The "coagulation box" and a new hemoglobin-driven algorithm for bleeding control in patients with severe multiple traumas.

Background: Extensive hemorrhage is the leading cause of death in the first few hours following multiple traumas. Therefore, early and aggressive treatment of clotting disorders could reduce mortality. Unfortunately, the availability of results from commonly performed blood coagulation studies are often delayed whereas hemoglobin (Hb) levels are quickly available.

Trauma care in Germany: major differences in case fatality rates between centers.

Background: Recent years have seen a further decline in the nationwide case fatality rate after major trauma in Germany, but it has not been clear until now whether all centers providing trauma care achieve comparable results. We have attempted to answer this question using data from the trauma registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, DGU).

Methods: The standardized mortality rate of each participating center was calculated on the basis of the RISC prognostic score (Revised Injury Severity Classification) and the observed case fatality rate of the center.

Recovery index, attentiveness and state of memory after xenon or isoflurane anaesthesia: a randomized controlled trial.

Background: Performance of patients immediately after anaesthesia is an area of special interest and so a clinical trial was conducted to compare Xenon with Isoflurane anaesthesia. In order to assess the early cognitive recovery the syndrome short test (SST) according to Erzigkeit (Geromed GmbH) was applied.

Methods: ASA I and II patients undergoing long and short surgical interventions were randomised to receive either general anaesthesia with Xenon or Isoflurane.

Assessing the depth of hypnosis of xenon anaesthesia with the EEG.

Xenon was approved as an inhaled anaesthetic in Germany in 2005 and in other countries of the European Union in 2007. Owing to its low blood/gas partition coefficient, xenons effects on the central nervous system show a fast onset and offset and, even after long xenon anaesthetics, the wake-up times are very short. The aim of this study was to examine which electroencephalogram (EEG) stages are reached during xenon application and whether these stages can be identified by an automatic EEG classification.

The breast feeding mother and xenon anaesthesia: four case reports. Breast feeding and xenon anaesthesia.

Background: Four nursing mothers consented to anaesthesia for urgent surgery only on condition that their ability to breast feed would not be impaired.

Methods: Following induction of general anaesthesia with propofol and remifentanil, 65-69% xenon supplemented with remifentanil was used as an inhalational anaesthetic for maintenance.

Results: After finishing surgery the women could be extubated between 2:52 and 7:22 minutes.

Long-distance repatriation by an EMS helicopter.

In Europe, long-distance repatriation flights are usually executed by fixed-wing aircraft. We report an international long-distance repatriation flight by the helicopter emergency medical service (HEMS), with a total flight time of almost 7 hours. The flight itself, the medical requirements, and aviation problems are discussed.

Alcohol-positive multiple trauma patients with and without blood transfusion: an outcome analysis.

Background: Blood transfusion is a common therapy for multiple trauma patients, and is often performed soon after hospital admission. It is unclear whether the need for a blood transfusion in multiply injured patients presenting with a positive blood alcohol concentration (BAC) is associated with increased morbidity/mortality, since their risk behavior differs significantly from patients with a negative BAC. In this study, we evaluated the role of blood transfusion in the treatment of BAC-positive multiple trauma patients.

Does brain temperature correlate with intracranial pressure?

Objective: A positive correlation between brain temperature and intracranial pressure (ICP) has been proposed for patients under intensive care conditions.

Design And Methods: Data were recorded at 5-minute intervals in patients under ICP monitoring conditions. Brain temperature: combined ICP/temperature probe (Raumedic), core temperature: indwelling urinary catheter with temperature probe (Rüsch).

Score-based immunoglobulin G therapy of patients with sepsis: the SBITS study.

Objective: Intravenous immunoglobulin as an adjunctive treatment in sepsis was regarded as promising by a Cochrane meta-analysis of smaller trials. In this phase III multicenter trial, we assessed whether intravenous immunoglobulin G (ivIgG) reduced 28-day mortality and improved morbidity in patients with score-defined severe sepsis.

Design: Randomized, double-blind, placebo-controlled, multicenter trial.

Olive oil based nutrition in multiple trauma patients: a pilot study.

Objective: A negative effect of hyperglycemia on clinical outcome has been proposed for patients treated under intensive care conditions. So far, however, the safety and effect of fat based nutrition regimen, especially of olive oil based emulsions, have not been systematically studied.

Design And Setting: Prospective, open-labeled, randomized, pilot study in a 14-bed surgical intensive care unit.

Plasma atrial natriuretic peptide and brain natriuretic peptide are increased in septic shock: impact of interleukin-6 and sepsis-associated left ventricular dysfunction.

Objective: Interest has recently focused on the use of neurohormonal markers such as atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) as indices of left ventricular systolic dysfunction and prognosis in heart failure. Also, peptides belonging to the interleukin-6 (IL-6) family have been shown to induce ANP and BNP secretion. We hypothesized that BNP and ANP spillover in the peripheral circulation reflects left ventricular dysfunction and IL-6 production in septic shock.