IMPROVEMENT OF TREATMENT TACTICS OF SEVERE COMBINED CRANIOCEREBRAL INJURY IN TERMS OF CLINICAL MANIFESTATIONS OF FAT EMBOLISM SYNDROME
1Department of Traumatology, Orthopaedics and Military Field Surgery, Avicenna Tajik State Medical University, Dushanbe, Tajikistan
2Tursunzade Central Regional Hospital, Tursunzade, Tajikistan
Objective: The reduction the lethality in the acute period of severe combined craniocerebral injury (SCCI) by improving the treatment tactics, in terms of the clinical manifestations of fat embolism syndrome (FES).
Methods: The results of treatment of 393 patients with SCCI at the age of 14 to 68 years are analyzed. Patients were divided into three groups: I group (traditional treatment) – 144 (36.7%); group II (optimized tactics) – 194 (49.3%); group III – children and adolescents aged 14-18 years – 55 (14.0%). In turn, patients of the II group are divided into the following subgroups: IIA (FES) – 33 (8.4%); IIB (SCCI) – 99 (25.6%); IIC (FES + SCCI) – 62 (15.7%).
Results: The implementation of optimized treatment tactics in combination with the identification and pathogenetic treatment of FES contributed to a reduction in deaths compared to traditional approaches. Overall mortality was 31.0%; 40.3% in group I; 12.2% in group IIA; 23.2% in group IIB; 40.3% in group IIB, and group IIIB – 21.8%. In a differentiated analysis, postoperative lethality as a whole was 26.5%; in group I – 34.1%; in group IIA – 5.3%; in group IIB – 20.8%; in group IIB – 33.9%, and in III group – 14.3%. Mortality after conservative treatment was 55.7%; in group I – 83.3%; in group IIA – 21.4%; in group IIB – 100.0%; in group IIB – 100.0%, and in group III – 35.0%.
Conclusions: The suggested approaches in the treatment of SCCI by improving tactics, properly the clinical manifestations of FES refer to effective ways to reduce the lethality in the acute period of traumatic illness.
Keywords: Severe combined craniocerebral injury, fat globulemia, fat embolism syndrome, optimized treatment tactics, lethality.
- Razzokov AA, Salimzsoda NF, Salikhov DN, Kurbanov SKh, Bandaev IS, Djuraev KhM, et al. Sovershenstvovanie meditsinskoy pomoshchi, diagnostiki i lechenya ostrogo perioda mnozhestvennoy i sochetannoy travmy [Improvement of medical aid, diagnostics and treatment of the acute period of multiple and combined trauma]. Dushanbe, RT: Maorif; 2016. 649 p.
- Salimov NF, Razzokov AA. Profilaktika dorozhno-transportnogo travmatizma v Tadzhikistane [Prevention of traffic accident in Tajikistan]. Vestnik Avitsenny [Avicenna Bulletin]. 2013;1:54-9.
- Shchekolova NB, Nenakhova JB, Zubareva NS. Analiz letal’nosti, oshibki i oslozhnenya pri lechenii postradavshikh s mnozhestvennymi i sochetannymi travmami [Analysis of mortality, errors and complications in the treatment of victims with multiple and concomitant injuries]. Ural’skiy meditsinskiy zhurnal. 2015;7(130):127-31.
- Puras VV, Talypov AE, Krylov VV. Letal’nost’ u posrtadavshikh s tyazhyoloy sochetannoy cherepno-mozgovoy travmoy [The lethality at suffered by severe combined craniocerebral trauma]. Neyrokhirurgya. 2010;1:31-9.
- Samokhvalov NB, Shyogolev AV, Gavrilin SV. Algoritm okazaniya reanimatologicheskoy pomoshchi postradavshim s tyazhyolymi sochetannymi povrezhdeniyami [The algorithm for providing resuscitative care to victims with severe concomitant injurV]. Vestnik anesteziologii i reanimatologii. 2011;8(2):3-8.
- Wurmb T. Polytrauma management in a period of change: time analysis of new strategies for emergency room treatment. Unfallchirurg. 2009;112(4):390-9.
- Grarimov AO, Voenov OV. «Damage control» pri tyazhyoloy neyrotravme: neyrokhirurgicheskie aspekty [«Damage control» in severe neurotrauma: neurosurgical aspects]. Ukrainskiy meditsinskiy zhurnal. 2013;3:49-54.
- Maday DYu, Golovko KP, Badalov VI, Maday OD, Zhirnova NA, Samokhvalov IM. Mnogoetapnoe khirurgicheskoe lechenie kak rezerv snizheniya letal’nosti u postragavshikh s sochetaniem chelyustno-litsevoy i cherepno-mozgovoy travm [Multi-stage surgical treatment as a means of dicreasing mortalitV in patients with combined maxillofacial and craniocerebral trauma]. Skoraya meditsinskaya pomoshch’. 2016;2:33-41.
- Maegele M. Changes in transfusion practice in multiple injuries between 1993 and 2006: a retrospective analysis on 5389 patients from the German Trauma Registry. Transfus Med. 2009;19(3):117-24.
- Probst C. 30 Years of polytrauma care: An analysis of the change in strategies and results of 4849 cases treated at a single institution. Injury. 2009;40 (1):77-83.
- Caputo ND. Whole-body computed tomographic scanning leads to better survival as opposed to selective scanning in trauma patients. A systematic review and meta-analysis. Journal of Trauma and Acute Care Surgery. 2014;77(4):534-9.
- Puras VV, Grigoryeva KV. Metody neyrovizualisatsii v diagnostike cherepnomozgovoy travmy. Chast’ I. Komp’yuternaya i magnitno-rezonansnaya tomografiya [The method of neurovisualization in diagnostics of craniocerebral trauma. Part 1. Computer and magnetic resonance image]. Neyrokhirurgiya. 2014;2:7-16.
- Davydova NS, Shen NP, Boltaev PG, Vasilenko PB, Skorokhodova LA. Sindrom zhirovoy embolii pri skeletnoy travme: osobennosti diagnostiki, ekonomicheskie aspekty i rol’ neinvazivnoy ventillyatsii lyogkikh v intensivnoy terapii [Fat embolism in skeletal trauma: particularities of the diagnosis, economic aspects and the role of non-invasive ventilation in intensive care]. Anesteziologiya i reanimatologiya. 2014;4:60-3.
- Dmitriev AV, Drosevich AE. Zhirovaya emboliya: etiologiya i klinicheskaya diagnostika: obzor literatury [Fat embolism: etiology and clinical diagnosis: literature review]. Vestnik obrazovaniya Rossiyskoy akademii estestvennykh nauk. 2016;1:83-8.
- Sirodzhov KKh, Kholov DI, Rakhimov AT, Akhmedov ShM, Safarov AKh. Optimizirovannyy podkhod k lecheniyu perelomov s uchyotom narusheniy nekotorykh aspektov lipidnogo spektra u bol’nykh s sochetannoy travmoy [Optimized approach to the treatment of fractures taking into account violations of some aspects of lipid spectrum in patients with concomitant traumatic brain injury]. Ural’skiy meditsinskiy zhurnal. 2016;5:90-4.
- Shteile AV. Sindrom zhirovoy embolii (analiticheskiy obzor) [The syndrome of fat embolism (Analytical collection)]. Sibirskiy meditsinskuiy zhurnal. 2009;2:117-26.
Razzokov Abduvali Abduhamitovich, Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Avicenna Tajik State Medical University
Nazarov Mahmadali Kadyralievich, Head of the Neurosurgical Department of the Tursunzade Central Regional Hospital
Address for correspondence:
Razzokov Abduvali Abduhamitovich
Doctor of Medical Sciences, Full Professor, Head of the Department of Traumatology, Orthopedics and Military Field Surgery, Avicenna Tajik State Medical University
734003, Republic of Tajikistan, Dushanbe, Rudaki Ave., 139
Tel.: (+992) 915 046001