Ischemic stroke in patients older and younger than 80 years.

OBJECTIVES: To compare short-term outcome and long-term mortality in old and younger patients with ischemic stroke. We hypothesized that short-term outcomes in patients≥80 and <80 years with no neurological worsening are similar. METHODS: The National Institute of Health Stroke Scale (NIHSS) was used to assess stroke severity. Short-term outcome was determined by the NIHSS score 7 days after stroke onset. Neurological worsening was defined as NIHSS score worsening >3 points. Risk factors, prior diseases, complications, and long-term mortality were registered. RESULTS: The study includes 592 patients≥80 years and 1275 patients<80 years. High NIHSS score on admission and day 7, neurological worsening, and complications were significantly more frequent among patients≥80 years. In patients with no neurological worsening, improvement in NIHSS score on day 7 was not associated with age≥80 years (P=0.75). Long-term mortality was associated with the number of risk factors in both age groups (P<0.05). CONCLUSION: Avoiding neurological worsening may have a large potential for reducing the difference in short-term outcome between old and young stroke patients by preventing treatable complications including pneumonia. Risk factor burden is important for long-term survival in both stroke patients≥80 years and <80 years.

Risk factor burden predicts long-term mortality after cerebral infarction.

OBJECTIVE: Previous studies have shown significant association between the number of traditional risk factors and long-term mortality of cerebral infarction in young stroke patients. The aim was to investigate risk factors separately and in sum in relation to long-term mortality after cerebral infarction, irrespective of age. MATERIALS AND METHODS: Long-term mortality in relation to number of traditional risk factors (angina pectoris, myocardial infarction, intermittent claudication, hypertension, diabetes mellitus, and smoking at the time of the index stroke) and etiology was studied in patients with acute cerebral infarction admitted to the Stroke Unit, Department of Neurology, Haukeland University Hospital, between February 2006 and February 2011. Only patients alive 30 days after stroke onset were included. Cox regression analyses were performed. RESULTS: After a mean follow-up time of 2.4 years, 14% with no risk factors had died, while the corresponding frequencies in patients with 1-3 or more risk factors were 13%, 19%, and 26%, respectively (P < 0.001). The number of risk factors was associated with mortality on Cox regression analysis (HR = 1.3, P < 0.001). CONCLUSION: Increasing number of traditional risk factors is associated with long-term mortality in patients with cerebral infarction, irrespective of age. Careful long-term follow-up is important, especially among patients with several risk factors.

Inspiratory work and airway pressure with continuous positive airway pressure delivery systems.

To determine work-of breathing with continuous positive airway pressure (CPAP) delivery systems, we used a lung model to simulate spontaneous breathing. "Additional work" during tidal breathing was derived by comparing change in airway pressure with change in tidal volume. Seven demand-flow CPAP delivery systems were compared with one continuous-flow, 5-L reservoir-bag system (flow of 60 L/min to maintain positive airway pressure). It was concluded that demand-flow CPAP delivery systems vary widely in the amount of additional work required of a patient. When a lung model is used, some demand-flow systems perform as well as, or better than, a continuous-flow reservoir-bag system.

Retrograde pressurization of a medical oxygen pipeline system: safety backup or hazard?

Pipeline systems are used in most hospitals today to deliver medical oxygen to patient care areas. Intermittent reports have appeared concerning serious problems and failure with these systems. Mandated reserve systems have not provided the necessary backup at times. This article describes an auxiliary system to supply oxygen in a zonal fashion to wall outlets. The system will function during most failure situations; a hazard is inherent in the knowledge of this technique and will be examined.