Post-traumatic renal failure in military personnel in Southeast Asia. Experience at clark USAF Hospital, Republic of the Philippines

A mortality of 63 per cent was noted in sixty-seven cases of post-traumatic renal failure occurring in Vietnam casualties, which is similar to that noted during the Korean conflict and in civilian institutions. We analyzed our data to determine the factors responsible for the high mortality in these patients. Frequent dialysis therapy was utilized, and the daily blood urea nitrogen averaged 92 mg/100 ml in those who survived and 100 mg/100 ml in those who died. Uremic symptoms were uncommon, and complications directly attributable to renal failure were not associated with increased mortality. Neither the clinical severity of the renal failure as measured by the daily urine volume nor the need for dialysis therapy showed a uniform relationship to survival. The high mortality could partially be attributed to the severe trauma in our patients. Multiple wounds were common, and 54 per cent had intra-abdominal injury. Only patients with isolated wounds on the extremities had a significantly higher survival. Infection occurred in 89 per cent of our patients and was the direct cause in 72 per cent of the deaths. Septic deaths were due to gram-negative pneumonia, septicemia or intra-abdominal infection. Wound infections alone did not affect survival but were the probable source for most of the fatal systemic infections. There was a high incidence of infection at multiple sites, antibiotic resistant bacteria and failure to respond to adequate antibiotic therapy. Jaundice and hemorrhage were complications also attributable to infection, and each occurred in 45 per cent of our patients, with associated mortalities of 90 and 80 per cent, respectively. Early and frequent dialysis therapy in our patients did not prevent the high incidence of septic complications seen in posttraumatic renal failure. Further emphasis on frequent debridement of wounds may be helpful. Improvement in parenteral nutrition may also be beneficial because of the marked catabolism noted in these patients.