The risk factors of colistin methanesulfonate associated nephrotoxicity.

PURPOSE: The risk factors of colistin methanesulfonate (CMS) associated nephrotoxicity are important. Our study attempts look into the prevalence of CMS-associated nephrotoxicity in Intensive Care Units (ICUs), and related risk factors. MATERIALS AND METHODS: The study was conducted between September 2010 and April 2012 on 55 patients who underwent CMS treatment. Nephrotoxicity risk was defined based on the Risk Injury Failure Loss End-stage kidney disease criteria. RESULTS: Fifty-five patients included in the study. A total of 22 (40%) patients developed nephrotoxicity. The correlation was detected between nephrotoxicity and patients over 65 with a high Acute Physiologic Assessment and Chronic Health Evaluation (APACHE) II score. APACHE II score was revealed an independent risk factor for nephrotoxicity. CONCLUSION: Advanced age and a high APACHE II score are significant risk factors in the development of nephrotoxicity at ICUs following CMS use. Patient selection and close monitoring are critical when starting CMS treatment.

Impact of the initiation time of colistin treatment for Acinetobacter infections.

This study aimed to address the relationship between the timing of colistin therapy and the outcome, defined as all-cause mortality in the intensive care unit (ICU). A retrospective study was undertaken in a 16-bed ICU of a 750-bed tertiary care hospital. A total of 46 patients who had been administered intravenous colistin treatment for colistin-susceptible-only Acinetobacter infections were included in the study. Colistin treatment was initiated in 26 (56.5 %) patients within 24 h of the diagnosis (early administration of colistin), whereas the rest of the patients had obtained delayed treatment (delayed administration of colistin). Of the 46 patients, 21 (45.6 %) died. With univariate analysis, age, age greater than 65 years, APACHE II score more than 20 at baseline, and delayed administration of colistin were found to be significant (p < 0.05). Logistic regression analysis revealed a significant association between delayed administration of colistin [adjusted odds ratio (OR), 5.06; confidence interval (CI), 1.18-21.67], and adverse outcome. Other variables included in the final model were underlying disease (OR, 2.81; CI, 1.15-6.84) and APACHE II score at baseline >20 (OR, 3.81; CI, 0.77-18.75). This study found that delayed administration of colistin and underlying disease were independently associated with adverse outcome.

Long-term results and complications of the syringopleural shunting for treatment of syringomyelia: a clinical study.

BACKGROUND: The use of drains in the treatment of syringomyelia has a simple and immediate appeal. Syringopleural shunting in syringomyelia has produced good short-term results, but limited information is available on long-term effects. We analyzed the complications and long-term outcomes after syringopleural shunting for syringomyelia. CLINICAL MATERIAL AND METHODS: Fourthy-four patients with large-sized syringomyelia underwent syringopleural shunting because of spinal cord compression between 1992 and 2010 in our clinic. Thirty-two patients had Chiari malformation type I (Group B), and 12 patients were associated with primary parenchymal cavitations (Group A). Their ages ranged from 14 to 71 years. Both craniovertebral decompression and syringopleural shunting were performed on 21 patients, whereas only syringopleural shunting was performed on another 21 patients. RESULTS: The follow-up period ranged from 1 year to 17 years (mean: 9.1 years). There was no operative mortality. Early postoperative MRI revealed that syringes of 43 patients had collapsed. There were 9 (20.5%) minor complications in 9 patients, including temporary neurological deficits (6), respiratory distress (2) and headache (1). Seven (15.9%) serious complications [permanent neurological deficit (1), shunt migration (2), shunt misplacement (1), spinal instability (1), tethering (1), CSF over drainage (1)] were seen in five patients. Four of them were treated with a secondary operation. Three patients (3/9; 33.3%) who were treated by syringopleural shunt alone (Group B2) required craniovertebral decompression, although the shunt was functional. During long-term follow-up, three patients stabilized, five patients (11.3%) developed a worse neurological condition, and two of these patients died 10 and 7 years after surgery. Of all patients, 88.6% showed significant clinical improvement. CONCLUSIONS: Although there were complications and failures, syringopleural shunting produced satisfactory results at long-term follow-up.

Noninvasive estimation of cerebral perfusion pressure with transcranial Doppler ultrasonography in traumatic brain injury.

AIM: In traumatic brain injury (TBI) patients, to overcome the secondary insults, cerebral perfusion pressure (CPP) oriented therapy is recommended. The study is assigned to estimate CPP values with middle cerebral artery (MCA) flow velocities measured noninvasively using transcranial Doppler ultrasonography (TCD). MATERIAL AND METHODS: Forty-seven TBI patients were studied. Intracranial pressure (ICP), mean arterial pressure (MAP) and MCA flow velocities of the patients were monitored. Invasive CPP was calculated as the difference between MAP and ICP. The formula : 'MAP x FVd/FVm +14' was used to estimate CPP noninvasively. Correlation of the noninvasive and invasive values were analysed. RESULTS: The mean values of noninvasive CPP and invasive CPP were 66.10 ± 10.55 mmHg and 65.40 ± 10.03 mmHg respectively. The correlation between noninvasive and invasive CPP measurements was strongly significant (p < 0.001) with a correlation coefficient of r = 0.920. CONCLUSION: With ICP monitoring systems, CPP is calculated and the therapy is guided according to these values. As it is recognized that brain perfusion can be assessed with TCD waveforms, noninvasive CPP estimation with MCA flow velocities may help to observe the trends in CPP values.

Haemodynamic augmentation in the treatment of vasospasm in aneurysmal subarachnoid hemorrhage.

AIM: Hypertension, hypervolemia and hemodilution therapy is a common approach to cerebral vasospasm after subarachnoid haemorrhage. This study is designed to see the difference of moderate or aggressive hypervolemia supported with induced hypertension in symptomatic vasospasm detected with transcranial Doppler ultrasonography (TCD) measurements. MATERIAL AND METHODS: Fifty eight patients who had aneurysm clipping and were admitted to the neurointensive care unit were treated with normovolemia and induced hypertension (n=35) or hypervolemia supported with induced hypertension (n=23) targeting a mean arterial pressure of 110-130 mm Hg and central venous pressure of 8-12 mm Hg. Daily TCD, fluid intake, fluid balance and haemodynamic values were recorded for 14 days. RESULTS: There were no differences detected in mean arterial pressure, central venous pressure, hematocrit values, fluid balance and middle cerebral artery flow velocities between the two groups through 14 days (p > 0.05). Hyponatremia, pulmonary edema and cerebral ischemia were observed as complications. CONCLUSION: Hypervolemia adds no benefit compared to normovolemia in the treatment of vasospasm occurred as a result of subarachnoid hemorrhage. Induced hypertension establishes the haemodynamic augmentation to prevent and treat vasospasm.

Correlation of pulsatility index with intracranial pressure in traumatic brain injury.

AIM: In traumatic brain injury (TBI) patients, it is desired to monitor the intracranial pressure (ICP) to assess the cerebral haemodynamics and guide the therapy. The study was designed to see if the pulsatility index (PI) measured by transcranial Doppler ultrasonography (TCD) predicts information about ICP values. MATERIAL AND METHODS: In 52 TBI patients with Glasgow Coma Scale (GCS) score < 9, invasive intracranial monitoring and TCD ultrasonography for PI were performed through five days. ICP, cerebral perfusion pressure (CPP), PI values were recorded and calculated. The correlation and regression analysis between ICP, PI and CPP were investigated in the whole group and in patients with a Glasgow Outcome Score (GOS) of 3-5. RESULTS: The decline in ICP and PI values was significant through five days. The correlation between ICP and PI was strongly significant (p < 0.0001) on days 1, 3 and 5. In patients with a GOS of 3-5, correlation of ICP and PI was also observed. The only significant correlation observed between CPP and PI was on day 5. CONCLUSION: The strong correlation observed between ICP and PI through the management period of TBI patients can lead us to use TCD ultrasonography-derived PI as a guide if invasive monitoring is not available.