RESUMO
Objective: To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 h. Design A retrospective cohort study was made covering the period 2015−2017. Setting An adult Intensive Care Unit (ICU).Patients/methodsEpidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. Results A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD > 24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD > 24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD > 24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups.ConclusionsEarly BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation (AU)
Objetivo: Identificar los factores clínico-radiológicos que se asocian a evolución precoz a muerte encefálica (ME), definida esta como la ocurrida en ≤24 horas Diseño Estudio de cohortes retrospectivo desde 2015 hasta 2017, ambos incluidos. Ámbito Servicio de Medicina Intensiva (SMI) de adultos.Pacientes y métodoAnálisis de variables clínico-epidemiológicas y de la TC craneal de ingreso en pacientes con evolución a ME. Resultados Se analizaron 166 ME, 86 varones, edad media 62,7 años, 42,8% hemorragia intracerebral, 18,7% HSA, 17,5% TCE, 7,8% ictus isquémico, 9% anoxia y 4,2% otras causas; 50% HTA, 34% dislipemia, 33% tabaquismo, 21% antiagregación, 19% enolismo. El 15% anticoagulación, 15% diabetes. El GCS fue tres en el 68,8% en ME precoz frente 38,2% en ME >24 h (p 0,0001); 85 hematoma supratentorial (90,9 mL en ME precoz vs. 82,7 mL ME tardía, p 0,54); 12 hematoma infratentorial. Desplazamiento medio de línea media 10,7 mm en ME precoz vs. 7,8 mm en ME tardía (p 0,045); 91 pacientes ventriculomegalia y 38 trasudado periependimario (p 0,021). Borramiento completo de cisternas basales 36 en ME precoz frente a 24 en ME tardía (p 0,005), borramiento de surcos (p 0,013), pérdida de diferenciación córtico-subcortical (p 0,0001) y ausencia de cisterna supraselar (p 0,005). La medición de la vaina del nervio óptico no mostró diferencias significativas entre los dos grupos.ConclusionesSe asoció con ME ≤ 24 horas el GCS < 5, el desplazamiento de línea media, la pérdida de diferenciación córtico-subcortical, el borramiento de surcos, el borramiento completo de cisternas basales, de la cisterna supraselar y la presencia de trasudado periependimario (AU)
Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Morte Encefálica/diagnóstico por imagem , Lesões Encefálicas Traumáticas/diagnóstico por imagem , Hemorragia Cerebral/diagnóstico por imagem , Unidades de Terapia Intensiva , Estudos Retrospectivos , Fatores de TempoRESUMO
OBJECTIVE: To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24â¯h. DESIGN: A retrospective cohort study was made covering the period 2015-2017. SETTING: An adult Intensive Care Unit (ICU). PATIENTS/METHODS: Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS: A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24â¯h (pâ¯=â¯0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9â¯ml in early BD versus 82.7â¯ml in BDâ¯>â¯24â¯h (pâ¯=â¯0.54). The mean midline shift was 10.7â¯mm in early BD versus 7.8â¯mm in BDâ¯>â¯24â¯h (pâ¯=â¯0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (pâ¯=â¯0.021). Thirty-six patients with early BD versus 24 with BDâ¯>â¯24â¯h presented complete effacement of basal cisterns (pâ¯=â¯0.005), sulcular effacement (pâ¯=â¯0.013), loss of cortico-subcortical differentiation (pâ¯=â¯0.0001) and effacement of the suprasellar cistern (pâ¯=â¯0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS: Early BD (>24â¯h) was associated to GCSâ¯<â¯5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
Assuntos
Morte Encefálica , Lesões Encefálicas Traumáticas , Adulto , Hemorragia Cerebral/diagnóstico por imagem , Hemorragia Cerebral/epidemiologia , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Estudos RetrospectivosRESUMO
OBJECTIVE: To identify clinical and radiological factors associated to early evolution to brain death (BD), defined as occurring within the first 24 hours. DESIGN: A retrospective cohort study was made covering the period 2015-2017. SETTING: An adult Intensive Care Unit (ICU). PATIENTS/METHODS: Epidemiological, clinical and imaging (CT scan) parameters upon admission to the ICU in patients evolving to BD. RESULTS: A total of 166 patients with BD (86 males, mean age 62.7 years) were analyzed. Primary cause: intracerebral hemorrhage 42.8%, subarachnoid hemorrhage 18.7%, traumatic brain injury 17.5%, anoxia 9%, stroke 7.8%, other causes 4.2%. Epidemiological data: arterial hypertension 50%, dyslipidemia 34%, smoking 33%, antiplatelet medication 21%, alcoholism 19%, anticoagulant therapy 15%, diabetes 15%. The Glasgow Coma Score (GCS) upon admission was 3 in 68.8% of the cases in early BD versus in 38.2% of the cases in BD occurring after 24 h (p = 0.0001). Eighty-five patients presented supratentorial hematomas with a volume of 90.9 ml in early BD versus 82.7 ml in BD >24 h (p = 0.54). The mean midline shift was 10.7 mm in early BD versus 7.8 mm in BD >24 h (p = 0.045). Ninety-one patients presented ventriculomegaly and 38 additionally ependymal transudation (p = 0.021). Thirty-six patients with early BD versus 24 with BD >24 h presented complete effacement of basal cisterns (p = 0.005), sulcular effacement (p = 0.013), loss of cortico-subcortical differentiation (p = 0.0001) and effacement of the suprasellar cistern (p = 0.005). The optic nerve sheath measurements showed no significant differences between groups. CONCLUSIONS: Early BD (>24 h) was associated to GCS < 5, midline shift, effacement of the basal cisterns, cerebral sulci and suprasellar cistern, and ependymal transudation.
Assuntos
Hemocultura/métodos , Abscesso Encefálico/diagnóstico , Reação em Cadeia da Polimerase Multiplex/métodos , Infecções Estreptocócicas/diagnóstico , Streptococcus pyogenes/genética , Líquido Sinovial/microbiologia , Abscesso Encefálico/microbiologia , Abscesso Encefálico/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Infecções Estreptocócicas/tratamento farmacológico , Infecções Estreptocócicas/cirurgiaRESUMO
No disponible
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Parada Cardíaca/complicações , Parada Cardíaca/diagnóstico , Cuidados Críticos/métodos , Reanimação Cardiopulmonar/métodos , Fibrilação Atrial/terapia , Antineoplásicos/uso terapêutico , Mieloma Múltiplo/complicações , Unidades de Terapia Intensiva , Epinefrina/uso terapêutico , Radiografia Torácica/métodos , Edema Pulmonar/diagnóstico , Fatores de RiscoAssuntos
Cuidados Críticos , Parada Cardíaca/induzido quimicamente , Oligopeptídeos/efeitos adversos , Inibidores de Proteases/efeitos adversos , Edema Pulmonar/induzido quimicamente , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Terapia Combinada , Dexametasona/administração & dosagem , Evolução Fatal , Coração/efeitos dos fármacos , Parada Cardíaca/terapia , Transplante de Células-Tronco Hematopoéticas , Humanos , Lenalidomida/administração & dosagem , Masculino , Pessoa de Meia-Idade , Mieloma Múltiplo/tratamento farmacológico , Mieloma Múltiplo/terapia , Oligopeptídeos/administração & dosagem , Inibidores de Proteases/administração & dosagem , Edema Pulmonar/terapia , Recidiva , Terapia de Salvação , Transplante AutólogoRESUMO
OBJECTIVE: Infectious complications related to external ventricular shunt (ICREVS) are a main problem in neurocritical intensive care units (ICU). The aim of the review is to assess the incidence of ICREVS and to analyse factors involved. METHODS: Retrospective analysis, adult polyvalent ICU in a third level reference hospital. Patients carrying external ventricular shunt (DVE) were included. Those patients with central nervous system infection diagnosed prior DVE placement were excluded. RESULTS: 87 patients were included with 106 DVE. Most common admittance diagnosis was subarachnoid haemorrhage (49.4%). 31 patients with 32 DVE developed an ICREVS. Infection rate is 19.5 per 1000 days of shunt for ICREVS and 14 per 1000 days for ventriculitis. 31.6% of the patients developed ICREVS and 25.3% ventriculitis. Patients who developed ICREVS presented higher shunt manipulations (2.0 ± 0.6 vs. 3.26 ± 1.02, p=0.02), shunt repositioning (0.1 ± 0.1 vs. 0.2 ± 0.1) and ICU and hospital stay (29.8 ± 4.9 vs 49.8 ± 5.2, p<0.01 y 67.4 ± 18.8 vs. 108.9 ± 30.2, p=0.02. Those DVE with ICREVS were placed for longer not only at infection diagnosis but also at removal (12.6 ± 2.1 vs. 18.3 ± 3.6 and 12.6 ± 2.1 vs. 30.4 ± 7.3 days, p<0.01). No difference in mortality was found. CONCLUSIONS: One out of three patients with a DVE develops an infection. The risk factors are the number of manipulations, repositioning and the permanency days. Patients with ICREVS had a longer ICU and hospital average stay without an increase in mortality.
Assuntos
Infecções Relacionadas a Cateter/epidemiologia , Derivação Ventriculoperitoneal/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Infecções Relacionadas a Cateter/mortalidade , Infecções Bacterianas do Sistema Nervoso Central/epidemiologia , Infecções Bacterianas do Sistema Nervoso Central/mortalidade , Ventriculite Cerebral/complicações , Ventriculite Cerebral/epidemiologia , Ventriculite Cerebral/terapia , Feminino , Mortalidade Hospitalar , Humanos , Incidência , Unidades de Terapia Intensiva , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Espanha/epidemiologia , Hemorragia Subaracnóidea/complicações , Hemorragia Subaracnóidea/epidemiologia , Hemorragia Subaracnóidea/terapiaRESUMO
No disponible