A.J. Layon

Incidence, clinical predictors, genomics, and outcome of acute kidney injury among trauma patients

Objective:To determine clinical and genomic characteristics and in-hospital mortality risk associated with acute kidney injury (AKI) in the multicenter prospective cohort of patients with blunt trauma. Summary Background Data:Less severe stages of AKI characterized by small changes in serum creatinine (sCr) are inadequately studied among trauma patients. Methods:We performed a secondary analysis of the “Inflammation and the Host Response to Injury” (Glue Grant) database to include adult blunt trauma patients without history of kidney disease. AKI was defined by the Risk, Injury, Failure, Loss, and End-stage Kidney (RIFLE) classification, which requires a 50% increase in sCr and stratifies patients into following 3 severity stages: risk, injury, and failure. Association between all stages of AKI and in-hospital mortality was analyzed using a multivariable logistic regression analysis. Genome-wide expression analysis was performed on whole blood leukocytes obtained within 12 hours of trauma. Results:AKI occurred in 26% of 982 patients. The adjusted risk for hospital death was 3 times higher for patients with AKI compared with patients without AKI (odds ratio = 3.05) (95% confidence interval, 1.73–5.40). This risk was evident in a dose-response manner and even patients with mild AKI had odds ratio for dying of 2.57 (95% confidence interval, 1.19–5.50) compared with patients without AKI. Genome-wide expression analysis failed to show a significant number of genes whose expression could discriminate among patients with and without AKI. Conclusions:In a multicenter prospective cohort of blunt trauma patients, AKI characterized by small changes in sCr was associated with an independent risk of hospital death.

Prolonged cardiopulmonary resuscitation with preservation of cerebral function in an elderly patient with asystole after electroconvulsive therapy.

This case report describes a patient who became asystolic after electroconvulsive therapy. The report describes the prolonged resuscitative events that lasted 54 minutes and discusses the effectiveness of chest compressions and the importance of monitoring the acid-base balance. The report also stresses the importance of being able to establish effective cardiac pacing in this patient. The updated resuscitation guidelines published by the American Heart Association are also discussed.

Advanced Airway Management in the Neurologically Injured Patient

A systematic approach to airway management has been shown to reduce the likelihood of an adverse outcome in the operating room [1–4]. Accordingly, in this chapter we discuss the unique challenges involved in the airway management of the neurologically injured patient and offer a strategy that may improve neurologic outcome after central nervous system (CNS) injury.