Shahram Paydar; Mojtaba Mahmoodi; Mohammad Jamshidi; Hadi Niakan; Mohammad Keshavarz; Nader Moeenvaziri; Mohammad Esmaeil Ghorbaninejad; Farnaz Farrokhnia; Forough Izadi Fard; Zahra Jaafari; Yalda Golshan; Hamidreza Abbasi; Shahram Bolandparvaz; Behnam Honarvar
Volume 2, Issue 3 , July 2014, , Pages 103-109
Abstract
Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability.Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma ...
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Objective: To explore the pros and cons of early versus delayed intervention when dealing with severe blunt liver injury with significant hemoperitoneum and hemodynamic instability.Methods: This retrospective cross-sectional study was performed at the Nemazi hospital, Shiraz, Southern Iran, level I trauma Center affiliated with Shiraz University of Medical Sciences. The study population comprised of all patients who were operated with the impression of blunt abdominal trauma and confirmed diagnosis of liver trauma during an 8-year period. All data were extracted from patients’ hospital medical records during the study period. The patients’ outcome was compared between those who underwent perihepatic packing or primary surgical repair.Results: Medical records of 76 patients with blunt abdominal liver trauma who underwent surgical intervention were evaluated. Perihepatic packing was performed more in patients who have been transferred to operation room due to unstable hemodynamics (p<0.001) as well as in patients with more than 1000 milliliters of hemoperitoneum based on pre-operative imaging studies (e.g. CT/US) (p=0.002).Conclusion: We recommend that trauma surgeons should approach perihepatic packing earlier in patients who have been developed at least two of these three criteria; unstable hemodynamics, more than 1000 milliliters hemoperitoneum and more than 1600 milliliters of intra-operative estimated blood loss. We believe that considering these criteria will help trauma surgeons to diagnose and treat high risk patients in time so significant hemorrhage (e.g. caused by dilatational coagulopathy, hypothermia and acidosis, etc.) can ultimately be prevented and more lives can be saved.
Hamid Reza Abbasi; Farnaz Farrokhnia; Sepideh Sefidbakht; Shahram Paydar; Shahram Bolandparvaz
Volume 1, Issue 1 , January 2013, , Pages 17-21
Abstract
Objective: To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure (PVP).Methods: This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were ...
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Objective: To determine the removal time of the chest tube in ICU trauma patients under positive ventilation pressure (PVP).Methods: This was randomized clinical trial being performed in ICU department of Rajaei trauma hospital from March to December 2011. A total number of 92 trauma patients who were admitted in ICU and were under ventilation and had chest tube were randomly assigned into two groups. In case group, chest tube was clamped after 5–7 days. In the control group, chest tube was retained until the patients were under PVP. The chest tube was removed if there was no air leak or the drainage was less than 300 mL.Results: Complications observed in the case and control groups were 4.4% of 4.3% respectively (p=0.862). Among case group with hemothorax, 6.7% developed complication while this ratio for pneumothorax was 7.1% and zero in those with hemopneumothorax (p=0.561), whereas respective values for the control group were 11.1%, 8.3% and zero (p=0.262). Complications were noticed in 10.5% of those with more than 300 ml of pulmonary drainage. There were no complications in patients without air leak. In mild leak, 4.8% of subjects experienced complication, in moderate leak, no complication occurred and in severe ones, complication was visible in 7.7% of patients (p=0.842).Conclusion: The present study showed that the removal of chest tube in patients under ventilation within 5-7 days after its insertion is safe without any complications.
