Improvement of quality of life (QOL) between 1 and 3-4 years after traumatic brain injury (TBI) in ICU patients.

BACKGROUND: Evaluation of changes in quality of life (QOL) in ICU patients several years after traumatic brain injury (TBI) is not well documented. METHODS: A prospective cohort study was conducted in all patients with TBI admitted between 2004 and 2008 to the ICU of Regional Hospital of Malaga (Spain). Functional status was evaluated by Glasgow Outcome Scale (GOS) and QOL by PAECC (Project for the Epidemiologic Analysis of Critical Care patients) questionnaire between 0 (normal QOL) to 29 points (worst QOL). RESULTS: A total of 531 patients. Median(Quartile1,Quartile 3) age: 35 (22, 56) years. After 3-4 years, 175 died (33%). Survivor QOL was deteriorated (median total PAECC score: 5 (0, 11) points) although 75.76% of patients who survived showed good functional situation (GOS normal or mild dysfunction). An improvement in QOL scores between 1 and 3-4 years was observed (median PAECC score differences between 3-4 years and 1 year: - 1(- 4, 0) points). QOL score improved during this interval of time: 62.6% of patients. Change in QOL was related by multivariate analysis to admission cranial-computed tomography scan (Marshall's classification), age, and Injury Severity Score (ISS), with the biggest improvement seen in younger patients and with more severe ISS. Basic physiological activities were maintained in the majority of patients. Subjective aspects and working activities improved between 1 and 3-4 years but with a high proportion still impaired in these items after 3-4 years. CONCLUSIONS: ICU patients with TBI after 1 year show improvement in QOL between 1 and 3-4 years, with the biggest improvement in QOL seen in younger patients and in those with more severe ISS.

Relationship between quality-of-life after 1-year follow-up and severity of traumatic brain injury assessed by computerized tomography.

PURPOSE: This paper studies the relationship between computed tomography (CT) scan on admission, according to Marshall's tomographic classification, and quality-of-life (QoL) after 1 year in patients admitted to the Intensive Care Unit (ICU) with traumatic brain injury (TBI). METHODS: This study used validated scales including the Glasgow Outcome Scale and the PAECC (Project for the Epidemiologic Analysis of Critical Care Patients) QoL questionnaire. RESULTS: We enrolled 531 patients. After 1 year, 171 patients (32.2%) had died (missing data = 6.6%). Good recovery was seen in 22.7% of the patients, while 20% presented moderate disability. The PAECC score after 1 year was 9.43 ± 8.72 points (high deterioration). Patients with diffuse injury I had a mean of 5.08 points vs 7.82 in those with diffuse injury II, 11.76 in those with diffuse injury III and 19.29 in those with diffuse injury IV (p < 0.001). Multivariate analysis found that QoL after 1 year was associated with CT Marshall classification, depth of coma, age, length of stay, spinal injury and tracheostomy. CONCLUSIONS: Patients with TBI had a high mortality rate 1 year after admission, deterioration in QoL and significant impairment of functional status, although more than 40% were normal or self-sufficient. QoL after 1 year was strongly related to cranial CT findings on admission.

Prognostic influence and computed tomography findings in dysautonomic crises after traumatic brain injury.

BACKGROUND: Dysautonomic crises represent a relatively unknown complication in patients with severe traumatic brain injury (TBI). Few studies have been undertaken of their pathophysiology and prognostic repercussions. We studied the prevalence of dysautonomic crises after TBI, their radiologic substrate, influence on the clinical course in the intensive care unit (ICU), and effect on neurologic recovery. METHODS: A case-control study involving 11 patients with dysautonomic crises admitted with TBI during a span of 1 year and 26 patients admitted with TBI but no crises during the first 3 months of the same year. The initial severity was assessed from Apache II, Glasgow Coma Scale (GCS) scores, and computed tomography (CT) during the first 24 hours. Complications were assessed by the duration of ICU stay, days on mechanical ventilation, need for tracheotomy, and number of infectious complications. Neurologic recovery was assessed with the GCS at discharge from the ICU and with the Glasgow Outcome Scale 12 months later. RESULTS: Both groups were similar at admission. The prevalence of dysautonomic crises was 9.3%. Patients with dysautonomic crises had more focal lesions on cranial CT than patients without crises, a significantly longer ICU stay, and a tendency to have a worse level of consciousness at discharge from the ICU but not 12 months later. CONCLUSIONS: Almost 10% of patients with severe TBI have dysautonomic crises during their ICU stay. Patients with dysautonomia were more likely to have focal intraparenchymal lesions, and crises were associated with greater morbidity and a longer ICU stay. Dysautonomic crises determined a worse short-term neurologic recovery.

[Postoperative complications of liver transplantation: relationship with mortality]. / Complicaciones postoperatorias en el trasplante hepático. Relación con la mortalidad.

BACKGROUND AND OBJECTIVE: Liver transplant is an effective procedure for fulminant hepatitis or chronic liver disease and offers an adequate quality of life. However, even though it is a consolidated treatment, patients can develop serious complications in the immediate postoperative course. PATIENTS AND METHOD: Prospective observational study of 131 patients admitted in our intensive care unit after liver transplant surgery. We studied variables related with the development of complications and their relation to outcome. RESULTS: Intensive care unit mortality was 11.5%. Median stay was 4 days. 90% of patients presented 2 or more complications. Hyperglycemia, thrombocytopenia and hypothermia were the most frequent complications but they were not related with mortality. Less frequent but related to outcome complications were acute renal failure (23.6% mortality vs. 1.3%; p < 0.01), ADRS (63.6% vs 6.7%; p < 0,01), low cardiac output (71.4% vs 4.3%; p < 0.01), > or = 2 vasoactive drugs (61.9% vs 1.8%; p < 0.01), encephalopathy (37.5% vs 9.8%; p < 0.05), pneumonia (80% vs 8%; p < 0.01) and hemorrhage (29.4% vs 8.8%; p < 0.05). Graph ischemia, coagulopathy, reperfusion syndrome and use of blood derivatives during surgery were factors related with the development of complications and mortality. Multivariate analysis showed a relationship with mortality and low cardiac output, number of vasoactive drugs and total time of graft ischemia. CONCLUSIONS: Complications during the postoperative course of liver transplant are frequent but most of them have no effect on prognosis. The negative effect of severe complications should be limited by optimizing the hemodynamic support in these patients and minimizing ischemia of transplanted organs.