Bold Voices - December 2011 - (Page 14)

AT THE BEDSIDE Study Seeks Initiator of Post-Trauma Intestinal Cell Damage A study at Kansas State University (K-State), Manhattan, investigates the molecule responsible for the overreaction that can cause cell death in the intestines after trauma. A K-State announcement says the study is “looking for a way to interrupt the chain of events leading to the over activation of complement” — as opposed to completely stopping the complement action, which can help protect from bacteria. Caution Urged in Early Withdrawal of Life Support After TBI Citing a high proportion of early deaths and limited accuracy of prognostic indicators, a Canadian study recommends using caution in regard to early withdrawal of life-sustaining therapy following severe traumatic brain injury (TBI). “Mortality Associated With Withdrawal of Life-Sustaining Therapy for Patients With Severe Traumatic Brain Injury: A Canadian Multicentre Cohort Study,” in the Oct. 4 Canadian Medical Association Journal, associates withdrawal of Variations in mortality life-sustaining therapy with 70.2 percent of TBI patient may be related to deaths, with half occurring variations in withdrawal within the first three days of life-sustaining therapy. of care. The study of 720 TBI patients in six Canadian level-one trauma centers also fi nds “significant variations in mortality across centers,” which may be partly explained by “regional variations in physician, family or community approaches to the withdrawal of lifesustaining therapy.” A related article in Internal Medicine News cites an accompanying commentary, which notes that “the way in which physicians manage uncertainty in predicting recovery from TBI in their discussions with families” may account for much of the variability in outcomes. According to the article, the commentary also says “poor discriminatory power of the tools available to measure the extent of brain injury and the lack of outcome data” contribute to much of the uncertainty. Although the study shows variable but often early withdrawal “raises the concern of not only hastening death but increasing mortality for patients who might recover with more time,” it also should be considered that “allowing patients to linger when death is inevitable is associated with prolonged suffering for both patients and families,” the commentary adds. ‘Promising’ solution offers possible clinical benefits after trauma. “Many times trauma patients who have lost a lot of blood will end up with acute respiratory distress syndrome or multiple organ dysfunction syndrome,” says Sherry Fleming, an associate professor in the Division of Biology at K-State University. “So they not only have to deal with the trauma, but also with their immune system attacking things that it shouldn’t.” Fleming and her team have developed one possible solution that would prevent activation of complement — a peptide that takes the place of the beta2 protein in binding to the molecular marker on the cell’s surface. Fleming calls this solution “promising” and says the American Heart Association-funded study will give her team “the opportunity to make major progress in this research.” 14 DECEMBER 2011

Table of Contents for the Digital Edition of Bold Voices - December 2011

Front/Digital Edition Viewing Guide
Another Angle
AACN Boards and Contact Information
Dec. 19 Deadline: National Awards Recognize Excellence, Leadership in HAI Prevention
Box Office Hit 'Contagion' Raises Questions About Virus
New Privacy Recommendations for Storing Newborn Screening Specimens
Motor Training Can Advance Social Development in Infants With Autism
In-Hospital Mobility Benefits Older Patients
NSAIDs May Harm Patients with Heart Disease, Hypertension
Pain Code' Encourages Use of Maximum Dosage
FDA's Treatment Recommendations for Simvastatin 80
Study Identifies Predictors of Sudden Cardiac Death Versus Surviving Heart Attack
Study Seeks Initiator of Post-Trauma Intestinal Cell Damage
Australian Study: 'How Dangerous is a Day in Hospital'
In Our Journals
ICU Staff Composition May Decrease Burnout
Use of Manikins May Improve Emergency Care
Celebrate Certification
AACN Financials
From the President

Bold Voices - December 2011