University of Texas Southwestern Medical Center and Parkland Health and Hospital System, Dallas, TX, USA.
Crit Care Med. 2012 Apr;40(4):1129-35. doi: 10.1097/CCM.0b013e3182376e9f.
To describe the incidence of postinjury multiple organ failure and its relationship to nosocomial infection and mortality in trauma centers using evidence-based standard operating procedures.
Prospective cohort study wherein standard operating procedures were developed and implemented to optimize postinjury care.
Seven U.S. level I trauma centers.
Severely injured patients (older than age 16 yrs) with a blunt mechanism, systolic hypotension (<90 mm Hg), and/or base deficit (≥6 mEq/L), need for blood transfusion within the first 12 hrs, and an abbreviated injury score ≥2 excluding brain injury were eligible for inclusion.
One thousand two patients were enrolled and 916 met inclusion criteria. Daily markers of organ dysfunction were prospectively recorded for all patients while receiving intensive care. Overall, 29% of patients had multiple organ failure develop. Development of multiple organ failure was early (median time, 2 days), short-lived, and predicted an increased incidence of nosocomial infection, whereas persistence of multiple organ failure predicted mortality. However, surprisingly, nosocomial infection did not increase subsequent multiple organ failure and there was no evidence of a "second-hit"-induced late-onset multiple organ failure.
Multiple organ failure remains common after severe injury. Contrary to current paradigms, the onset is only early, and not bimodal, nor is it associated with a "second-hit"-induced late onset. Multiple organ failure is associated with subsequent nosocomial infection and increased mortality. Standard operating procedure-driven interventions may be associated with a decrease in late multiple organ failure and morbidity.
使用循证标准操作规程描述创伤中心损伤后多器官衰竭的发生率及其与医院感染和死亡率的关系。
前瞻性队列研究，制定并实施标准操作规程以优化损伤后护理。
美国 7 家一级创伤中心。
严重损伤患者（年龄大于 16 岁），钝性损伤机制，收缩压<90mmHg，和/或碱缺失≥6mEq/L，需要在最初 12 小时内输血，且损伤严重程度评分（abbreviated injury score）≥2 除外脑损伤。
共纳入 1200 例患者，其中 916 例符合纳入标准。所有接受重症监护的患者均前瞻性记录器官功能障碍的每日标志物。总体而言，29%的患者发生多器官衰竭。多器官衰竭的发生时间较早（中位数时间为 2 天），持续时间短，并预测医院感染发生率增加，而多器官衰竭持续存在则预测死亡率。然而，令人惊讶的是，医院感染并没有增加随后的多器官衰竭，也没有证据表明存在“二次打击”引起的迟发性多器官衰竭。
严重损伤后多器官衰竭仍然常见。与当前的概念相反，其发生时间仅为早期，而不是双峰式，也与“二次打击”引起的迟发性无关。多器官衰竭与随后的医院感染和死亡率增加有关。标准操作规程驱动的干预措施可能与迟发性多器官衰竭和发病率降低有关。
