RESUMO
Extracorporeal membrane oxygenation (ECMO) has become a salvage therapy for patients with severe acute respiratory distress syndrome (ARDS). The management of orthopaedic trauma in ECMO-supported patients with ARDS remains an evolving area of interest. Orthopaedic injuries are often temporized with external fixators, skeletal traction, or splints due to hemodynamic instability as well as concerns of exacerbating underlying pulmonary injury. However, patients requiring ECMO support do not rely on their pulmonary system for oxygenation, the need for delayed fixation may not apply. However, patients utilizing ECMO therapy can have external cardiac and pulmonary support depending on their cannulation strategy, bypassing the need for delayed fixation. We present a case series of two polytrauma patients with ARDS who underwent surgical management of pelvic ring and femoral shaft fractures while receiving ECMO support. Both patients underwent surgical management without complication and were able to be weaned from ECMO and ventilator support postoperatively. These cases highlight the potential benefits to orthopaedic fixation and underscore the need for further clinical research.
RESUMO
The present study examined whether in-hospital assessments of heart rate and blood pressure predicted symptoms of post-traumatic stress (PTS) in 110 patients undergoing total knee replacement surgery. After controlling for conceptually relevant factors, in-hospital cardiovascular functioning predicted symptoms of PTS three months following surgery. Specifically, lower pre-surgical and post-surgical systolic and diastolic blood pressure predicted more symptoms of avoidance and PTS (total). In contrast, higher heart rate prior to and shortly following surgery predicted marginally more intrusive thoughts. The present findings suggest that routinely collected medical data may provide a means to identify patients at risk for problematic outcomes following surgery.