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Biomedical subjects

R P Dutton

Publications and source records attributed to R P Dutton.

5 recordsLinked to original sources
PubMed2001

Resuscitation from traumatic shock.

Shock is the body's response to decreased cellular perfusion. It can begin with hemorrhage, mechanical obstruction of the circulation, cardiac dysfunction, central nervous system injury, or sepsis. Once triggered, shock is perpetuated by the release of toxic compounds from ischemic cells. The treatment of shock consists of the removal or correction of the triggering pathology, followed by resuscitation back to the normal state. Clinical research in shock resuscitation in the past year has focused on recognizing the presence of shock in patients at risk, particularly those with normal vital signs but ongoing, occult hypoperfusion. In the laboratory, the emphasis has been on minimizing the initial hemorrhagic insult, minimizing the release of toxins from ischemic cells, and blocking the response to the toxins that are released.

Journal Article↗
PubMed2001

Using CT to diagnose tracheal rupture.

OBJECTIVE: A retrospective study was performed to assess CT sensitivity for diagnosing tracheal rupture. Intubated cadaver tracheas were examined to assess endotracheal tube balloon overdistention and deformity and to evaluate the relationship of balloon pressures to tracheal injury. MATERIALS AND METHODS: Neck or chest CT scans of 14 patients with tracheal rupture and 41 control trauma patients with pneumomediastinum but without tracheal injury were reviewed and compared to assess the presence and location of extrapulmonary air, whether direct visualization of tracheal wall disruption was possible, the size and shape of endotracheal tube balloon, signs of transtracheal balloon herniation in intubated patients, and the location of the extratracheal endotracheal tube. Intact and experimentally injured cadaver tracheas were used to evaluate tube balloon pressure and configuration. RESULTS: All 14 patients with tracheal rupture had deep cervical air and pneumomediastinum. Overdistention of the tube balloon occurred in 71% (5/7) of the intubated patients, and balloon herniation occurred in 29% (2/7). Direct tracheal injury was seen in 71% (10/14) of the patients as a wall defect (n = 8) or deformity (n = 2). Overall, CT was 85% sensitive for detecting tracheal injury. Patients with tracheal injury had a significantly lower incidence of pneumothorax (p = 0.01) than did the control group. The CT appearance of balloon herniation through defects in the cadaver tracheas closely mimicked those of patients with tracheal injury. The amount of balloon pressure required to rupture the intubated trachea was extremely high and rupture was difficult to obtain. CONCLUSION: CT can reveal tracheal injury and can be used to select trauma patients with pneumomediastinum for bronchoscopy, leading to early confirmation and treatment.

Adolescent↗
PubMed1996

Excess mortality associated with the use of a rapid infusion system at a level 1 trauma center.

The Rapid Infusion System (RIS) is a device which can deliver warm fluid and blood products rapidly and at precise rates. It has been in use since 1990 for the management of victims of major trauma at the R Adams Cowley Shock Trauma Center (STC) in Baltimore. Although the RIS is unquestionably a convenience to the anesthesiologist, no study to date has addressed its effect on patient outcome. We have therefore undertaken a retrospective review of all uses of the RIS on trauma patients during the years in which it has been available at the Shock Trauma Center, comparing actual patient mortality both to expected mortality derived from the STC Trauma Registry, and to matched historical controls who did not receive fluids via the RIS. A total of 527 patients were included in the study. The mean volume infused via the RIS was 9724 ml, and the total volumes ranged from 24-117 585 ml. Overall survival was significantly less than expected (52.9% vs. 61.8%, P < 0.001). Survival in penetrating trauma was similar to expected, but in blunt trauma it was considerably less (48.8% vs. 63.0%, P < 0.001). Patients whose probability was between 0.1% and 0.9% also survived significantly less frequently than expected (44.3% vs. 57%, n = 105, P < 0.008). In those patients who received less than 6000 ml via the RIS, the actual and expected survival rates were almost identical. In those receiving more than 6000 ml (180 patients), the difference between actual and expected survival was striking (37.2% vs. 57.2%, P < 0.0001). As compared to matched control patients injured to the same extent during the same time period, patients who received fluids via the RIS had a 4.8 times greater chance of dying (95% confidence interval 2.4-7.1). These data call into question current protocols for rapid volume infusion in trauma management and point to the need for further prospective trials.

Fluid Therapy↗
PubMed1993

Comparison of thoracic and lumbar epidural infusions of bupivacaine and fentanyl for post-thoracotomy analgesia.

Epidural analgesia, via either a thoracic or lumbar route, is commonly used to provide postoperative analgesia following thoracotomy for pulmonary resection, but little data indicate which location is better in terms of postoperative analgesia, side effects, or associated complications. In this study, 45 patients, who were scheduled to have epidural analgesia and undergo a lateral thoracotomy, were randomized to receive either a thoracic or a lumbar catheter. Pain assessments and routine clinical data were recorded to determine if either thoracic or lumbar epidural catheters provided superior analgesia, fewer side effects, or fewer complications. This study found no statistical difference in pain relief or side effects between lumbar and thoracic epidural analgesia for post-thoracotomy pain. An increased infusion rate (6.4 +/- 1.9 v 5.1 +/- 1.4 mL/h, P = 0.02) was required in the lumbar group to achieve equivalent analgesic levels.

Adult↗