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1.
Ther Hypothermia Temp Manag ; 9(3): 184-189, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30376419

RESUMO

Favorable neurologic outcomes have been reported in near-hanging (NH) victims treated with therapeutic hypothermia (TH), but variable methods and small samples sizes limit interpretability. This study examines the relationship between clinical predictors, TH, and outcomes in NH patients. A risk profile was created by examining relationships between variables. Categorical predictors were assessed with chi-square tests and continuous variables were assessed with t-tests. Logistic regression was conducted to evaluate the unique effect of TH. Thirty-seven NH patients were treated, 22 with cardiac arrest (CA). Poor outcome was significantly associated with age, Glasgow Coma Scale-Motor (GCS-M), pupillary response, and out-of-hospital CA (OHCA) (p's < 0.02). Patients with poor neurologic outcomes were older (M = 40.2 vs. M = 27.6) and had lower GCS-M scores (M = 1.1 vs. M = 4.1). Poor outcome probability was 76% in patients with GCS-M <3, 100% with nonreactive pupils, and 72.1% with OHCA. TH was associated with a worse outcome overall that was not significant after adjusting for GCS-M. Our study demonstrates no impact of TH on NH outcome when controlling for variables associated with poor outcome and relative certainty of poor outcome with CA, GCS-M 1, and nonreactive pupils. Study findings could assist in decisions on the utilization of TH.


Assuntos
Asfixia/terapia , Lesões Encefálicas/terapia , Hipotermia Induzida , Tentativa de Suicídio , Adolescente , Adulto , Idoso , Escala de Coma de Glasgow , Humanos , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/terapia , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
2.
Am Surg ; 83(7): 687-695, 2017 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-28738936

RESUMO

Recent clinical research in patients with blunt chest injury has focused on the benefits of surgical fixation of rib fractures. Noninvasive ventilation (NIV) has been demonstrated to prevent the need for intubation and ventilation in posttraumatic respiratory failure. The preemptive use of NIV in patients with rib fractures has not been extensively studied. Our study evaluated the outcomes of patients with ≥3 rib fractures and hospitalized for ≥ 4 days. Seventy-one patients treated with NIV were compared with 270 patients without NIV. NIV patients were older (65.8 vs 56.5 years) had more rib fractures (6.25 vs 5.32) and a higher body mass index (31 vs 27.8) than the comparison group, P < 0.05, but did not have an increased mortality or incidence of respiratory failure. NIV patients did have a statistically significant increase in length of stay compared to control (12.8 vs 8.8, P < 0.05). In the total sample, worse clinical outcomes were associated with older age, increased number of and bilateral rib fractures, higher Injury Severity Score, lower Glasgow Coma Scale, and higher body mass index. Outcomes in the most severely injured group of patients treated with NIV were comparable to other studies using surgical fixation of rib fractures and epidural pain control.


Assuntos
Ventilação não Invasiva , Respiração com Pressão Positiva , Fraturas das Costelas/terapia , Traumatismos Torácicos/terapia , Ferimentos não Penetrantes/terapia , Idoso , Estudos de Coortes , Humanos , Pessoa de Meia-Idade , Respiração com Pressão Positiva/métodos , Indução de Remissão , Estudos Retrospectivos , Fraturas das Costelas/etiologia , Ferimentos não Penetrantes/complicações
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