RÉSUMÉ
Coma pode ser definido como um estado de não-responsividade e não-reatividade do organismo, e o seu diagnóstico é feito quando temos uma Escala de Coma de Glasgow menor ou igual a 7. De acordo com a literatura médica, aproximadamente 60 por cento dos casos de coma têm origem em desordens metabólicas, que levam a alterações no suprimento de metabólitos ou modificações da excitabilidade neuronal.
Sujet(s)
Mâle , Femelle , Coma , Maladies métaboliques/complications , Maladies métaboliques/physiopathologie , Coma post-traumatique , Coma diabétique , Échelle de coma de GlasgowSujet(s)
Accommodation oculaire/physiologie , Traumatismes cranioencéphaliques/complications , Myopie/étiologie , Spasme/étiologie , Adulte , Encéphale/anatomopathologie , Coma post-traumatique/complications , Traumatismes cranioencéphaliques/diagnostic , Femelle , Humains , Imagerie par résonance magnétique , Mâle , Myopie/diagnosticRÉSUMÉ
BACKGROUND: Tracheostomy in children remains controversial regarding the risk of complications. METHODS: Forty-six trauma patients (35 male and 11 female, mean age = 6.8 years) were admitted to the intensive care unit between 1987 and 1991 with severe head injury plus coma. Tracheostomy was performed with standard technique after 5.9 days (range, 2-12 days) of intubation. RESULTS: There were no deaths from tracheostomy, but six deaths resulted from severe head injury. One child was discharged with tracheostomy. The 39 survivors remained with tracheostomy 16.14 days (range, 4-71 days) in the intensive care unit. After cannula removal, 31 remained asymptomatic; 8 had respiratory distress: 2 were normal, 5 had endoscopic treatment for subglottic granulomas/stenosis from intubation, and 1 had tracheomalacia from tracheostomy. In 1997, the 18 patients located for follow-up were asymptomatic. At endoscopy, 8 were normal, 9 had subglottal granulomas from intubation, and 1 had 20% tracheal stenosis from tracheostomy. CONCLUSION: Most complications after tracheostomy result from intubation. Tracheostomy has an acceptable risk in children with severe head injury who need prolonged ventilatory support.