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Title: The pulmonary and systemic response to trauma
Author: White, Timothy Oliver
Awarding Body: University of Edinburgh
Current Institution: University of Edinburgh
Date of Award: 2005
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Hypotheses. The severity and specific anatomical location of an initial traumatic injury are important in determining the level of risk of subsequent post traumatic respiratory compromise. An immediate post-traumatic stress response can be identified, and the subsequent activation of the inflammatory and coagulation cascades can be related to the degree of injury sustained and the subsequent development of complications. Results. Regression analysis of possible epidemiological factors determining the risk of ARDS demonstrated that the Injury Severity Score (ISS), the presence of a femoral fracture, the combination of long bone and abdominal injuries and unstable physiological observations on admission were each independently associated with ARDS. In the prospective clinical cohort study, the serum concentrations of a number of mediators, particularly interleukin-6, was shown to correlate with the severity of injury. However, no marker was found to be a useful indicator of the later development of respiratory insufficiency. In the laboratory study, an immediate depressant response of the cardiovascular system to injury was identified, the components of the stress response were observed to evolve in a reproducible manner, and the additional surgical treatment of the injury was not found to make a significant difference to this response. Conclusion. Several epidemiological, clinical and laboratory factors contributing to the development of the post-traumatic stress response are measurable. A group of patients at increased risk of respiratory insufficiency can be identified by their epidemiological features, but the role of measurements of inflammatory and coagulation activation remains to be defined.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (M.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available