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Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran

PURPOSE: Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloi...

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Autores principales: Paydar, Shahram, Taheri Akerdi, Ali, Nikseresht, Sadra, Abdolrahimzadeh-Fard, Hossein, Shayan, Leila, Ghahramani, Zahra, Bolandparvaz, Shahram, Abbasi, Hamid Reza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878457/
https://www.ncbi.nlm.nih.gov/pubmed/32893115
http://dx.doi.org/10.1016/j.cjtee.2020.08.004
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author Paydar, Shahram
Taheri Akerdi, Ali
Nikseresht, Sadra
Abdolrahimzadeh-Fard, Hossein
Shayan, Leila
Ghahramani, Zahra
Bolandparvaz, Shahram
Abbasi, Hamid Reza
author_facet Paydar, Shahram
Taheri Akerdi, Ali
Nikseresht, Sadra
Abdolrahimzadeh-Fard, Hossein
Shayan, Leila
Ghahramani, Zahra
Bolandparvaz, Shahram
Abbasi, Hamid Reza
author_sort Paydar, Shahram
collection PubMed
description PURPOSE: Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients. METHODS: In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test. RESULTS: A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p < 0.003), and the coagulation profile worsened although the change was not statistically significant. CONCLUSION: The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible.
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spelling pubmed-78784572021-02-18 Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran Paydar, Shahram Taheri Akerdi, Ali Nikseresht, Sadra Abdolrahimzadeh-Fard, Hossein Shayan, Leila Ghahramani, Zahra Bolandparvaz, Shahram Abbasi, Hamid Reza Chin J Traumatol Original Article PURPOSE: Traumatic hemorrhagic shock is a life-threatening event worldwide. Severe brain trauma accompanying femoral fractures can trigger inflammatory responses in the body and increase pre-inflammatory cytokines such as TNF-α, IL-1. The primary treatment in these cases is hydration with crystalloids, which has both benefits and complications. The purpose of this study was to investigate the effects of fluid therapy on the hemodynamics, coagulation profiles, and blood gases in such patients. METHODS: In this cross-sectional study, patients were divided into two groups: femoral fracture group and non-femoral group. The hemodynamic status, coagulation profile, and blood gases of patients in both groups were evaluated upon arrival at the hospital and again 2 h later. Data were analyzed by t-test and ANOVA with repeated data and paired samples t-test. RESULTS: A total of 681 trauma patients (605 men and 76 women) participated in this study, including 69 (86.3%) men and 11 (13.8%) women in femoral fracture group and 536 men (89.2%) and 65 women (10.8%) in non-femoral group. The laboratory parameters were evaluated in response to the equal amount of crystalloid fluid given upon arrival and 2 h later. Blood gases decreased in the fracture group despite fluid therapy (p < 0.003), and the coagulation profile worsened although the change was not statistically significant. CONCLUSION: The treatment of multiple-trauma patients with femoral bone fractures should be more concerned with the need for the infusion of vasopressors such as norepinephrine. If there is evidence of clinical shock, excessive crystalloid infusion (limited to 1 L) should be avoided, and blood and blood products should be started as soon as possible. Elsevier 2021-02 2020-08-15 /pmc/articles/PMC7878457/ /pubmed/32893115 http://dx.doi.org/10.1016/j.cjtee.2020.08.004 Text en © 2020 Chinese Medical Association. Production and hosting by Elsevier B.V. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Paydar, Shahram
Taheri Akerdi, Ali
Nikseresht, Sadra
Abdolrahimzadeh-Fard, Hossein
Shayan, Leila
Ghahramani, Zahra
Bolandparvaz, Shahram
Abbasi, Hamid Reza
Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran
title Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran
title_full Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran
title_fullStr Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran
title_full_unstemmed Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran
title_short Should we change our approach to resuscitating victims of femoral fracture? A clinical experience in a busy trauma hospital in Shiraz, Iran
title_sort should we change our approach to resuscitating victims of femoral fracture? a clinical experience in a busy trauma hospital in shiraz, iran
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7878457/
https://www.ncbi.nlm.nih.gov/pubmed/32893115
http://dx.doi.org/10.1016/j.cjtee.2020.08.004
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