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Claudia E Goettler

Publications and source records attributed to Claudia E Goettler.

14 recordsLinked to original sources
PubMed2006

Predicting the need for early tracheostomy: a multifactorial analysis of 992 intubated trauma patients.

BACKGROUND: Tracheostomy has few, severe risks, while prolonged endotracheal intubation causes morbidity. The need for tracheostomy was assessed, based on early clinical parameters. METHODS: Adult trauma patients (January 1994-August 2004), intubated for resuscitation, ventilated >24 hours, were retrospectively evaluated for demographics, physiology, brain, and pulmonary injury. Tracheostomy patients were compared with those without. Chi-square, Mann-Whitney, and multivariate logistic regression were used with statistical significance at p < 0.05.* RESULTS: Of 992 patients, 430 (43%) underwent tracheostomy at 9.22 +/- 5.7 days. Risk factors were age (45.6* +/- 18.8 vs. 36.7 +/- 15.9, OR: 2.1 (18 years increments), ISS (30.3* +/- 12.5 vs. 22.0 +/- 10.3, OR: 2.1 (12u increments), damage control (DC) [68%*(n = 51) vs. 32%*(n = 51), OR: 3.8], craniotomy [70%*(n = 21) versus 30%(n = 9), OR: 2.6], and intracranial pressure monitor (ICP) [65.4%*(n = 87) vs. 34.6%(n = 46), OR: 2.1]. A 100% tracheostomy rate (n = 30, 3.0%) occurred with ISS (injury severity score) = 75, ISS >or=50, and age >or=55, admit/24 hour GCS (Glasgow Coma Scale) = 3 and age >or=70, AIS abdomen, chest or extremities >or=5 and age >or=60, bilateral pulmonary contusions (BPC) and >or=8 rib fractures, craniotomy and age >or=50, craniotomy with intracranial pressure (ICP) and age >or=40, or craniotomy and GCS or=90% (n = 105, 10.6%) was found with ISS >or=54, ISS >or=40, and age >or=40, admit/24 hour GCS = 3 and age >or=55, paralysis and age >or=40, BPC and age >or=55.A tracheostomy rate >or=80% (n = 248, 25.0%) occurred with ISS >or=38, age >or=80, admit/24 hour GCS = 3 and age >or=45, DC and age >or=50, BPC and age >or=50, aspiration and age >or=55, craniotomy with ICP, craniotomy with GCS or=90% risk undergo early tracheostomy and that it is considered in the >or=80% risk group to potentially decreased morbidity, increased patient comfort, and optimize resource utilization.

Adult↗
PubMed2006

Alcohol withdrawal syndrome: Turning minor injuries into a major problem.

BACKGROUND: Abrupt cessation of chronic drinking patterns places hospitalized patients at risk for alcohol withdrawal syndrome (AWS). The purpose of this study was to investigate the effect of AWS on length of stay, morbidity, mortality, and cost in low injury acuity trauma patients. METHODS: A retrospective review of the National Trauma Registry of the American College of Surgeons database from July 1999 to February 2004 was performed. All patients 15 years or older admitted to our Level I trauma center with an Injury Severity Score (ISS) <16 were included. AWS patients were compared with those without AWS. Demographics, mechanism of injury (MOI), ISS, revised trauma score, Glasgow Coma score, hospital course, morbidity, requirement of additional procedures, mortality, and cost were compared. Analysis was done with chi2 test and Student's t test. A p value of < or =0.05 determined significance. RESULTS: Of 6,431 patients, 55 (0.9%) developed AWS. AWS patients were likely men (p < 0.001); had a higher ISS (p = 0.001) and lower Glasgow Coma score (p = 0.01); had more ventilator days (p = 0.008), intensive care unit days (p < 0.0001), and hospital days (p < 0.0001); suffered more complications, including respiratory failure (p < 0.0001), pneumonia (p < 0.0001), urinary tract infection (p = 0.0005), sepsis (p < 0.0001), tracheostomy (p < 0.0001), and percutaneous endoscopic gastrostomy (p < 0.0001); and had higher cost (p < 0.0001). Mortality was similar (p = 0.38) among groups. CONCLUSIONS: Low injury acuity patients with AWS have increased morbidity, leading to increased hospital stay and cost. To allow minor injuries to remain minor problems, the best modality to identify patients at risk and to achieve AWS prophylaxis require further investigation.

Adult↗
PubMed2004

Language barrier leads to the unnecessary intubation of trauma patients.

Airway evaluation in trauma patients is performed immediately upon patient contact, with communication being a vital component to this exam. Language and communication barriers may lead to the unnecessary placement of an artificial airway with resultant patient risk and elevation of health care costs. The objective of our study was to evaluate potentially preventable intubations in Spanish-speaking patients. A 9-year retrospective review was performed using the National Trauma Registry for The American College of Surgeons (NTRACS) database. We evaluated patients intubated on arrival to the trauma center and remaining intubated for less than 48 hours. Deaths were excluded. Patients who typically speak English were compared with patients who typically speak Spanish. Mechanism of injury (MOI), hypotension during resuscitation (HDR), illicit substance use, alcohol use, mean Glasgow Coma Score (GCS), mean Injury Severity Score (ISS), payer source, and hospital cost were compared. Forty-nine per cent and 38 per cent of Spanish and English speaking individuals, respectively, were intubated for less than 48 hours (P = 0.072). MOI, HDR, ISS, illicit substance use, alcohol use, and payer source were similar. GCS was statistically higher in the Spanish-speaking group (14 vs 12; P = 0.004). Language and communication barriers lead to potentially preventable intubations in trauma patients.

Adult↗
PubMed2003

Initial presentation of Crohn's disease in pregnancy: report of a case.

PURPOSE: This study evaluates the current morbidity and mortality of Crohn's disease presenting for the first time in pregnancy. METHODS: A review of the English-language literature was performed to collect all reported cases of Crohn's disease presenting in pregnancy. RESULTS: This review demonstrates a maternal mortality of 4 percent and morbidity of 40 percent and a fetal mortality of 38 percent, with 24 percent normal outcome of pregnancy. CONCLUSIONS: This study shows improved maternal and fetal outcome compared with earlier data.

Abruptio Placentae↗
PubMed2003

Clinical predictors of subtherapeutic aminoglycoside levels in trauma patients undergoing once-daily dosing.

BACKGROUND: After publication of the Hartford nomogram in 1995, conflicting data have emerged regarding the use of once-daily aminoglycoside (ODA) regimens in critically ill patients. The purpose of this study was to characterize a trauma patient population with low 10-hour aminoglycoside levels (THL) within the Hartford ODA protocol. METHODS: Patients admitted to a Level I trauma center who received aminoglycosides were eligible for study. Clinical and demographic data were prospectively collected. Patients were dosed according to the Hartford protocol and a THL was obtained. Patients with THL < 2.0 microg/mL (OFF cohort) were compared with those falling within the nomogram (ON cohort). RESULTS: Of 79 patients receiving ODA therapy, 46 (58.2%) patients fell off the nomogram. The OFF cohort was associated with younger age and higher creatinine clearance, and related inversely to net resuscitative volume. CONCLUSION: Trauma patients undergoing ODA therapy with low THL are younger and exhibit less net preaminoglycoside resuscitative volume and higher creatinine clearance. These findings may have important clinical implications regarding antibiotic efficacy in these select patients.

Adult↗
PubMed2003

The relationship of Injury Severity Score and Glasgow Coma Score to rehabilitative potential in patients suffering traumatic brain injury.

The predictive utility of the Injury Severity Score (ISS) and Glasgow Coma Score (GCS) in relation to rehabilitative potential and functional outcome in traumatic brain injury (TBI) is untested. The purpose of this study was to define the relationship of ISS and GCS to rehabilitative potential using the functional independence measure (FIM) score. Trauma and inpatient rehabilitation (IR) registries were queried for demographic, disposition, and injury scoring data. FIM scores at admission (A) and discharge (D) were assessed including IR FIM gain (G). Analysis of variance was used to examine the relationship of ISS and GCS to FIM with predictive utility investigated through bivariate analysis. Of 5488 patients admitted to a Level I trauma center (1999-2000) 1437 suffered TBI with 285 (20%) entering IR. Compared with low-ISS patients the high-ISS patients had significantly lower FIM-A and FIM-D, but FIM-G was static. GCS results were similar, excluding FIM-G which was significantly higher for GCS < or = 8 compared with GCS > 8. Bivariate analysis revealed no ISS correlation with FIM-G (r = 0.16) and a weak GCS correlation (FIM-G r = -0.15). As prospective predictive measures ISS and GCS correlate weakly with rehabilitative potential in TBI patients. Severely injured patients including those with severe TBI have a rehabilitative gain toward functional independence that is similar to that of when compared with those less severely injured.

Adolescent↗
PubMed2002

Brachial plexopathy after prone positioning.

Two cases of brachial plexus injury after prone position in the intensive care unit are described. Mechanisms of brachial plexus injury are described, as are methods for prevention of this unusual complication.

Adult↗
PubMed2002

Prone positioning does not affect cannula function during extracorporeal membrane oxygenation or continuous renal replacement therapy.

INTRODUCTION: Prone positioning in respiratory failure has been shown to be a useful adjunct in the treatment of severe hypoxia. However, the prone position can result in dislodgment or malfunction of tubes and cannulae. Certain patients receiving extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT) may also benefit from positional therapy. The impact of cannula-related complications in these patients is potentially disastrous. The safety and efficacy of prone positioning of these patients has not been previously reported. MATERIALS AND METHODS: A retrospective chart review evaluated ECMO or CRRT cannula location, and displacement or malfunction during positional change or while prone. The study was set in a General Surgery and Trauma Intensive Care Unit. The subjects were all patients at our institution who simultaneously underwent ECMO or CRRT and prone positioning from July 1996 to July 2001. There were no interventions. RESULTS: Ten patients underwent ECMO and 42 patients underwent CRRT during the study period. Seven patients underwent simultaneous prone positioning and either ECMO (4/10) or CRRT (4/42). A total of 68 turning events (prone to supine or supine to prone) were recorded, with each patient averaging 9.7 (range, 4-16) turning episodes. Turning was performed with sheets and extra nursing personnel; no special mechanical assist devices were used. No patients experienced inadvertent cannula removal during turning. Two patients had poor flow through their cannulae. In one patient, this occurred in the supine position and required repositioning of the cannula. In the second patient, cannulae were changed twice and flow was poor in both the supine and the prone positions. All ECMO and CRRT patients received venous cannulae. Cannula location (seven internal jugular and 11 femoral) did not the affect risk of malfunction. DISCUSSION AND CONCLUSIONS: Patients with venous cannulae for ECMO or CRRT can be safely placed in the prone position. Flow rates are maintained in this position. Potential cannula complications of ECMO and CRRT are not a contraindication to prone positioning in severely ill patients.

Adult↗
PubMed2002

Utility of flexion and extension radiographs of the cervical spine in the acute evaluation of blunt trauma.

BACKGROUND: The purpose of this study is to investigate the usefulness of flexion and extension radiographs of the cervical spine for the acute evaluation of ligamentous injury in cases of awake blunt trauma. METHODS: A review of 106 consecutive cases of blunt trauma evaluated with flexion and extension radiographs of the cervical spine obtained in the acute setting at a Level I trauma center was performed. The data compiled included the age, sex, mechanism of injury, type of radiographic evaluations, interpretation of all radiographic studies, and clinical outcome on follow-up. RESULTS: Sixty-six of the patients (62%) were involved in motor vehicle crashes. Other injuries included 15 falls (14%), 9 blunt assaults (8.5%), and 16 other types of blunt trauma (15%). Thirteen cervical spine injuries were diagnosed in 9 of 106 patients (8.5%). Injuries included two fractures, eight acute disc herniations, two ligamentous injuries, and one cord contusion diagnosed on the basis of all radiologic evaluation and clinical follow-up. Seventy-four patients (70%) had a range of flexion and extension motion interpreted as adequate for diagnostic purposes. Five of the 74 patients (6.75%) with an adequate range of motion had cervical spine injuries. No ligamentous injuries were misdiagnosed in this group. Thirty-two of the flexion and extension examinations (30%) were interpreted as inadequate because of limited motion. Four of the 32 patients (12.5%) with inadequate flexion and extension examinations had injuries subsequently detected on cross-sectional imaging (computed tomographic scanning or magnetic resonance imaging) including severe ligamentous injury. CONCLUSION: When adequate motion was present on flexion and extension radiographs, the false-negative rate was zero in this study. However, in the acute setting, 30% of the examinations were limited by inadequate motion. A higher percentage of injury (12.5%) was detected by subsequent cross-sectional imaging in these patients. Limited flexion and extension motion on physical examination should preclude the use of flexion and extension radiographs, as they are of limited diagnostic utility. Cross-sectional imaging may be warranted in this high-risk group of patients.

Acute Disease↗
PubMedDate not supplied

Laparoscopy in trauma.

Explore the source record for details and available documents.

Contraindications↗
PubMedDate not supplied

Low-dose dopamine: a physiologically based review.

BACKGROUND: In an attempt to prevent or alter the course of acute renal failure, many surgeons continue to use low-dose dopamine. This article critically reviews the physiologic reasons why low-dose dopamine is not clinically efficacious. METHODS: A critical review of English language literature. RESULTS: The effect of dopamine on renal blood flow remains controversial. If dopamine does increase renal blood flow, the vascular anatomy of the kidney would limit its effectiveness. Rather than improving renal function, dopamine has been shown to impair renal oxygen kinetics, inhibit feedback systems that protect the kidney from ischemia, and may worsen tubular injury. Dopamine has not been proven useful in the prevention or alteration of the course of acute renal failure as a result of heart failure, cardiac surgery, abdominal aortic surgery, sepsis, and transplantation. Dopamine has been associated with multiple complications involving the cardiovascular, pulmonary, gastrointestinal, endocrine, and immune systems. CONCLUSIONS: Based on the anatomy and physiology of the kidney, low-dose dopamine would not be expected to improve renal failure and this has been demonstrated by the lack of efficacy in clinical trials.

Acute Kidney Injury↗
PubMedDate not supplied

A collaborative systems approach to rural burn care.

A collaborative systems approach was created between the regional verified burn center (BC) and the rural verified Level 1 trauma center (TC) to treat minor burns. This study assesses the feasibility of providing outpatient burn care at the TC. A retrospective review was performed from January 2000 to June 2005 of burn patients seen at the TC. Seven trauma/critical care surgeons and a dedicated burn nurse staffed the clinic twice a week. Burn surgeons from the BC provided consultation via email and telephone links and served as the regional resource. In the TC clinic, 314 injuries occurred in 311 patients. 196 patients were male with an average age of 34.5 +/- 1.1 years. The mean burn TBSA was 2.9 +/- 0.2%. Fourteen patients (4%) required skin grafts. Patients averaged 3.5 +/- 0.1 clinic visits over a mean follow-up period of 42.9 +/- 7.4 days from initial injury. There were 1252 scheduled appointments during the study period. Silver sulfadiazine or triple antibiotic ointment was applied in the majority of the cases. Thirty-one patients (9.9%) were documented to have complications, most of which were local wound infections. Long-term sequelae (scarring, chronic pain, and contractures) occurred in 13.4% of patients. Clinical success in outpatient burn care can be achieved at a non burn center with dedicated personnel. The successful collaboration between the BC and TC can unload some minor burn care from the burn center, while providing good clinical care to the local rural population.

Adolescent↗