Do sicker surviving trauma patients take longer to recover? Can recovery be shortened?

Joseph Civetta, Judith Hudson-Civetta, Nicholas Namias, Orlando Kirton, Eleanor Gomez, Michael Herman, Manricio Lyim, Lirry Martin

Research output: Contribution to journalArticle

Abstract

Introduction: Initial severity of illness (APACHE II [APS]) has been used to predict mortality rates. We noted high APS correlated with longer recovery times. We devised Ischemia-Reperfusion Prevention (IRP) and gastric intramucosal pH (pHi) treatment to alter the late effects of high initial abnormal physiology. Methods: All trauma patients admitted to the ICU from September through December in 1993 and 1995 were compared. The latter group received intravenous folate, lidocaine, vitamin C, selenium, mannitol, polymyxin B, and hydrocornsone as well as enterai vitamins A and E, glutamine, and n-acetylcysteine. Interventions in the ICU tried to achieve pHi > 7.2S. For long-term patients, all but folate, lidocaine and hydrocornsone were continued. Results: In 1993, 143 patients were judged to meet treatment criteria; 101 patients were treated in 1995. The initial APS was higher in 1995 (19.2 ±9) compared to 1993, 15.7 ±8.5, p = .002. APS decreased more on day 2 in 1995 than in 1993 (-7.1 vs. -4.8) (p = .003), to 11.7 in 1995 vs. 11.2 in 1993. In 1993 the relationship between initial APS and ICU days was significant (ANOVA p < .0001). By Scheffe's test, APS for duration (1-2) < (5-6), (7-13), (> 13); (3-4)< (7-13), (>13); (5-6) < (>13). In 1995 APS was significantly different by duration (p= 0003 by ANOVA). Scheffe's test revealed the difference was APS for duration (1-2) < (7-13), (>13). ICU days 1-2 3-4 5-6 7-13 >13 1993 # pts lived 35 31 19 23 24 APS 9.2 ± 3 12.3 ± 6 15.3 ± 6 17.5 ± 7 22 ± 7.8 1995 # pts lived 31 12 13 23 14 APS 13.6 ±5 18.4 ± 7 17.1 ± 6 20.4 ± 7 22 ± 8 APS 1993 v 1995 p .0001 .006 .428 .160 .887 Conclusions: Prior to IRP and pHi, APS was related to duration of illness in survivors; each APS point increased ICU stay about one day out to 14 days. In 1995, this effect was reduced 39%. APS scores in 1995 were significantly higher than 1993 for durations (1-2) and (3-4), i.e., recovery time of higher APS was shortened. There were no longer differences in 1995 APS after day 2. We infer that the strategies diminish recovery time by abating the late effects of high initial abnormal physiology.

Original languageEnglish (US)
Pages (from-to)A124
JournalCritical care medicine
Volume26
Issue number1 SUPPL.
StatePublished - Dec 1 1998
Externally publishedYes

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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    Civetta, J., Hudson-Civetta, J., Namias, N., Kirton, O., Gomez, E., Herman, M., Lyim, M., & Martin, L. (1998). Do sicker surviving trauma patients take longer to recover? Can recovery be shortened? Critical care medicine, 26(1 SUPPL.), A124.