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Evaluation of the last 2 decades in the characteristics of presentation, management and prognosis of serious spontaneous intracerebral hemorrhage in a third level hospital.
Morán Gallego, Francisco Javier; Sanchez Casado, Marcelino; López de Toro Martin Consuegra, Ismael; Marina Martinez, Luis; Alvarez Fernandez, Javier; Sánchez Carretero, María José.
Afiliação
  • Morán Gallego FJ; Servicio Medicina Intensiva, Hospital Universitario de Toledo, Spain.
  • Sanchez Casado M; Servicio Medicina Intensiva, Hospital Universitario de Toledo, Spain. Electronic address: mmsc16@gmail.com.
  • López de Toro Martin Consuegra I; Servicio Medicina Intensiva, Hospital Universitario de Toledo, Spain.
  • Marina Martinez L; Servicio Medicina Intensiva, Hospital Universitario de Toledo, Spain.
  • Alvarez Fernandez J; Servicio Neurocirugía, Hospital Universitario de Toledo, Spain.
  • Sánchez Carretero MJ; Servicio Medicina Intensiva, Hospital Universitario de Toledo, Spain.
Neurocirugia (Astur : Engl Ed) ; 35(4): 169-176, 2024.
Article em En | MEDLINE | ID: mdl-38295901
ABSTRACT

OBJECTIVE:

To analyze the change in the characteristics of presentation, evolution and treatment in the ICU, as well as the functional evolution at 12 months of spontaneous intracranial hemorrhages (ICHs) treated in an ICU reference center. PATIENT AND

METHODS:

Descriptive, retrospective study in a Neurocritical Reference Hospital. All admissions of patients with HICE during three periods are studied 1999-2001 (I), 2015-2016 (II) and 2020-2021 (III). Evolution in the three periods of demographic variables, baseline characteristics of the patients, clinical variables and characteristics of bleeding, evolutionary data in the ICU are studied. At one year we assessed the GOS scale (Glasgow Outcome Score) according to whether they had a poor (GOS 1-3) or good (GOS 4-5) prognosis.

RESULTS:

300 admitted patients, distributed in periods I 28.7%, II 36.3% and III 35%. 56.7% were males aged 66 (55.5-74) years; ICH score 2 (1-3). The ICU stay was 5 (2-14) days with a mortality of 36.8%. GOS 1-3 a year in 67.3% and GOS 4-5 in 32.7%. Comparing the three periods, we observed a higher prevalence in women, and the presence of cardiovascular factors; no changes in etiology; in relation to the location, it increases cerebellar hemorrhage and in the brainstem. Although the severity was greater, the stay in the ICU, the use of invasive mechanical ventilation and tracheostomy were lower. Open surgery has decreased its use by 50%. Mortality continues to be high, stagnating in the ICU at 35% and entails a high degree of disability one year after assessment.

CONCLUSIONS:

Severe ICH is a complex pathology that has changed some characteristics in the last two decades, with more severe patients, with more cardiovascular history and a greater predominance of brainstem and cerebellar hemorrhage. Despite the increase in severity, better parameters during the ICU stay, with open surgery used 50% less. Mortality remains stagnant at 35% with high disability per year.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hemorragia Cerebral / Escala de Resultado de Glasgow / Unidades de Terapia Intensiva Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Neurocirugia (Astur : Engl Ed) Ano de publicação: 2024 Tipo de documento: Article

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Hemorragia Cerebral / Escala de Resultado de Glasgow / Unidades de Terapia Intensiva Tipo de estudo: Observational_studies / Prognostic_studies / Risk_factors_studies Limite: Aged / Female / Humans / Male / Middle aged Idioma: En Revista: Neurocirugia (Astur : Engl Ed) Ano de publicação: 2024 Tipo de documento: Article