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Ronald Simon

Bio: Ronald Simon is an academic researcher from Lincoln Hospital. The author has contributed to research in topics: Abdominal trauma & Trauma center. The author has an hindex of 10, co-authored 13 publications receiving 834 citations.

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Journal ArticleDOI
TL;DR: Prophylactic mesh closure of the abdomen may facilitate the prevention and bedside treatment of intra-abdominal hypertension and reduce these complications.
Abstract: Objective: To define the incidence, prophylaxis, and treatment of intra-abdominal hypertension (IAH) and its relevance to gut mucosal pH (pHi), multiorgan dysfunction syndrome, and the abdominal compartment syndrome (ACS). Methods: Seventy patients in the SICU at a Level I trauma center (1992-1996) with life threatening penetrating abdominal trauma had intra-abdominal pressure estimated by bladder pressure. pHi was measured by gastric tonometry every 4 to 6 hours. IAH (intra-abdominal pressure> 25 cm of H 2 O) was treated by bedside or operating room laparotomy. Results: Injury severity was comparable between patients who had mesh closure as prophylaxis for IAH (n = 45) and those who had fascial suture (n = 25). IAH was seen in 10 (22.2%) in the mesh group versus 13 (52%) in the fascial suture group (p = 0.012) for an overall incidence of 32.9%. Forty-two patients had pHi monitoring, and 11 of them had IAH. Of the 11patients, eight patients (72.7%) had acidotic pHi (7.10± 0.2) with IAH without exhibiting the classic signs of ACS. The pHi improved after abdominal decompression in six and none developed ACS. Only two patients with IAH and low pHi went on to develop ACS, despite abdominal decompression. Multiorgan dysfunction syndrome points and death were less in patients without IAH than those with IAH and in patients who had mesh closure. Conclusions: IAH is frequent after major abdominal trauma. It may cause gut mucosal acidosis at lower bladder pressures, long before the onset of clinical ACS. Uncorrected, it may lead to splanchnic hypoperfusion, ACS, distant organ failure, and death. Prophylactic mesh closure of the abdomen may facilitate the prevention and bedside treatment of IAH and reduce these complications.

323 citations

Journal ArticleDOI
TL;DR: A trend toward lower IL-6 levels in AI suggests a link between reduced IL- 6 levels and understimulation of the pituitary-adrenal axis in this group, and glucocorticoid supplementation appeared to improve short-term survival when AI occurred.

268 citations

Journal Article
TL;DR: It is concluded that the majority of colon injuries can be managed by repair or resection with anastomosis, and end colostomy is unavoidable in Flint 3 injuries of the left colon.
Abstract: The results of a prospective protocol for penetrating injuries of the colon in 252 patients are presented. The protocol emphasized definitive management of the injury by repair, resection and anastomosis or exteriorized repair. Colostomy was reserved for left colon injuries requiring resection or for delayed treatment. Two hundred nineteen patients (86.9%) had definitive treatment by repair (N=159), resection and anastomosis (N=26), or exteriorized repair. This was successful in 205 patients (93,6%). Three patients had anastomotic leak after repair or ileocolostomy. Eight of the 34 patients with exteriorized repair had suture-line breakdown and 26 (76.5%) patients avoided a colostomy

63 citations

Journal ArticleDOI
TL;DR: The data suggest that Doppler indices should be an integral part of the physical examination and can screen patients with proximal injuries for further studies such as duplex sonography or arteriography.
Abstract: This prospective study assessed the role of Doppler pressure indices (Ankle-Brachial Index [ABI] or Brachial Brachial Index [BBI]) in the evaluation for occult arterial injury from penetrating proximity extremity trauma (PET). A total of 258 patients with 323 PETs were evaluated by physical examination and Doppler pressure (ABI/BBI) determination. An ABI/BBI of < 0.9 was considered abnormal. The findings were compared with those of arteriography in all patients. Eleven injuries (3.4%) found on arteriography were associated with normal indices. Five of these injuries were treated by repair (4 patients) or angiographic embolization of a bleeding vessel (1 patient), all in lesions proximal to the knee or elbow joints. The other six lesions were observed without intervention. All of the 29 injuries associated with abnormal indices had positive arteriographic findings. The 4 lesions that were treated operatively were proximal and the remaining 25, all with distal penetration, were observed without observation. As compared to angiography, Doppler indices yielded the following results: 283 true-negative, 11 false-negative, 29 true-positive, and 0 false-positive, for a sensitivity of 72.5%, a specificity of 100%, a positive predictive value of 100%, and a negative predictive value of 96%. These data suggest that Doppler indices should be an integral part of the physical examination and can screen patients with proximal injuries for further studies such as duplex sonography or arteriography.

56 citations

Journal Article
TL;DR: It is concluded that the vast majority of penetrating duodenal injuries should be managed by primary repair or resection and anastomosis, and complex duodnal decompression or diverticulization rarely are necessary.
Abstract: Based on a retrospective analysis of 100 penetrating duodenal injuries, the role of primary repair or resection and anastomosis was assessed prospectively in 66 patients (1986-1992). Duodenal exclusion was reserved for extensive combined pancreato-duodenal injuries. Seven of the 66 patients died from extensive abdominal trauma (mean Abdominal Trauma Index, ATI 70) within 48 hours of admission. Fifty-six patients had primary repair, while pyloric exclusion was performed for three patients with extensive pancreatico-duodenal injuries. Three patients (5.1%) developed duodenal fistula, two being in the primary repair group (3.6%). All three patients had associated injury to the head of the pancreas

40 citations


Cited by
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Journal ArticleDOI
TL;DR: These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.
Abstract: Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. In the absence of consensus definitions and treatment guidelines the diagnosis and management of IAH and ACS remains variable from institution to institution. An international consensus group of multidisciplinary critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to develop practice guidelines for the diagnosis, management, and prevention of IAH and ACS. Prior to the conference the authors developed a blueprint for consensus definitions and treatment guidelines which were refined both during and after the conference. The present article is the second installment of the final report from the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of the Abdominal Compartment Syndrome. The prevalence and etiological factors for IAH and ACS are reviewed. Evidence-based medicine treatment guidelines are presented to facilitate the diagnosis and management of IAH and ACS. Recommendations to guide future studies are proposed. These definitions, guidelines, and recommendations, based upon current best evidence and expert opinion are proposed to assist clinicians in the management of IAH and ACS as well as serve as a reference for future clinical and basic science research.

1,352 citations

01 Jan 2006
TL;DR: State-of-the-art definitions for IAH and ACS are proposed based upon current medical evidence as well as expert opinion and recommended that these definitions be used for future clinical and basic science research.
Abstract: ObjectiveIntra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been increasingly recognized in the critically ill over the past decade. The variety of definitions proposed has led to confusion and difficulty in comparing one study to another.DesignAn international consensus group of critical care specialists convened at the second World Congress on Abdominal Compartment Syndrome to standardize definitions for IAH and ACS based upon the current understanding of the pathophysiology surrounding these two syndromes.MethodsPrior to the conference the authors developed a blueprint for the various definitions, which was further refined both during and after the conference. The present article serves as the final report of the 2004 International ACS Consensus Definitions Conference and is endorsed by the World Society of Abdominal Compartment Syndrome (WSACS).ResultsIAH is redefined as an intra-abdominal pressure (IAP) at or above 12 mmHg. ACS is redefined as an IAP above 20 mmHg with evidence of organ dysfunction/failure. ACS is further classified as either primary, secondary, or recurrent based upon the duration and cause of the IAH-induced organ failure. Standards for IAP monitoring are set forth to facilitate accuracy of IAP measurements from patient to patient.ConclusionsState-of-the-art definitions for IAH and ACS are proposed based upon current medical evidence as well as expert opinion. The WSACS recommends that these definitions be used for future clinical and basic science research. Specific guidelines and recommendations for clinical management of patients with IAH/ACS are published in a separate review.

1,192 citations

Journal ArticleDOI
23 Feb 2000-JAMA
TL;DR: The data suggest that a short corticotropin test has a good prognostic value and could be helpful in identifying patients with septic shock at high risk for death.
Abstract: ContextThe hypothalamic-pituitary-adrenal axis is a major determinant of the host response to stress. The relationship between its activation and patient outcome is not known.ObjectiveTo evaluate the prognostic value of cortisol levels and a short corticotropin stimulation test in patients with septic shock.Design and SettingProspective inception cohort study conducted between October 1991 and September 1995 in 2 teaching hospital adult intensive care units in France.ParticipantsA total of 189 consecutive patients who met clinical criteria for septic shock.InterventionA short corticotropin stimulation test was performed in all patients by intravenously injecting 0.25 mg of tetracosactrin; blood samples were taken immediately before the test (T0) and 30 (T30) and 60 (T60) minutes afterward.Main Outcome MeasuresTwenty-eight–day mortality as a function of variables collected at the onset of septic shock, including cortisol levels before the corticotropin test and the cortisol response to corticotropin (Δmax, defined as the difference between T0 and the highest value between T30 and T60).ResultsThe 28-day mortality was 58% (95% confidence interval [CI], 51%-65%) and median time to death was 17 days (95% CI, 14-27 days). In multivariate analysis, independent predictors of death (P≤.001 for all) were McCabe score greater than 0, organ system failure score greater than 2, arterial lactate level greater than 2.8 mmol/L, ratio of PaO2 to fraction of inspired oxygen no more than 160 mm Hg, cortisol level at T0 greater than 34 µg/dL and Δmax no more than 9 µg/dL. Three groups of patient prognoses were identified: good (cortisol level at T0 ≤34 µg/dL and Δmax >9 µg/dL; 28-day mortality rate, 26%), intermediate (cortisol level at T0 34 µg/dL and Δmax ≤9 µg/dL or cortisol level at T0 >34 µg/dL and Δmax >9 µg/dL; 28-day mortality rate, 67%), and poor (cortisol level at T0 >34 µg/dL and Δmax ≤9 µg/dL; 28-day mortality rate, 82%).ConclusionOur data suggest that a short corticotropin test has a good prognostic value and could be helpful in identifying patients with septic shock at high risk for death.

962 citations

Journal ArticleDOI
TL;DR: The 2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and Children with Septic Shock continues to emphasize early use of age-specific therapies to attain time-sensitive goals, and a major new recommendation in the 2007 update is earlier use of inotrope support through peripheral access until central access is attained.
Abstract: Background:The Institute of Medicine calls for the use of clinical guidelines and practice parameters to promote “best practices” and to improve patient outcomes.Objective:2007 update of the 2002 American College of Critical Care Medicine Clinical Guidelines for Hemodynamic Support of Neonates and C

933 citations

Journal ArticleDOI
TL;DR: Infusion of stress doses of hydrocortisone reduced the time to cessation of vasopressor therapy in human septic shock and was associated with a trend to earlier resolution of sepsis-induced organ dysfunctions.
Abstract: ObjectiveTo investigate the effects of stress doses of hydrocortisone on the duration of vasopressor therapy in human septic shock.DesignProspective, randomized, double-blind, single-center study.SettingTwenty-bed multidiscipllnary intensive care unit in a 1400-bed university hospital.PatientsForty

836 citations