Biomedical subjects

Scott D'Amours

Publications and source records attributed to Scott D'Amours.

4 recordsLinked to original sources

PubMed2006

Results from the International Conference of Experts on Intra-abdominal Hypertension and Abdominal Compartment Syndrome. I. Definitions.

OBJECTIVE: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. The variety of definitions proposed has led to confusion and difficulty in comparing one study to another. DESIGN: An international consensus group of critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to standardize definitions for IAH and ACS based upon the current understanding of the pathophysiology surrounding these two syndromes. METHODS: Prior to the conference the authors developed a blueprint for the various definitions, which was further refined both during and after the conference. The present article serves as the final report of the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of Abdominal Compartment Syndrome (WSACS). RESULTS: IAH is redefined as an intra-abdominal pressure (IAP) at or above 12 mmHg. ACS is redefined as an IAP above 20 mmHg with evidence of organ dysfunction/failure. ACS is further classified as either primary, secondary, or recurrent based upon the duration and cause of the IAH-induced organ failure. Standards for IAP monitoring are set forth to facilitate accuracy of IAP measurements from patient to patient. CONCLUSIONS: State-of-the-art definitions for IAH and ACS are proposed based upon current medical evidence as well as expert opinion. The WSACS recommends that these definitions be used for future clinical and basic science research. Specific guidelines and recommendations for clinical management of patients with IAH/ACS are published in a separate review.

Abdomen↗

PubMed2005

Institutional practice guidelines on management of pelvic fracture-related hemodynamic instability: do they make a difference?

BACKGROUND: The management of patients with hemodynamic instability related to pelvic fracture is a major challenge, with high morbidity and mortality. Evidence-based institutional practice guidelines (PG) were developed as a strategy to optimize the care of these patients. The aims of this study were to evaluate the adherence to the new PG and compare the outcomes before and after their implementation. METHODS: Major blunt trauma patients (Injury Severity Score [ISS] > 15) with hemodynamic instability (initial base deficit > 6 mEq/L or received > 6 units of packed red blood cells [PRBCs] during the first 12 hours) related to pelvic fracture were investigated. Patients presenting with ongoing bleeding from other regions or with severe head injury (Glasgow Coma Scale score < 9) were excluded. The pre-PG group (n = 17) were patients managed during the 18 months ending on December 31, 2001. The post-PG group (n = 14) consisted of patients managed during the subsequent 18 months. Demographics, ISS, shock severity, resuscitation, and outcome data were prospectively collected. The adherence to the key steps of PG was evaluated retrospectively in the pre-PG and prospectively in the post-PG group, including abdominal clearance (AC) with diagnostic peritoneal aspiration/lavage or ultrasound (<15 minutes), noninvasive pelvic binding (PB) (<15 minutes), pelvic angiography (PA) (<90 minutes after admission), and minimally invasive orthopedic fixation (MIOF) (<24 hours). Data are presented as mean +/- SEM or percentages. RESULTS: The pre-PG and post-PG groups were similar regarding age (40 +/- 4 years vs. 42 +/- 6 years), gender (both 71% male), ISS (39 +/- 3 vs. 37 +/- 4), admission base deficit (9 +/- 1 vs. 10 +/- 1) admission systolic blood pressure (116 +/- 7 vs. 112 +/- 6 mm Hg), Glasgow Coma Scale score (12 +/- 1 vs. 12 +/- 1), and PRBC transfusion in the first 12 hours (9 +/- 2 U vs. 9 +/- 2 U). The adherence to the guidelines in the post-PG period was as follows: AC, 100%; PB, 86% (p < 0.05 based on t test or chi test); PA, 93% (p < 0.05 based on t test or chi test); and MIOF, 86%. In the pre-PG period, adherence to the guidelines was as follows: AC, 65%; PB, 0%; PA, 30%; and MIOF 52%. In the post-PG period, the 24-hour PRBC transfusion decreased from 16 +/- 2 U to 11 +/- 1 U and the mortality decreased from 35% to 7% (p < 0.05 based on t test or chi test for both). CONCLUSION: The adherence to the PG as a reflection of optimal management was significantly improved. PG focusing particular on timely hemorrhage control reduced the 24-hour transfusion requirements and the mortality rate in the post-PG group.

Adult↗

PubMed2005

Abdominal trauma: a disease in evolution.

BACKGROUND: The last decade has seen many changes in the way we investigate and manage abdominal injuries. This study assessed the pattern of abdominal injury and its investigation in patients admitted to a major trauma centre. METHODS: A retrospective registry review of all adult trauma patients admitted to Liverpool Hospital between January 1996 and December 2003 was undertaken. All adult trauma patients were included, identifying mechanism of injury, injury severity score, abbreviated injury score for the abdomen, investigations and intervention. The study period was divided (period 1 from 1996 to 1999, period 2 from 2000 to 2003) and the two periods compared to assess change. RESULTS: The study involved 1224 patients with abdominal injuries. Of these, 969 (79%) were a result of blunt trauma. The main causes were road accidents (61%), interpersonal violence (24%) and falls (7%). Penetrating injury increased from 16% to 25% between the two periods. There were 1274 intra-abdominal injuries, made up of 607 solid organ (liver (n = 220, 36%), spleen (n = 195, 32%), renal (n = 144, 24%) ), 291 hollow viscus (small bowel (n = 160, 55%), large bowel (n = 104, 36%) ) and 168 vascular. Four hundred and thirty-six (36%) patients underwent laparotomy, 65% for blunt trauma. Between the two periods there was a 46% decrease in the use of diagnostic peritoneal lavage, with a 40% increase in computed tomography and 325% increase in focused assessment with sonography for trauma. CONCLUSIONS: This study defined abdominal injury pattern and identified a significant shift in mechanism of injury and abdominal investigation at a major trauma centre during an 8-year study period. Abdominal trauma is indeed a disease in evolution.

Abdominal Injuries↗

PubMed2004

Continuous intra-abdominal pressure measurement technique.

BACKGROUND: Abdominal compartment syndrome can develop within 12 hours of intensive care unit (ICU) admission in high-risk (shock/trauma, burn, pancreatitis, postabdominal aortic surgery) patients. The current standard of intra-abdominal pressure (IAP) measurement via the urinary catheter is labor intensive, and its intermittent nature could prevent timely recognition of significant changes in IAP. We propose that continuous IAP (CIAP) can be accurately measured via the irrigation port of a three-way catheter and has good agreement with the standard intermittent IAP (IIAP). METHODS: CIAP was prospectively validated by comparing it with IIAP measurement in general surgical and trauma patients admitted to the ICU with a three-way urinary catheter. CIAP was measured via the irrigation port of the three-way catheter transduced to the bedside monitor as a continuous trace without intermittent clamping of the catheter. The standard IIAP measurements were performed via the urine drainage port after clamping the catheter and filling the bladder with 50 mL of 0.9% saline. Each patient had three separate paired measurements performed in standardized manner to compare CIAP with IIAP. Patients' demographics, injury severity, type of surgery, body mass index (BMI), and the paired individual IAP measurements were recorded. The paired measurements were compared using the Bland-Altman (B-A) method for comparing a new clinical measurement with an established one. Data are presented as mean +/- standard error of the mean. RESULTS: During a 6-month period (ending in July 2003), 25 patients were investigated. The mean age was 61.5 +/- 4 years, 66% were men, and BMI was 29.2 +/- 2 kg/m(2). Six patients had vascular surgical, four elective and three urgent general surgical interventions. There were 12 trauma patients with ISS of 23 +/- 2. The CIAP was 14.2 +/- 0.66 (range 2 to 24) mm Hg, and the IIAP was 14.0 +/- 0.68 (range 3 to 24) mm Hg. Seventy-five percent of the measured pairs were exactly the same; in 21%, there was 1 mm Hg difference and in 4% 2 mm Hg. There was no measurement difference greater than 2 mm Hg. The mean difference between the CIAP and IIAP was 0.019 +/- 0.05 mmHg. The B-A statistics revealed that the difference between the means of measurements in each individual patient was between +/-1.96 SD (95% confidence intervals). The B-A scatter plot did not follow any patterns of typical systematic bias. CONCLUSION: CIAP measurement with a three-way urinary catheter is a simple and accurate method for monitoring IAP. It has an excellent agreement with the IIAP over wide pressure ranges and should replace the current labor-intensive intermittent technique.

Abdomen↗