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Patrick Reilly

Publications and source records attributed to Patrick Reilly.

81 records · Page 5Linked to original sources
PubMed2002

Abdominal compartment syndrome in the open abdomen.

BACKGROUND: Multiple methods exist to manage in the intensive care unit the patient with an open abdomen. An increasingly common method is the vacuum packed technique. This method accommodates considerable expansion of intra-abdominal contents and should obviate the potential development of the abdominal compartment syndrome (ACS). Despite this, some patients with these temporary abdominal dressings will go on to develop ACS. For the purpose of this study we have defined this clinical entity as the open abdomen ACS. HYPOTHESIS: Patients with an open abdomen who develop ACS have a poor prognosis. Fluid requirements and resuscitative indices may predict which of these patients will develop open abdomen ACS. METHODS: A retrospective review was performed of patients with trauma who had an open abdomen treated with vacuum packed dressings at our urban level I trauma center. Over 1 year (July 1, 1999-June 30, 2000), 5 patients managed with an open abdomen developed ACS. These patients were compared with 15 consecutive patients with an open abdomen who did not develop clinical ACS during that same period. Fluid resuscitation, base deficit, pH, lactate level, systolic blood pressure, prothrombin time, temperature, peak inspiratory pressure, and PCO(2) were abstracted. The Fisher exact test was used for statistical analysis. RESULTS: In patients managed with an open abdomen, ACS developed between 1.5 and 12 hours (mean [SD], 7.5 [3.9] hours) after placement of the vacuum packed dressing. The base deficit, pH, peak inspiratory pressure, PCO(2,) and lactate level were more abnormal and the crystalloid requirements were significantly higher in the ACS group. The systolic blood pressure, temperature, and prothrombin time did not differ between groups. Three patients with ACS developed a second episode of ACS. Mortality in the ACS group was 3 (60%) of 5 patients vs 1 (7%) of 15 patients in the control group. CONCLUSIONS: Management of the open abdomen with the temporary abdominal closure does not prevent the development of ACS. Mortality is high when ACS occurs in this scenario. Severe physiologic derangement and high crystalloid requirements may predict which patients will develop ACS.

Abdomen↗
PubMedDate not supplied

The use of retrievable inferior vena cava filters in trauma: implications for the trauma team.

Prevention of venothromboembolic complications remains a challenge in trauma care. Guidelines for prophylaxis published by the Eastern Association for the Surgery of Trauma stratify patients by risk and recommend therapies based on scientific evidence. New innovations such as retrievable inferior vena cava filters are being used by trauma surgeons for patients at risk for pulmonary embolism but in whom anticoagulation is contraindicated. Some available devices offer a limited timeframe for retrieval beyond which the device becomes permanent. The increased utilization of this technology presents case management challenges to trauma teams. Patients who are unreliable or may be difficult to track posthospitalization (homeless, migrant workers, prison system, etc.) run the risk of not having their filters removed as initially intended. Nurses can play a critical role in helping to manage and direct the discharge plan and case management of trauma patients with retrievable inferior vena cava filters.

Algorithms↗