the nonunion, ability to work, complications, and clinical result (function of the upper ankle joint). Primarily, there were 3 cases of open fractures. Three fractures were located in the dia-/metaphyseal region and primarily treated with an unreamed tibial nail (UTN), while 1 open metaphyseal fracture was treated with an external fixator. The mean interval between injury and operation of the nonunion was 9.1 (4.4-12) months. All nonunions healed within 3 (2-4) months. The mean clinical and radiological follow-up was 11.5 (9-14) months. All patients were able to work within an average of 2.3 months. The function of the upper ankle joint was unrestricted in 3 cases, and in 1 case there was a mild functional deficit. The use of an interlocking plate for the management of hypertrophic nonunions of the distal tibial shaft represents a reliable, new treatment option.

Bone Plates↗
PubMed2005

[Strategies for surgical treatment of multiple trauma including pelvic fracture. Review of the literature].

OBJECTIVE: In the management of multiply injured patients the question of the optimal time point for surgical treatment of individual injuries still remains open. Especially in severely injured patients with pelvic fractures, this decision differs between rapid surgical interventions in life-threatening situations or time-consuming reconstructive surgery. Besides the "early" operative treatment, i.e., within the first 24 h after trauma, the "late," i.e., definitive or secondary surgical fracture stabilization, exists. The following study represents a review of the current recommendations in the literature concerning the optimal time and fracture management of multiply injured patients with pelvic fracture. METHODS: Clinical trials were systematically collected (MEDLINE, Cochrane, and hand searches), reviewed, and classified into evidence levels (1 to 5 according to the Oxford system). RESULTS: According to the literature there is consensus on "early" operative stabilization of multiply injured patients with hemodynamically and mechanically unstable pelvic fractures, open pelvic fractures, or complex pelvic trauma. External fixation and the pelvic C-clamp are the methods of choice in emergency situations, whereas currently internal fracture fixation is only proposed in exceptional circumstances. In contrast, the point in time for the secondary definitive fracture stabilization remains controversially discussed. This discussion ranges from the postulation that extensive definitive fracture treatment be avoided during days 2-4 after trauma to the recommendation that definitive internal fixation of pelvic fractures be undertaken early, i.e., within the 1st week after trauma. CONCLUSION: Basically, the principles of trauma management of multiply injured patients with life-threatening hemorrhage from mechanically unstable pelvic fractures are divided into two main time periods. On the one hand, there is the emergency stabilization of the pelvic ring as the most important goal within the acute period to control the bleeding, at least with extraperitoneal tamponade if necessary. On the other hand, once the hemorrhaging has been stopped, the "late" and definitive internal fracture stabilization of the pelvis should be performed depending on the fracture pattern.

Clinical Trials as Topic↗
PubMed2004

[Shock trauma room management of pelvic injuries. A systematic review of the literature].

OBJECTIVE: Injuries to the pelvis may occur as a life threatening situation which then requires immediate surgical treatment. A review of the literature represents the range of current recommendations. METHODS: Clinical trials were systematically collected (Medline, Cochrane and hand searches) reviewed and classified into evidence levels (1 to 5 according to the Oxford system). RESULTS: According to the literature there is a consent that immediate resuscitation and surgical intervention is essential in complex pelvic fractures. In contrast the way of emergency stabilization of the pelvis (fixateur externe or c-clamp) is still under discussion as well as the radiological diagnostic (x-ray or CT) and the way of bleeding control (tamponade or embolization). CONCLUSION: Emergency management of pelvic fractures means treatment of a life threatening injury in first place. Although there are different methods that can be used, they all follow the same principle of resuscitation and mechanical stabilization of the pelvis in parallel.

Clinical Trials as Topic↗
PubMed2003

[New aspects for minimally invasive interventions in orthopedic trauma surgery].

The minimally invasive method has gained complete acceptance for the treatment of diaphyseal fractures. In the majority of cases, this procedure is combined with stabilization of the fracture with insertion of an intramedullary implant. In cases of metaphyseal fracture, use of minimally invasive techniques depends on the extent of simultaneous involvement of the articular surface. For joint fractures, the main goal is anatomic reconstruction. At the same time as these less invasive surgical procedures and markedly improved methods of visualization have evolved, the implants themselves have also advanced. The standard implant of the future for plate osteosynthesis will be the interlocking plate. Minimally invasive surgical techniques will certainly continue to gather ground in the future for the entire field of accident surgery. Reduction of the surgical approach means less postoperative pain for the patient, earlier mobilization, and shortening of hospital stay and the whole process of rehabilitation.

Diagnostic Imaging↗
PubMed2001

[Hannover Fracture Scale '98--reevaluation and new prospects for an established score system].

UNLABELLED: The Hannover Fracture Scale (HFS) was first introduced in 1983. As the treatment of open fractures has improved over the years, mainly due to new implants, the prognosis of open fractures has also changed. Thus a reevaluation of this limb salvage score has become necessary. DESIGN: Retrospectively all parameters of the HFS were evaluated in 182 open fractures of the upper and lower extremity treated in our institution between June '94 and June '96. Statistical means included the multivariant analysis, ROC analysis, calculation of sensitivity, specify and accuracy for the criterion of primary amputation. Finally the HFS'98 was established, which is characterized by eight domains (bone loss, skin injury, muscle injury, wound contamination, neurology, periost stripping, local and systemic circulation), a total score range from 0-22 points and a cut off point (amputation recommended) at a score of > or = 11. This score was then prospectively applied on another 87 open long bone fractures, treated in our institution between July '96 and Dec. '97. RESULTS: This validation of the HFS'98 revealed a sensitivity of 0.82 and a specify of 0.99. In comparison the NISSSA and the MESS presented a sensitivity and specify of 0.71, 0.99 and 0.82, 0.99 respectively based on data of the prospective study group. In addition the Gustilo classification for open fractures has been defined by certain score ranges of the HFS'98. CONCLUSION: In conclusion the HFS'98 has become a reliable extremity salvage score with a fairly high positive predictive value of 0.99, which is applicable for all open long bone fractures regardless of their location.

Adolescent↗
PubMed2001

Hannover Fracture Scale '98--re-evaluation and new perspectives of an established extremity salvage score.

OBJECTIVE: as the treatment of open fractures has improved over the years, the prognosis of open fractures has also changed. Thus, a re-evaluation of the Hannover Fracture Score (HFS), first introduced in 1983, has become necessary. DESIGN: retrospectively all parameters of the HFS were evaluated in 182 open fractures of the upper and lower extremity treated in our institution between June 1994 and 1996. Statistical means included multivariant analysis, ROC analysis, calculation of sensitivity, specificity and accuracy. Finally the HFS 98 was established, which is characterised by eight domains with a total score range from 0 to 22 points and a cut off point (amputation recommended) at a score > or =11. This score was then prospectively applied on another 87 open long bone fractures, treated during July 1996 and December 1997. RESULTS: this validation of the HFS '98 revealed a sensitivity of 0.82 and a specificity of 0.99. In comparison the NISSSA and the MESS presented a lower sensitivity and same specificity based on the same study group. CONCLUSION: in conclusion the HFS '98 has become a reliable extremity salvage score with a fairly high positive predictive value of 0.99, which is applicable for all the open long bone fractures regardless of their location.

Adult↗
PubMed2001

[Bone screw osteosynthesis of medial femoral neck fracture in elderly patients].

This study evaluated the complication rate and surgical outcome following cannulated screw fixation of femoral neck fractures in elderly patients. Between 1.6.97 and 31.12.98 we operated on 110 patients with 112 fractures. The mean age was 78.4 years (range 25-96 years). Mean follow up was 6.8 months (range 3-16 months). The mortality rate was 22.7% (25/110). 60 patients with 61 fractures could be evaluated for complications, reoperations, pain and walking ability. 68.9% of the fractures healed. Avascular necrosis developed in 18%. Non-union rate was 8.2% and redislocation rate 4.9%. 18 patients needed a second operation, two thirds received an arthroplasty and one third had implant removal or replacement. In 81.6% of the patients (the patients with secondary arthroplasty excluded) pain relief was good. Insufficient reduction and malposition of the screws are the most common causes for failure of cannulated screw fixation of femoral neck fractures in the elderly.

Adult↗
PubMed2001

The effect of trauma on neutrophil L-selectin expression and sL-selectin serum levels.

Among identified adhesion molecules, the L-selectin on neutrophils enables the first step of leukocyte adherence to activated endothelial cells. To allow firm adhesion of neutrophils, L-selectin is then split off the cell membrane. It was hypothetized that an increase of the constitutively high serum level of soluble L-selectin may indicate an ongoing pathological neutrophil sequestration to the endothelial cells associated with activation and injury of the cells. To evaluate this hypothesis, sL-selectin serum levels and neutrophil L-selectin expression of healthy volunteers (group A, n = 15), as well as of surgical patients, were investigated. Group B (n = 26) included patients subjected to elective limb surgery (mean operation time, 122 min), and group C (n = 45) comprised trauma patients. sL-selectin serum levels were measured daily over a 14-day period. Neutrophil L-selectin expression was evaluated by FACS analysis using the humanized anti-L-selectin antibody HuDreg 55 over a period of 3 days at minimum in both experimental groups. The binding of sL-selectin to endothelial cells was also examined in vitro. Elective limb surgery resulted in lower pre- and post-operative sL-selectin plasma levels (800-1,000 ng/mL) compared to healthy volunteers (1,100-1,200 ng/mL) with insignificant changes throughout the study period. Trauma patients revealed even lower sL-selectin levels (400-600 ng/mL). When these patients were discriminated by the multiple organ dysfunction (MOD) score of Moore in +MOD (n = 9, ISS = 31.7) and -MOD (n = 36, ISS = 25.0), a significant difference became evident. In +MOD patients sL-selectin levels remained on a low basis of 350 ng/mL, whereas in -MOD patients the initial low sL-selectin level subsequently rose to 800 ng/mL, similar to that of elective surgery patients. FACS analysis revealed a significant drop in neutrophil L-selectin expression 24 h after trauma compared to normal. Also, +MOD and -MOD patients were significantly discriminated by the L-selectin expression at this time. The in vitro studies revealed evidence for binding of sL-selectin to endothelial cells independently on the presence of neutrophils. According to our data, increasing severity of the post-operative/posttraumatic course is associated with decreasing sL-selectin serum levels and also reduced neutrophil L-selectin expression. In view of the in vitro results, this probably indicates competitive enhanced binding of sL-selectin to endothelial cells, thus masking the elevated activation of neutrophils and their ability for endothelial adherence.

Adolescent↗
PubMed2000

"Recommendations for uniform reporting of data following major trauma--the Utstein style" (as of July 17, 1999). An International Trauma Anaesthesia and Critical Care Society (ITACCS).

Basic and advanced care of trauma patients has always been an important aspect of prehospital and immediate in-hospital emergency medicine, involving a broad spectrum of disciplines, specialties and skills delivered through Emergency Medical Services Systems which, however, may differ significantly in structure, resources and operation. This complex background has, at least in part, hindered the development of a uniform pattern or set of criteria and definitions. This in turn has hitherto rendered data incompatible, with the consequence that such differing systems or protocols of care cannot be readily evaluated or compared with acceptable validity. Guided by previous consensus processes evolved by the ERC, the AHA and other International Organizations--represented in ILCOR--on 'Uniform reporting of data following out-of-hospital and in-hospital cardiac arrest--the Utstein style' an international working group of ITACCS has drafted a document, 'Recommendations for uniform reporting of data following major trauma--the Utstein style'. The reporting system is based on the following considerations: A structured reporting system based on an "Utstein style template" which would permit the compilation of data and statistics on major trauma care, facilitating and validating independent or comparative audit of performance and quality of care (and enable groups to challenge performance statistics which did not take account of all relevant information). The recommendations and template should encompass both out-of-hospital and in-hospital trauma care. The recommendations and template should further permit intra- and inter-system evaluation to improve the quality of delivered care and identification of the relative benefits of different systems and innovative initiatives. The template should facilitate studies setting out to improve epidemiological understanding of trauma; for example such studies might focus on the factors that determine survival. The document is structured along the lines of the original Utstein Style Guidelines publication on 'prehospital cardiac arrest'. It includes a glossary of terms used in the prehospital and early hospital phase and definitions, time points and intervals. The document uses an almost identical scheme for illustrating the different process time clocks--one for the patient, one for the dispatch centre, one for the ambulance and, finally, one for the hospital. For clarity, data should be reported as core data (i.e. always obtained) and optional data (obtained under specific circumstances). In contrast to the graphic approach used for the Utstein template for pre- or in-hospital cardiac arrest, respectively, the present template introduces, for the time being, at least, a number of terms and definitions and a semantic rather than a graphic report form. The document includes the following sections: The Section Introduction and background The Section on Trauma Data Structure Development: presents a general outline of the development of structured data using object-orientated modelling (which will be discussed in due course) and includes a set of explanatory illustrations. The Section on Terms and Definitions: outlines terms and definitions in trauma care, describing different types of trauma (blunt, penetrating, long bone, major/combined, multiple/polytrauma and predominant trauma). The Section on Factors relating to the circumstances of the injury describes the following items: cause of injury (e.g. type of injury (blunt or penetrating), burns, cold, crush, laceration, amputation, radiation, multiple, etc. Severity of Injury e.g. prehospital basic abbreviated injury score developed by the working group. The score contains anatomical and physiological disability data, with the anatomical scale ranging ordinally from 1. Head to 9. External; the physiological disability scale ranging ordinally from 0--unsurvivable. Mechanism of injury recording for transportation incidents etc. e.g. the type of impact, po

Data Collection↗
PubMed1999

Parameters of multiple organ dysfunction fail to predict secondary amputation following limb salvage in multiply traumatized patients.

OBJECTIVE: The purpose of this retrospective analysis was to evaluate whether systemic parameters that are used to characterize multiple organ dysfunction could also be used to predict the optimal time for amputation in patients failing limb salvage surgery following severe extremity injury. METHODS: The principal criterion for the study group was a lower limb amputation following a type IIIb or IIIc open tibial shaft fracture in multiply traumatized patients. This group was then divided into one group of primary amputation (group A) and one group of secondary amputation (group B). Beside these groups a third group of total traumatic lower limb amputation was recruited (group C). Data analysis included demographics, injury severity according to the ISS, evaluation of the limb injury by three different salvage scores (HFS, MESS and NISSSA) and organ function monitoring by the Denver MOD Score over a 14-day period posttrauma or up to 7 days after secondary amputation. RESULTS: Within the period 1987-1997 a total of 15 patients were recruited for group A (primary amputation), 10 patients for group B (secondary amputation) and nine patients for group C (traumatic amputation). The MOD score was only positive for pulmonary dysfunction, also reflected by the Horovitz quotient, in those patients that died later in either group. Mortality was higher in group A (three out of 15) compared with group B (one out of 10), which may be due to a higher ISS in group A (mean ISS 28.2 vs. 21.0 of group B). Although the MOD score of all recovered patients revealed no significant difference between group A and B, secondary amputation resulted in significantly longer demand of mechanical ventilation. According to our results secondary amputation may lead to transiently decreased pulmonary function but does not necessarily end in multiple organ dysfunction. The need for amputation in failed limb salvage was not indicated by systemic parameters. CONCLUSION: The right time for secondary amputation in order to prevent subsequent pulmonary dysfunction cannot be predicted by parameters otherwise indicating organ dysfunction. As the risk of secondary amputation for developing pulmonary dysfunction apparently cannot be estimated the decision for amputation or limb salvage should be made initially after trauma and should be the definite one.

Adolescent↗
PubMed1999

Protection by vitamin B2 against oxidant-mediated acute lung injury.

The effect of vitamin B2 (riboflavin) on oxidant-mediated acute lung injury has been examined in three different rat models. Pulmonary injury was induced by intravenous injection of cobra venom factor (CVF), by the intrapulmonary deposition of IgG immune complexes, or by hind limb ischemia-reperfusion. In each of the three models, injury was characterized by increases in vascular permeability (leakage of 125I-labeled bovine serum albumin), alveolar hemorrhage (extravasation of 51Cr-labeled rat erythrocytes), and neutrophil accumulation (myeloperoxidase activity). Intraperitoneal administration of riboflavin at a dose of 6 micromoles/kg body weight reduced vascular leakage by 56% in the CVF model, by 31% in the immune complex model, and by 53% in the lung injury model following ischemia-reperfusion of the hind limbs. Similar treatment reduced hemorrhage by 76%, 51%, and 70% in the three models of lung injury. In the CVF model, riboflavin was also shown to decrease products of lipid peroxidation (conjugated dienes) in lungs (by 45%) and in plasma (by 74%). Neutrophil accumulation in the lungs was not influenced by riboflavin administration in any of the three models. The studies demonstrate that riboflavin can mount a significant protection against oxidant-mediated inflammatory organ injury.

Animals↗
PubMed1999

Long term results after multiple injuries including severe head injury.

OBJECTIVE: To describe the long term results in patients with multiple injuries including severe head injury. DESIGN: Retrospective and prospective clinical study. SETTING: Level I trauma centre, Germany. PATIENTS: Patients aged 16-60 years who had been injured more than 2 years before, whose Injury Severity Score was over 20 and whose cranial Abbreviated Injury Score (AIS) was over 3. MAIN OUTCOME MEASURES: Glasgow Outcome Scale (GOS), functional, neuropsychological, vocational and social outcomes. RESULTS: 58 patients, median age 24 (range 16-53, interquartile range (IQR) 21-32) years were investigated 5 (3-9; IQR 4-7) years after their injury. Median ISS was 34 (21-57; IQR 26-41) and GCS 6 (3-8; IQR 4-7). Duration of coma was 10 (2-51; IQR 7-22) days and neurological rehabilitation lasted 169 (10-830; IQR 80-300) days. Movements of the elbow and ankle was most impaired by injury. All psychometric tests showed deficits, particularly in speed of processing, concentration, recent memory, and learning performance. The social environment had been changed in half and vocational rehabilitation was dependent on age. 24 (42%) returned to their former profession, 18 (31%) were retrained to another profession, 16 (27%) were unemployed or retired on a pension. 31 (53%) made a good recovery with moderate disability, 19 (33%) had severe disability, and 8 (14%) remained in a persistent vegetative state assessed by the GOS. CONCLUSION: Early and concentrated rehabilitation facilitates functional, social, and neuropsychological reintegration.

Adolescent↗
PubMed1999

Adenosine-triphosphate in trauma-related and elective hypothermia.

BACKGROUND: In trauma patients, hypothermia is a frequent event. According to the literature, the majority of trauma patients are presenting a core temperature of less than 34 degrees C at admission. In contrast to the benefit of hypothermia in elective surgery, clinical experience with hypothermia in trauma patients has identified hypothermia to be one major cause of severe posttraumatic complications. It was hypothesized that this diverse effect of hypothermia is related to depletion of high-energy phosphates like adenosine triphosphate (ATP) in trauma patients. To verify this hypothesis, the relation of ATP plasma levels and hypothermia was examined in a clinical study. METHODS: Three different groups of patients were under study. The first group (group A, normothermic control group) included patients (n = 15) undergoing elective surgery of the lower limb with a mean operation time of 113 minutes. The second study group (group B, hypothermic control) was composed of patients (n = 15) who were subjected to elective coronary artery bypass operation under hypothermia (31 degrees C for 48 minutes, mean total operation time being 205 minutes). The third study group (group C) included trauma patients (n = 23, mean Injury Severity Score [ISS] of 24.7). At the time of admission, 10 patients presented a core temperature more than or equal to 34 degrees C (group C1, mean ISS, 25.2; mean T(A), 34.5 degrees C), 13 patients presented a T(A) less than 34 degrees C (group C2, mean ISS, 26.0; mean T(A), 32.9 degrees C). In both groups of surgical patients, the ATP plasma level was measured preoperatively, at 2, 4, and 24 hours postoperatively. For trauma patients, this measurement was performed at admission and 24 hours later. Within the same schedule, body core temperature was recorded and the clinical course was documented as well. RESULTS: Elective limb surgery in normothermic patients resulted only in a transient decrease in ATP plasma levels (preoperative, 87.8 micromol/dL; 4 hours postoperative, 52.0 micromol/dL). At 24 hours, the ATP plasma level (62.6 +/- 10.0 micromol/dL) has increased toward baseline level. Elective hypothermia in patients subjected to coronary bypass also resulted only in a transient decrease in ATP plasma levels. During the operation period, including hypothermia, the ATP plasma level was comparable (50.4 micromol/dL) to group A and also returned back toward normal values at 24 hours (58.2 micromol/dL). All trauma patients revealed a significant low ATP plasma level at admission compared with both control groups. Looking at subdivided groups the most significant drop in ATP plasma level (28.5 micromol/dL) was noted in patients presenting an initial core temperature less than 34 degrees C and ISS more than 30. Even 24 hours later, the ATP level of this subgroup was significantly diminished, despite a rise up to 44.4 micromol/dL. In contrast, only a moderate drop in ATP plasma concentration (59.2 micromol/dL) was noted in the group of T(A) more than or equal to 34 degrees C and ISS less than 20. This group revealed almost normal values (68.3 micromol/dL) 24 hours after trauma. In addition to hypothermia, the metabolic state, reflected by the plasma lactate levels, significantly influenced the ATP plasma levels, as high lactate levels were paralleled by low ATP levels. Also, the overall outcome was related to injury severity and hypothermia. CONCLUSION: Hypothermia in elective surgery, established by active cooling, preserves the ATP storage and maintains an aerobic metabolism, which both contribute to the beneficial effect of hypothermia in ischemia/reperfusion in cardiovascular surgery. However, in trauma patients hypothermia is caused by insufficient heat production due to utilization of ATP under anaerobic metabolic conditions. Low ATP plasma levels combined with hypothermia seem to be a predisposition for post-traumatic complications like organ failure.

Adenosine Triphosphate↗
PubMed1999

Ischemia-reperfusion directly increases pulmonary endothelial permeability in vitro.

Endothelial cells derived from human umbilical veins represent an established model for endothelial cell research. However, it may be possible that endothelial cell physiology shows topographic differences. Until now, our research concentrated on an ovine ischemia/reperfusion model. Sheep subjected to 3 h of infrarenal aortic clamping followed by 4 h of reperfusion developed secondary lung damage. This damage is related to an infiltration of polymorphonuclear granulocytes into the lung tissue in accordance with an increased pulmonary permeability. To study this phenomenon in vitro, endothelial cells of ovine pulmonary arteries were cultured onto Transwell-membranes. The permeability of a monolayer of the endothelial cells was tested after stimulation with PMA, TNF-alpha, serum of experimental sheep, and serum of control sheep. Different sizes (4, 20, and 70 kDa) of dextran molecules conjugated to FITC were applicated at the top of the monolayer. After 5 h of incubation, fluorescence activity of both the upper and lower chamber was measured. PMA stimulation lead to a permeability of over 80%. Serum of experimental sheep increased permeability with 21.3% (mean of all dextrans). This increase was partially mediated by TNF-alpha (mean increase in permeability 15.4%). Thus, ischemia-reperfusion injury evokes high levels of cytokines. These cytokines may cause a remote increase in pulmonary endothelial permeability, leading to acute respiratory distress syndrome (ARDS) or organ failure.

Animals↗
PubMed1999

[Role of adenosine triphosphate (ATP) in trauma-induced and elective hypothermia].

BACKGROUND: In trauma patients hypothermia is a frequent event. According to the literature the majority of trauma patients are presenting a core temperature of less than 34 degrees C at admission. In contrast to the benefit of hypothermia in elective surgery, clinical experience with hypothermia in trauma patients has identified hypothermia to be one major cause of severe posttraumatic complications. It was hypothetized that this diverse effect of hypothermia is related to depletion of high energy phosphates like adenosine-tri-phosphate (ATP) in trauma patients. To verify this hypothesis the relation of ATP plasma levels and hypothermia was examined in a clinical study. METHODS: Three different groups of patients were under study. The first group (group A, normothermic control group) included patients (n = 15) undergoing elective surgery of the lower limb with a mean operation time of 113 minutes. The second study group, hypothermic control (group B), comprised patients (n = 15) that were subjected to elective coronary artery bypass operation under hypothermia (31 degrees C for 48 minutes, mean total operation time being 205 minutes). The third study group (group C) included trauma patients (n = 23, mean ISS of 24.7). At the time of admission 10 patients presented a core temperature > or = 34 degrees C (group C1, mean ISS 25.2, mean TA 34.5 degrees C), 13 patients presented a TA < 34 degrees C (group C2, mean ISS 26.0, mean TA 32.9 degrees C). In both groups of surgical patients the ATP plasma level was measured preoperatively, at 2 hr, 4 hr and 24 hr postoperatively. In trauma patients this measurement was performed at admission and 24 hours later. Within the same schedule body core temperature was recorded and the clinical course was documented as well. RESULTS: Elective limb surgery in normothermic patients resulted only in a transient decrease in ATP plasma levels (preoperative: 87.8 mumol/dl, 4 hr postoperative: 52.0 mumol/dl). At 24 hours the ATP plasma level (62.6 +/- 10.0 mumol/dl) has increased towards baseline level. Elective hypothermia in patients subjected to coronary bypass also resulted only in a transient decrease in ATP plasma levels. During the operation period, including hypothermia, the ATP plasma level was comparable (50.4 mumol/dl) to group A and also returned back towards normal values at 24 hours (58.2 mumol/dl). All trauma patients revealed a significant low ATP plasma level at admission as compared to both control groups. Looking at subdivided groups the most significant drop in ATP plasma level (28.5 mumol/dl) was noted in patients presenting an initial core temperature < 34 degrees C and ISS > 30. Even 24 hours later the ATP level of this subgroup was significantly diminished despite a rise up to 44.4 mumol/dl. In contrast an only moderate drop in ATP plasma concentration (59.2 mmol/dl) was noted in the group of TA > or = 34 degrees C and ISS < 20. This group revealed almost normal values (68.3 mmol/dl) 24 hours after trauma. Beside hypothermia the metabolic state, reflected by the plasma lactate levels, significantly influenced the ATP plasma levels, as high lactate levels were paralleled by low ATP levels. Also the over all outcome was related to injury severity and hypothermia. CONCLUSION: Hypothermia in elective surgery, established by active cooling, preserves the ATP storage and maintains an aerobic metabolism, which both contribute to the beneficial effect of hypothermia in ischemia/reperfusion in cardiovascular surgery. However, in trauma patients hypothermia is caused by insufficient heat production due to utilization of ATP under anaerobic metabolic conditions. Low ATP plasma levels combined with hypothermia seem to be a predisposition for posttraumatic complications like organ failure.

Adenosine Triphosphate↗