Subject(s)
Humans , Health Care Surveys , Patients , Neuroticism , Wounds and Injuries , Central Nervous System , SpainABSTRACT
No disponible
Subject(s)
Humans , Aged , Brain Injuries, Traumatic/therapy , Age Factors , Prognosis , Intensive Care UnitsABSTRACT
OBJECTIVE: To analyze outcomes and factors related to mortality among very elderly trauma patients admitted to intensive care units (ICUs) participating in the Spanish trauma ICU registry. DESIGN: A multicenter nationwide registry. Retrospective analysis. November 2012-May 2017. SETTING: Participating ICUs. PATIENTS: Trauma patients aged ≥ 80 years. INTERVENTIONS: None. Main variables of interest: The outcomes and influence of limitation of life sustaining therapy (LLST) were analyzed.comparisons were established using the Wilcoxon test, Chi-squared test or Fisher's exact test as appropriate. Multiple logistic regression analysis was performed to analyze variables related to mortality. A p-value < 0.05 was considered statistically significant. RESULTS: The mean patient age was 83.4 ± 3.3 years; 281 males (60.4%). Low-energy falls were the mechanisms of injury in 256 patients (55.1%). The mean ISS was 20.5 ± 11.1, with a mean ICU stay of 7.45 ± 9.9 days. The probability of survival based on the TRISS methodology was 69.8 ± 29.7%. The ICU mortality rate was 15.5%, with an in-hospital mortality rate of 19.2%. The main cause of mortality was intracranial hypertension (42.7%). The ISS, the need for first- and second-tier measures to control intracranial pressure, and being admitted to the ICU for organ donation were independent mortality predictors. LLST was applied in 128 patients (27.9%). Patients who received LLST were older, with more severe trauma, and with more severe brain injury. CONCLUSIONS: Very elderly trauma ICU patients presented mortality rates lower than predicted on the basis of the severity of injury
OBJETIVO: Analizar el desenlace y los factores relacionados con la mortalidad de los pacientes traumáticos muy ancianos ingresados en las Unidades de Cuidados Intensivos (UCI) participantes en el Registro Español de Trauma en las UCI (RETRAUCI). DISEÑO: Registro multicéntrico nacional. Análisis retrospectivo. Noviembre de 2012-mayo de 2017. Ámbito: Las UCI participantes. Pacientes o PARTICIPANTES: Pacientes traumáticos con edad ≥ 80 años. INTERVENCIONES: Ninguna. Variables de interés principales: Analizamos el desenlace y la influencia de la limitación de los tratamientos de soporte vital (LLST). Las comparaciones entre grupos se realizaron mediante la prueba de Wilcoxon, la prueba de Chi-cuadrado y la prueba exacta de Fisher según estuviera indicado. Se realizó un análisis multivariante mediante regresión logística para analizar las variables asociadas a la mortalidad. Un valor de p < 0,05 se consideró el límite de la significación estadística. RESULTADOS: La edad media fue de 83,4 ± 3,3 años. Varones 281 (60,4%). La causa principal del traumatismo fueron las caídas de baja energía en 256 pacientes (55,1%). El Injury Severity Score (ISS) medio fue de 20,5 ± 11,1. La estancia media en las UCI fue de 7,45 ± 9,9 días. La probabilidad de supervivencia, de acuerdo con la metodología TRISS fue de 69,8 ± 29,7%. La mortalidad en las UCI fue del 15,5%. La mortalidad hospitalaria fue del 19,2%. La causa principal fue la hipertensión intracraneal (42,7%). El ISS, la necesidad de medidas de primer o segundo nivel para controlar la presión intracraneal y el ingreso en las UCI orientado a la donación de órganos fueron predictores independientes de mortalidad. Se documentó la LLST en 128 pacientes (27,9%). Los pacientes con LLST fueron mayores, con una mayor gravedad lesional y un traumatismo craneoencefálico más grave. CONCLUSIONES: Los pacientes traumáticos muy ancianos en las UCI presentaron menor mortalidad de la predicha por la gravedad del traumatismo
Subject(s)
Humans , Male , Female , Aged, 80 and over , Critical Care Outcomes , Records/standards , Accidental Falls/mortality , Head Injuries, Penetrating/mortality , Spain , Retrospective Studies , Logistic Models , Multivariate Analysis , Fatal Outcome , Hospital MortalityABSTRACT
OBJECTIVE: To analyze outcomes and factors related to mortality among very elderly trauma patients admitted to intensive care units (ICUs) participating in the Spanish trauma ICU registry. DESIGN: A multicenter nationwide registry. Retrospective analysis. November 2012-May 2017. SETTING: Participating ICUs. PATIENTS: Trauma patients aged ≥80 years. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: The outcomes and influence of limitation of life sustaining therapy (LLST) were analyzed. Comparisons were established using the Wilcoxon test, Chi-squared test or Fisher's exact test as appropriate. Multiple logistic regression analysis was performed to analyze variables related to mortality. A p-value <0.05 was considered statistically significant. RESULTS: The mean patient age was 83.4±3.3 years; 281 males (60.4%). Low-energy falls were the mechanisms of injury in 256 patients (55.1%). The mean ISS was 20.5±11.1, with a mean ICU stay of 7.45±9.9 days. The probability of survival based on the TRISS methodology was 69.8±29.7%. The ICU mortality rate was 15.5%, with an in-hospital mortality rate of 19.2%. The main cause of mortality was intracranial hypertension (42.7%). The ISS, the need for first- and second-tier measures to control intracranial pressure, and being admitted to the ICU for organ donation were independent mortality predictors. LLST was applied in 128 patients (27.9%). Patients who received LLST were older, with more severe trauma, and with more severe brain injury. CONCLUSIONS: Very elderly trauma ICU patients presented mortality rates lower than predicted on the basis of the severity of injury.
Subject(s)
Intensive Care Units , Intracranial Pressure , Aged , Aged, 80 and over , Hospital Mortality , Humans , Male , Registries , Retrospective StudiesABSTRACT
No disponible
Subject(s)
Humans , Aged , Aged, 80 and over , Craniocerebral Trauma/epidemiology , Prognosis , Anticoagulants/therapeutic use , Craniocerebral Trauma/diagnosis , Craniocerebral Trauma/mortality , Neurosurgery , Critical Care/trendsABSTRACT
PURPOSE: Our purpose was to assess the amino acids' (AAs) profile in trauma patients and to assess the effect of the route of nutrition and the exogenous ALA-GLN dipeptide supplementation on plasma AAs' concentration. METHODS: This is a secondary analysis of a previous randomized controlled trial. On day 1 and day 6 after trauma, plasma concentration of 25 AAs was measured using reverse phase high-performance liquid chromatography. Results were analyzed in relation to the route of nutrition and supplementation of ALA-GLN dipeptide. Differences between plasma AAs' concentrations at day 1 and day 6 were evaluated using the Student's t test or Mann-Whitney-Wilcoxon test. One-way ANOVA and the Kruskal-Wallis test were used to compare groups. A two-sided p value less than 0.05 was considered statistically significant. RESULTS: Ninety-eight patients were analyzed. Mean plasma concentrations at day 1 were close to the lower normal level for most AAs. At day 6 we found an increase in the eight essential AAs' concentrations and in 9 out of 17 measured non-essential AAs. At day 6 we found no differences in plasma concentrations for the sum of all AAs (p = .72), glutamine (p = .31) and arginine (p = .23) distributed by the route of nutrition. Administration of ALA-GLN dipeptide increased the plasma concentration of alanine (p = .004), glutamine (p < .001) and citrulline (p = .006). CONCLUSIONS: We found an early depletion of plasma AAs' concentration which partially recovered at day 6, which was unaffected by the route of nutrition. ALA-GLN dipeptide supplementation produced a small increase in plasma levels of glutamine and citrulline.
Subject(s)
Amino Acids/metabolism , Dietary Supplements , Dipeptides/administration & dosage , Wounds and Injuries/metabolism , Adolescent , Adult , Aged , Amino Acids/blood , Dipeptides/pharmacokinetics , Enteral Nutrition , Female , Humans , Injury Severity Score , Male , Middle Aged , Nutritional Status , Parenteral Nutrition , Treatment Outcome , Wounds and Injuries/blood , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Hyponatremia/complications , Single Dose , Inappropriate ADH Syndrome/chemically induced , Antidiuretic Hormone Receptor Antagonists/therapeutic use , Hyponatremia/drug therapy , Inappropriate ADH Syndrome/complications , Inappropriate ADH Syndrome/drug therapySubject(s)
Benzazepines/therapeutic use , Hyponatremia/drug therapy , Inappropriate ADH Syndrome/complications , Adult , Benzazepines/administration & dosage , Brain Injuries, Traumatic/complications , Cerebral Hemorrhage/complications , Critical Care , Critical Illness , Dose-Response Relationship, Drug , Drug Evaluation , Female , Humans , Hyponatremia/etiology , Male , Middle Aged , Retrospective Studies , Sodium/blood , Subarachnoid Hemorrhage/complications , Tolvaptan , Water-Electrolyte Balance/drug effectsABSTRACT
No disponible
Subject(s)
Humans , Male , Young Adult , Middle Aged , Shock/etiology , Spinal Cord Injuries/complications , Albuterol/administration & dosage , Bradycardia/complications , Hypotension/complications , Atropine/administration & dosage , Dopamine/administration & dosageSubject(s)
Adrenergic beta-2 Receptor Agonists/therapeutic use , Albuterol/therapeutic use , Bronchodilator Agents/therapeutic use , Cervical Vertebrae/injuries , Neck Injuries/complications , Shock, Traumatic/drug therapy , Spinal Cord Injuries/drug therapy , Spinal Fractures/complications , Administration, Oral , Adrenergic beta-2 Receptor Agonists/administration & dosage , Adrenergic beta-2 Receptor Agonists/pharmacology , Albuterol/administration & dosage , Albuterol/pharmacology , Bradycardia/drug therapy , Bradycardia/etiology , Bronchodilator Agents/administration & dosage , Bronchodilator Agents/pharmacology , Dopamine/therapeutic use , Heart Rate/drug effects , Humans , Hypotension/drug therapy , Hypotension/etiology , Male , Middle Aged , Spinal Cord Injuries/etiology , Young AdultABSTRACT
No disponible
Subject(s)
Humans , Brain Death , Ultrasonography, Doppler, Transcranial , Critical Care/methodsSubject(s)
Brain Death , Ultrasonography, Doppler, Transcranial , Brain , Cerebrovascular Circulation , HumansABSTRACT
STUDY DESIGN: Retrospective study. OBJECTIVES: The objective of this study was to compare the CO2 response of acute tetraplegic cervical spinal cord injury (SCI) patients undergoing mechanical ventilation with a control group of critically ill patients ready for weaning of mechanical ventilation and successfully extubated. SETTING: This study was conducted at the intensive care unit of a University Hospital in Mallorca, Spain. METHODS: CO2 response was studied in 12 acute tetraplegic cervical SCI patients at the C4-C7 level and 22 control patients. The control group patients were consecutively selected from a database of patients with mechanical ventilation and who were successfully extubated after a CO2 response test. To increase the CO2 , we used the method of re-inhalation of expired air, and we evaluated the hypercapnic ventilatory response, the change in minute ventilation induced by the increase of partial pressure of arterial carbon dioxide (PaCO2 ), which measures the whole respiratory system (metabolic control, neuromuscular or ventilatory apparatus), and the hypercapnic drive response, the change in the airway occlusion pressure at 100 ms induced by the increase in PaCO2, which measures the chemosensitivity of the respiratory center. RESULTS: Cervical SCI patients were younger than the control group patients (26±7 and 62±12 years, respectively; P<0.001). Mean values of the hypercapnic ventilatory response in cervical SCI and control groups were 0.52±0.31 and 0.64±0.33 l min(-1) per mm Hg (P=0.40), respectively, and the hypercapnic drive response was 0.24±0.16 and 0.48±0.23 cm H2O per mm Hg (P=0.001), respectively. CONCLUSION: Acute tetraplegic cervical SCI patients had reduced hypercapnic drive response that may contribute to the difficult weaning, without reduction in hypercapnic ventilatory response.
