Renal dysfunction in trauma: even a little costs a lot.

BACKGROUND: Acute renal failure (ARF) is a devastating complication in critically ill patients. There is a paucity of data that describes the impact of ARF on the outcome of trauma patients admitted to the intensive care unit. METHODS: We studied trauma patients admitted to the surgical intensive care unit to determine the effect of increases in serum creatinine on the number of ventilator days, length of stay, mortality, and cost. We used the administrative database of the hospital and the trauma registry. Renal failure (RF) was defined as one or more of the following: creatinine >1.5 mg/dL, increase in creatinine of >50%, or increase of creatinine by 0.5 mg/dL. RESULTS: We obtained data on 1,033 patients. Two hundred and forty-six (23.8%) patients met at least one criterion for RF. Only 25 of these patients had one or more episodes of renal replacement therapy. The RF group had mortality of 24.4% compared with 2.3% in the no renal failure group (p < 0.0001). For each 1 mg/dL increase from the initial creatinine, length of stay increased by 2.21 days, ventilator days increased by 1.09 days, and the mortality risk increased by 1.83 times (CI, 1.47-2.29; p < 0.0001). For any diagnosis of renal dysfunction, the average cost increase was $3,088.00 and increased mortality risk was 7.19 times (CI, 4.11-12.58). CONCLUSION: Vigilance in preventing creatinine increases and ameliorating or removing potential causes should occur as soon as creatinine begins to rise to avoid worsening renal function, to reduce cost, and to improve patient outcome.

The effect of gradually increased blood flow on ischemia-reperfusion injury in rat kidney.

BACKGROUND: Gradually increased blood flow to the ischemic rat kidney was studied to assess the ability to diminish ischemia-reperfusion injury. METHODS: The left renal artery and vein were isolated in 25 rats. Microclamps were applied for 45 minutes and were released at once (group II) or gradually (group III). Renal arterial blood flow and K+ activity were measured. Bilateral kidneys were harvested for histopathology and for malonyldealdehyde and myeloperoxidase levels. RESULTS: Increased K+ activity returned to preischemic values faster in group III than in group II. No statistically significant difference existed in malonyldealdehyde and myeloperoxidase levels; histopathologic scoring showed less tissue damage in group III (P < .05). Contralateral kidney samples showed signs of ischemia in group II. CONCLUSIONS: Gradually increased blood flow to the ischemic kidney decreases ischemic changes. Ischemic insult to 1 kidney causes histopathologically detectable changes to the contralateral kidney, which can be diminished by gradual reperfusion.

Gastrointestinal complications after ruptured aortic aneurysm repair.

Gastrointestinal complications after ruptured aortic abdominal aneurysm (AAA) repair are not well defined and are limited to descriptions of ischemic colitis. We sought to delineate risk factors predicting gastrointestinal complications after ruptured AAA repair. Data from 100 consecutive patients after ruptured AAA repair between July 1980 and June 2000 were gathered for multiple preoperative, intraoperative, and postoperative factors. These variables were analyzed relative to postoperative gastrointestinal complications and resulting mortality. Overall mortality was 48 per cent. Gastrointestinal complications were encountered 29 times in 27 patients of 100 total patients (27%). Complications included prolonged adynamic ileus (three), acute pancreatitis (four) and cholecystitis (two), perforated duodenal ulcer (one), bowel obstruction (three), antibiotic-associated colitis (six), ischemic colitis (three), bowel infarction (four), and liver failure (three). Comparison of patients with and without gastrointestinal complications showed no predictive preoperative or intraoperative variables. Gastrointestinal complications are common in ruptured aortic aneurysm repair and carry increased mortality and morbidity. Surgeons must maintain a high level of suspicion to anticipate possible gastrointestinal complications.