Howard R. Champion

INDICATIONS FOR EARLY HÆMODIALYSIS IN MULTIPLE TRAUMA

Abstract Renal function in 751 cases of multiple trauma was studied to define a level of function compatible with ultimate survival. Established definitions of renal failure were ignored. A daily renal index was calculated using urine volume, serum-creatinine, and blood-urea-nitrogen (B.U.N.). The data for 3600 patient-days were analysed on a computer. Probability of survival was less than 0.1 in patients with a creatinine >4 mg. per 100 ml. or a B.U.N. >80 mg. per 100 ml. or a renal index >3 on one occasion or >2 on two consecutive days. The renal index provided an earlier and more accurate prognosis in a significant number of patients when compared with the other variables. The impairment of renal function associated with death in the patient studied is considerably less than currently accepted criteria for haemodialysis. Dialysis to within the levels shown to be compatible with survival offers a method of reducing the high mortality. Clinical application of the renal index as an indication for early haemodialysis in major trauma is proposed.

A mathematical model for volume replacement in bleeding patients

Patients with massive hemorrhage of diverse etiology are still associated with a high mortality rate despite reaching hospital alive. A multitude of factors contribute to this disappointing outcome and include delayed diagnosis, difficult technical surgery, surgical inexpertise, a lack of dedicated operating rooms, and inadequate or inappropriate resuscitatory measures. Other problems may be encountered which are specifically related to massive transfusion. Anemia from inadequate red-cell replacement, bleeding diatheses, and serious hypothermia may occur. If these hurdles are surmounted the patient may still develop organ failure syndromes and sepsis with a grave prognosis. Daily encounters with exsanguinating injuries from blunt trauma have resulted in rigid resuscitation protocols based on predetermined proportions of blood components to form a composite infusate compatible with life. This permits essential surgical attention to be directed elsewhere in the early critical management. Previous mathematic approaches to transfusion have concentrated on exchange transfusions and have assumed constant blood volumes [lo]. For therapeutic value in a