Assuntos
Humanos , Pesquisas sobre Atenção à Saúde , Pacientes , Neuroticismo , Ferimentos e Lesões , Sistema Nervoso Central , EspanhaRESUMO
No disponible
Assuntos
Humanos , Idoso , Lesões Encefálicas Traumáticas/terapia , Fatores Etários , Prognóstico , Unidades de Terapia IntensivaRESUMO
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
Assuntos
Humanos , Masculino , Feminino , Idoso de 80 Anos ou mais , Resultados de Cuidados Críticos , Registros/normas , Acidentes por Quedas/mortalidade , Traumatismos Cranianos Penetrantes/mortalidade , Espanha , Estudos Retrospectivos , Modelos Logísticos , Análise Multivariada , Evolução Fatal , Mortalidade HospitalarRESUMO
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.
Assuntos
Unidades de Terapia Intensiva , Pressão Intracraniana , Idoso , Idoso de 80 Anos ou mais , Mortalidade Hospitalar , Humanos , Masculino , Sistema de Registros , Estudos RetrospectivosAssuntos
Lesões Encefálicas Traumáticas/diagnóstico , Lesões Encefálicas Traumáticas/terapia , Fatores Etários , Idoso , Anticoagulantes/administração & dosagem , Comorbidade , Cuidados Críticos , Fragilidade/diagnóstico , Escala de Coma de Glasgow , Humanos , Estudos Multicêntricos como Assunto , Seleção de Pacientes , TriagemRESUMO
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.
Assuntos
Aminoácidos/metabolismo , Suplementos Nutricionais , Dipeptídeos/administração & dosagem , Ferimentos e Lesões/metabolismo , Adolescente , Adulto , Idoso , Aminoácidos/sangue , Dipeptídeos/farmacocinética , Nutrição Enteral , Feminino , Humanos , Escala de Gravidade do Ferimento , Masculino , Pessoa de Meia-Idade , Estado Nutricional , Nutrição Parenteral , Resultado do Tratamento , Ferimentos e Lesões/sangue , Adulto JovemRESUMO
No disponible
Assuntos
Humanos , Hiponatremia/complicações , Dose Única , Síndrome de Secreção Inadequada de HAD/induzido quimicamente , Antagonistas dos Receptores de Hormônios Antidiuréticos/uso terapêutico , Hiponatremia/tratamento farmacológico , Síndrome de Secreção Inadequada de HAD/complicações , Síndrome de Secreção Inadequada de HAD/tratamento farmacológicoAssuntos
Benzazepinas/uso terapêutico , Hiponatremia/tratamento farmacológico , Síndrome de Secreção Inadequada de HAD/complicações , Adulto , Benzazepinas/administração & dosagem , Lesões Encefálicas Traumáticas/complicações , Hemorragia Cerebral/complicações , Cuidados Críticos , Estado Terminal , Relação Dose-Resposta a Droga , Avaliação de Medicamentos , Feminino , Humanos , Hiponatremia/etiologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Sódio/sangue , Hemorragia Subaracnóidea/complicações , Tolvaptan , Equilíbrio Hidroeletrolítico/efeitos dos fármacosRESUMO
No disponible
Assuntos
Humanos , Masculino , Adulto Jovem , Pessoa de Meia-Idade , Choque/etiologia , Traumatismos da Medula Espinal/complicações , Albuterol/administração & dosagem , Bradicardia/complicações , Hipotensão/complicações , Atropina/administração & dosagem , Dopamina/administração & dosagemAssuntos
Agonistas de Receptores Adrenérgicos beta 2/uso terapêutico , Albuterol/uso terapêutico , Broncodilatadores/uso terapêutico , Vértebras Cervicais/lesões , Lesões do Pescoço/complicações , Choque Traumático/tratamento farmacológico , Traumatismos da Medula Espinal/tratamento farmacológico , Fraturas da Coluna Vertebral/complicações , Administração Oral , Agonistas de Receptores Adrenérgicos beta 2/administração & dosagem , Agonistas de Receptores Adrenérgicos beta 2/farmacologia , Albuterol/administração & dosagem , Albuterol/farmacologia , Bradicardia/tratamento farmacológico , Bradicardia/etiologia , Broncodilatadores/administração & dosagem , Broncodilatadores/farmacologia , Dopamina/uso terapêutico , Frequência Cardíaca/efeitos dos fármacos , Humanos , Hipotensão/tratamento farmacológico , Hipotensão/etiologia , Masculino , Pessoa de Meia-Idade , Traumatismos da Medula Espinal/etiologia , Adulto JovemRESUMO
No disponible
Assuntos
Humanos , Morte Encefálica , Ultrassonografia Doppler Transcraniana , Cuidados Críticos/métodosRESUMO
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.