Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 96
Filtrar
1.
Physiol Res ; 68(4): 651-658, 2019 08 29.
Artigo em Inglês | MEDLINE | ID: mdl-31177793

RESUMO

Brain tissue oxygenation (rSO(2)) measured by near-infrared spectroscopy (NIRS) is lower in hemodialysis patients than in the healthy population and is associated with cognitive dysfunction. The involved mechanisms are not known. We conducted this study to identify the factors that influence the rSO2 values in end-stage renal disease (ESRD) patients and to describe rSO2 changes during hemodialysis. We included a cohort of ESRD patients hemodialyzed in our institution. We recorded rSO2 using INVOS 5100C oximetry system (Medtronic, Essex, U.K.) and analyzed changes in basic laboratory values and hemodynamic fluctuations. Baseline rSO2 was lower in patients with heart failure (45.2±8.3 % vs. 54.1±7.8 %, p=0.006) and was significantly linked to higher red cell distribution width (RDW) (r=-0.53, p?0.001) and higher BNP level (r=-0.45, p=0.01). The rSO(2) value decreased in first 15 min of hemodialysis, this decrease correlated with drop in white blood count during the same period (r=0.43, p=0.02 in 10 min, r=0.43, p=0.02 in 20 min). Lower rSO(2) values in patients with heart failure and higher RDW suggest that hemodynamic instability combined with vascular changes probably leads to worse cerebral oxygenation in these patients. Decrease of rSO(2) in 15th minute of hemodialysis accompanied with a significant drop in leukocyte count could be explained by complement activation.


Assuntos
Hipóxia Encefálica/epidemiologia , Hipóxia Encefálica/metabolismo , Falência Renal Crônica/metabolismo , Falência Renal Crônica/terapia , Vigilância da População , Diálise Renal/tendências , Idoso , Idoso de 80 Anos ou mais , Circulação Cerebrovascular/fisiologia , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Falência Renal Crônica/epidemiologia , Masculino , Pessoa de Meia-Idade , Oximetria/tendências , Diálise Renal/efeitos adversos , Fatores de Risco
2.
Am Surg ; 85(5): 549-555, 2019 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-31126370

RESUMO

Survivors of near-hangings suffer anoxic brain injuries, but it remains uncertain whether the incidence of associated injuries warrants extensive workup or trauma activation. An 11-year retrospective review was conducted on adult patients with a hanging mechanism who underwent trauma workup and management. The majority of patients (n = 98) were white (88.8%) males (75.5%) with an average age of 30 ± 12.3 years. Two-hundred fifty-four CT and magnetic resonance scans were performed and eight injuries were uncovered: three thyroid cartilage/hyoid fractures; three vertebral injuries; and two cervical vascular injuries. Anoxic brain injury was diagnosed clinically in 35 patients (35.7%) and was present in all 19 patients (19.4%) who died. Only one patient had intra-abdominal injury requiring surgical intervention. Injuries were more likely in patients with abnormal Glasgow Coma Scale (GCS) versus normal GCS (55% vs 10.5%, respectively). Patients who present after near-hanging have a low incidence of associated injuries. Workup can be restricted to patients with abnormal GCS scores and for specific signs and symptoms or high-risk energy mechanisms. The trauma team can be activated for signs of trauma.


Assuntos
Lesões Encefálicas/epidemiologia , Vértebras Cervicais/lesões , Hipóxia Encefálica/epidemiologia , Lesões do Pescoço/epidemiologia , Traumatismos da Coluna Vertebral/epidemiologia , Tentativa de Suicídio , Adolescente , Adulto , Lesões Encefálicas/diagnóstico , Lesões Encefálicas/terapia , Feminino , Humanos , Hipóxia Encefálica/diagnóstico , Hipóxia Encefálica/terapia , Masculino , Lesões do Pescoço/diagnóstico , Lesões do Pescoço/terapia , Estudos Retrospectivos , Traumatismos da Coluna Vertebral/diagnóstico , Traumatismos da Coluna Vertebral/terapia , Adulto Jovem
3.
World Neurosurg ; 128: e107-e115, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30980979

RESUMO

BACKGROUND: Perioperative neurologic complication after an anterior cervical discectomy and fusion (ACDF) is uncommon but may have significant clinical consequences. OBJECTIVE: We aim to estimate the incidence of perioperative neurologic complications, identify their risk factors, and evaluate their impact on morbidity and mortality after ACDF. METHODS: ACDF cases (n = 317,789 patients) were extracted from the National Inpatient Sample between 1999 and 2011. Based on their Elixhauser-van Walraven score (VWR), patients were classified as low (VWR < 5), moderate (5-14), or high risk (>14) for surgery. The primary outcome was perioperative neurologic complications. Secondary outcomes included morbidity (hospital length of stay >14 days or discharge disposition to a location other than home) and in-hospital mortality. RESULTS: The rate of perioperative neurologic complications, morbidity, and mortality after ACDF was 0.4%, 8.4%, and 0.1%, respectively. Perioperative neurologic complications were highly associated with in-house morbidity (odds ratio [OR], 3.7 [3.1-4.4]) and mortality (OR, 8.0 [4.1-15.5]). The strongest predictors for perioperative neurologic complications were moderate- (OR, 3.1 [2.6-3.7]) and high-risk VWR (OR, 5.4 [3.3-8.9]), postoperative hematoma/seroma formation (OR, 5.4 [3.9-7.4]), and obesity (OR, 1.9 [1.6-2.3]). The rate of perioperative neurologic complications increased from 0.2% to 0.7% from 1999 to 2011, which was temporally associated with the rise in moderate- (P = 0.002) and high-risk patients (P = 0.001) undergoing ACDF. CONCLUSIONS: Perioperative neurologic complications are independent predictors of in-hospital morbidity and mortality after ACDF. Both morbidity and perioperative neurologic complications have increased between 1999 and 2011, which may be due, in part, to increasing numbers of moderate- and high-risk patients undergoing ACDF.


Assuntos
Vértebras Cervicais/cirurgia , Discotomia/métodos , Mortalidade Hospitalar , Complicações Pós-Operatórias/epidemiologia , Fusão Vertebral/métodos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , Humanos , Hipóxia Encefálica/epidemiologia , Monitorização Neurofisiológica Intraoperatória , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Radiculopatia/cirurgia , Fatores de Risco , Doenças da Medula Espinal/cirurgia , Traumatismos da Medula Espinal/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
4.
Am J Obstet Gynecol ; 220(4): 348-353, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30529344

RESUMO

Obstetricians and gynecologists belong to 1 of the medical specialties with the highest rate of litigation claims. Among birth injury cases, those cases with cerebral palsy outcomes account for litigation settlements or judgments often in the millions of dollars. In cases of potential perinatal asphyxia, a threshold level of metabolic acidosis (base deficit ≥12 mmol/L) is necessary to attribute neonatal encephalopathy to an intrapartum hypoxic event. With increasing duration or severity of a hypoxic stress resulting in metabolic acidosis, newborn infant umbilical artery base deficit increases. It may be alleged that, as base deficit levels increase beyond 12 mmol/L, there is an increased likelihood and severity of cerebral palsy. As a corollary, it may be claimed that an earlier delivery (by minutes) would reduce the base deficit and prevent or reduce the severity of cerebral palsy. This issue is of relevance to obstetricians as defendants, because retrospective "expert" analysis of cases may suggest that optimal management decisions would have resulted in an earlier delivery. In addressing the association of metabolic acidosis and cerebral palsy, base deficit should be measured as the extracellular component (base deficitextracellular fluid) rather than the commonly used base deficitblood. Studies suggest that, beyond the base deficit threshold of 12 mmol/L, the incidence and severity of cerebral palsy does not significantly increase (until ≥20 mmol/L), although the risk of neonatal death rises markedly. Thus, among most infants with hypoxia-associated neonatal encephalopathy, the occurrence of cerebral palsy is unlikely to be impacted by delivery time variation of few minutes, and this argument should not serve as the basis for medical legal claims.


Assuntos
Acidose/sangue , Traumatismos do Nascimento/sangue , Paralisia Cerebral/sangue , Hipóxia Encefálica/sangue , Jurisprudência , Acidose/epidemiologia , Traumatismos do Nascimento/epidemiologia , Paralisia Cerebral/epidemiologia , Feminino , Sangue Fetal , Humanos , Hipóxia Encefálica/epidemiologia , Incidência , Recém-Nascido , Doenças do Recém-Nascido , Responsabilidade Legal , Obstetrícia , Gravidez , Artérias Umbilicais
5.
Disabil Rehabil ; 40(6): 697-704, 2018 03.
Artigo em Inglês | MEDLINE | ID: mdl-27976928

RESUMO

PURPOSE: Investigate health care providers' perceptions of referral and admission criteria to brain injury inpatient rehabilitation in two Canadian provinces. METHODS: Health care providers (n = 345) from brain injury programs (13 acute care and 16 rehabilitation facilities) participated in a cross-sectional web-based survey. The participants rated the likelihood of patients (traumatic brain injury and cerebral hypoxia) to be referred/admitted to rehabilitation and the influence of 19 additional factors (e.g., tracheostomy). The participants reported the perceived usefulness of referral/admission policies and assessment tools used. RESULTS: Ninety-one percent acute care and 98% rehabilitation participants reported the person with traumatic brain injury would likely or very likely be referred/admitted to rehabilitation compared to respectively 43% and 53% for the patient with hypoxia. Two additional factors significantly decreased the likelihood of referral/admission: older age and the combined presence of minimal learning ability, memory impairment and physical aggression. Some significant inter-provincial variations in the perceived referral/admission procedure were observed. Most participants reported policies were helpful. Similar assessment tools were used in acute care and rehabilitation. CONCLUSIONS: Health care providers appear to consider various factors when making decisions regarding referral and admission to rehabilitation. Variations in the perceived likelihood of referral/admission suggest a need for standardized referral/admission practices. Implications for Rehabilitation Various patient characteristics influence clinicians' decisions when selecting appropriate candidates for inpatient rehabilitation. In this study, acute care clinicians were less likely to refer patients that their rehabilitation counter parts would likely have admitted and a patient with hypoxic brain injury was less likely to be referred or admitted in rehabilitation than a patient with a traumatic brain injury. Such discrepancies suggest that policy-makers, managers and clinicians should work together to develop and implement more standardized referral practices and more specific admission criteria in order to ensure equitable access to brain injury rehabilitation services.


Assuntos
Lesões Encefálicas , Hipóxia Encefálica/reabilitação , Reabilitação Neurológica/organização & administração , Encaminhamento e Consulta/normas , Cuidados Semi-Intensivos , Traqueostomia/reabilitação , Adulto , Idoso , Lesões Encefálicas/epidemiologia , Lesões Encefálicas/reabilitação , Canadá/epidemiologia , Estudos Transversais , Feminino , Humanos , Hipóxia Encefálica/epidemiologia , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Fatores de Risco , Cuidados Semi-Intensivos/métodos , Cuidados Semi-Intensivos/organização & administração , Traqueostomia/estatística & dados numéricos
6.
Br J Anaesth ; 119(5): 885-899, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-29077813

RESUMO

The care of surgical patients with obstructive sleep apnoea (OSA) invokes concerns with safety and liability because of the risk that exists for perioperative death or near-death. The purpose of this review is to analyse the available literature to identify risk factors for perioperative critical complications in patients with OSA. Literature reports were screened for life threatening complications and deaths in surgical patients with OSA. The critical complications were sub-grouped as death/near-death events (death and anoxic brain damage) vs critical respiratory events (CRE)/other events and analysed for various risk factors. Both univariate and multivariate analyses were conducted to identify the potential risk factors.In total, 15 case reports and two medico-legal reports, comprising of 60 total patients with OSA were included in our analysis. Overall, there were 43 deaths or near-death events and 12 critical respiratory events and five other life threatening events. Ten patients (17%) with OSA were undiagnosed before surgery. Only 31% (11/35) were on preoperative continuous positive airway pressure (CPAP), with 36% (4/11) of them continuing CPAP in the postoperative period. The majority of them received a morphine equivalent daily dose less than 10 mg. Eighty percent of the events occurred in the first 24 h and 67% occurred on the general hospital ward.Patients with OSA are at risk of critical complications including death during the initial 24 h after surgery. Morbid obesity, male sex, undiagnosed OSA, partially treated/untreated OSA, opioids, sedatives, and lack of monitoring are risk factors for death or near-death events.


Assuntos
Hipóxia Encefálica/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Insuficiência Respiratória/epidemiologia , Apneia Obstrutiva do Sono/epidemiologia , Procedimentos Cirúrgicos Operatórios/mortalidade , Adulto , Idoso , Causalidade , Comorbidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
7.
Clin Neurophysiol ; 128(9): 1682-1695, 2017 09.
Artigo em Inglês | MEDLINE | ID: mdl-28753456

RESUMO

OBJECTIVE: In postanoxic coma, EEG patterns indicate the severity of encephalopathy and typically evolve in time. We aim to improve the understanding of pathophysiological mechanisms underlying these EEG abnormalities. METHODS: We used a mean field model comprising excitatory and inhibitory neurons, local synaptic connections, and input from thalamic afferents. Anoxic damage is modeled as aggravated short-term synaptic depression, with gradual recovery over many hours. Additionally, excitatory neurotransmission is potentiated, scaling with the severity of anoxic encephalopathy. Simulations were compared with continuous EEG recordings of 155 comatose patients after cardiac arrest. RESULTS: The simulations agree well with six common categories of EEG rhythms in postanoxic encephalopathy, including typical transitions in time. Plausible results were only obtained if excitatory synapses were more severely affected by short-term synaptic depression than inhibitory synapses. CONCLUSIONS: In postanoxic encephalopathy, the evolution of EEG patterns presumably results from gradual improvement of complete synaptic failure, where excitatory synapses are more severely affected than inhibitory synapses. The range of EEG patterns depends on the excitation-inhibition imbalance, probably resulting from long-term potentiation of excitatory neurotransmission. SIGNIFICANCE: Our study is the first to relate microscopic synaptic dynamics in anoxic brain injury to both typical EEG observations and their evolution in time.


Assuntos
Coma/fisiopatologia , Eletroencefalografia/tendências , Parada Cardíaca/fisiopatologia , Hipóxia Encefálica/fisiopatologia , Sinapses/fisiologia , Idoso , Coma/diagnóstico , Coma/epidemiologia , Feminino , Parada Cardíaca/diagnóstico , Parada Cardíaca/epidemiologia , Humanos , Hipóxia Encefálica/diagnóstico , Hipóxia Encefálica/epidemiologia , Potenciação de Longa Duração/fisiologia , Masculino , Potenciais da Membrana/fisiologia , Pessoa de Meia-Idade , Países Baixos/epidemiologia , Transmissão Sináptica/fisiologia
8.
N Engl J Med ; 376(18): 1737-1747, 2017 05 04.
Artigo em Inglês | MEDLINE | ID: mdl-28467879

RESUMO

BACKGROUND: The effect of bystander interventions on long-term functional outcomes among survivors of out-of-hospital cardiac arrest has not been extensively studied. METHODS: We linked nationwide data on out-of-hospital cardiac arrests in Denmark to functional outcome data and reported the 1-year risks of anoxic brain damage or nursing home admission and of death from any cause among patients who survived to day 30 after an out-of-hospital cardiac arrest. We analyzed risks according to whether bystander cardiopulmonary resuscitation (CPR) or defibrillation was performed and evaluated temporal changes in bystander interventions and outcomes. RESULTS: Among the 2855 patients who were 30-day survivors of an out-of-hospital cardiac arrest during the period from 2001 through 2012, a total of 10.5% had brain damage or were admitted to a nursing home and 9.7% died during the 1-year follow-up period. During the study period, among the 2084 patients who had cardiac arrests that were not witnessed by emergency medical services (EMS) personnel, the rate of bystander CPR increased from 66.7% to 80.6% (P<0.001), the rate of bystander defibrillation increased from 2.1% to 16.8% (P<0.001), the rate of brain damage or nursing home admission decreased from 10.0% to 7.6% (P<0.001), and all-cause mortality decreased from 18.0% to 7.9% (P=0.002). In adjusted analyses, bystander CPR was associated with a risk of brain damage or nursing home admission that was significantly lower than that associated with no bystander resuscitation (hazard ratio, 0.62; 95% confidence interval [CI], 0.47 to 0.82), as well as a lower risk of death from any cause (hazard ratio, 0.70; 95% CI, 0.50 to 0.99) and a lower risk of the composite end point of brain damage, nursing home admission, or death (hazard ratio, 0.67; 95% CI, 0.53 to 0.84). The risks of these outcomes were even lower among patients who received bystander defibrillation as compared with no bystander resuscitation. CONCLUSIONS: In our study, we found that bystander CPR and defibrillation were associated with risks of brain damage or nursing home admission and of death from any cause that were significantly lower than those associated with no bystander resuscitation. (Funded by TrygFonden and the Danish Heart Foundation.).


Assuntos
Reanimação Cardiopulmonar , Cardioversão Elétrica , Hipóxia Encefálica/etiologia , Institucionalização/estatística & dados numéricos , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Dinamarca , Feminino , Humanos , Hipóxia Encefálica/epidemiologia , Análise de Intenção de Tratamento , Masculino , Pessoa de Meia-Idade , Casas de Saúde , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , Risco , Análise de Sobrevida , Voluntários
9.
Resuscitation ; 115: 32-38, 2017 06.
Artigo em Inglês | MEDLINE | ID: mdl-28363819

RESUMO

AIM: This study aimed to examine rates of redeemed prescriptions of antidepressants and anxiolytics, used as markers for cerebral dysfunction in out-of-hospital cardiac arrest (OHCA) survivors, and examine the association between bystander CPR and these psychoactive drugs. METHODS: We included all 30-day survivors of OHCA in Denmark between 2001 and 2011, who had not redeemed prescriptions for antidepressants or anxiolytics in the last six months prior to OHCA. Main outcome measures were redeemed prescriptions of antidepressants and anxiolytics within one year after OHCA. RESULTS: Among 2,001 30-day survivors, 174 (8.6% died and 12.0% redeemed a first prescription for an antidepressant and 8.2% for an anxiolytic drug within one year after arrest. The corresponding frequencies for redeemed prescribed drugs among age- and sex-matched population controls were 7.5% and 5.2%, respectively. Among survivors who received bystander CPR, prescriptions for antidepressants and anxiolytics were redeemed in 11.1% [95% CI 9.2-13.3%] and 6.3% [95% CI 4.9-8.0%] of the cases, respectively, versus 17.2% [95% CI 13.9-21.1%] and 13.4% [95% CI 10.5-17.0%], respectively, among patients who had not received bystander CPR. Adjusted for age, sex, year of arrest, comorbidity, witnessed status and socioeconomic status, bystander CPR was associated with significant reductions in redeemed prescriptions for antidepressants, Hazard Ratio (HR) 0.71 [95% CI 0.52-0.98], P=0.031; and anxiolytics, HR 0.55 [95% CI 0.38-0.81], P=0.002. CONCLUSION: Relative to no bystander CPR, redeemed prescriptions for antidepressants and anxiolytics were significantly lower among 30-day survivors of OHCA who received bystander CPR, suggesting a cerebral dysfunction-lowering potential of bystander CPR.


Assuntos
Ansiolíticos/uso terapêutico , Antidepressivos/uso terapêutico , Reanimação Cardiopulmonar/psicologia , Prescrições de Medicamentos/estatística & dados numéricos , Hipóxia Encefálica/epidemiologia , Parada Cardíaca Extra-Hospitalar/terapia , Fatores Etários , Idoso , Reanimação Cardiopulmonar/estatística & dados numéricos , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/psicologia , Modelos de Riscos Proporcionais , Sistema de Registros , Sobreviventes/psicologia , Fatores de Tempo
10.
Am J Perinatol ; 34(10): 935-957, 2017 08.
Artigo em Inglês | MEDLINE | ID: mdl-28329897

RESUMO

Objective Risk factors for placental abruption have changed, but there has not been an updated systematic review investigating outcomes. Methods We searched PubMed, EMBASE, Web of Science, SCOPUS, and CINAHL for publications from January 1, 2005 through December 31, 2016. We reviewed English-language publications reporting estimated incidence and/or risk factors for maternal, labor, delivery, and perinatal outcomes associated with abruption. We excluded case studies, conference abstracts, and studies that lacked a referent/comparison group or did not clearly characterize placental abruption. Results A total of 123 studies were included. Abruption was associated with elevated risk of cesarean delivery, postpartum hemorrhage and transfusion, preterm birth, intrauterine growth restriction or low birth weight, perinatal mortality, and cerebral palsy. Additional maternal outcomes included relaparotomy, hysterectomy, sepsis, amniotic fluid embolism, venous thromboembolism, acute kidney injury, and maternal intensive care unit admission. Additional perinatal outcomes included acidosis, encephalopathy, severe respiratory disorders, necrotizing enterocolitis, acute kidney injury, need for resuscitation, chronic lung disease, infant death, and epilepsy. Conclusion Few studies examined outcomes beyond the initial birth period, but there is evidence that both mother and child are at risk of additional adverse outcomes. There was also considerable variation in, or absence of, the reporting of abruption definitions.


Assuntos
Descolamento Prematuro da Placenta/epidemiologia , Descolamento Prematuro da Placenta/etiologia , Asfixia Neonatal/epidemiologia , Asfixia Neonatal/etiologia , Transfusão de Sangue , Paralisia Cerebral/epidemiologia , Cesárea , Feminino , Retardo do Crescimento Fetal/epidemiologia , Humanos , Hipóxia Encefálica/epidemiologia , Hipóxia Encefálica/etiologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Mortalidade Materna , Mortalidade Perinatal , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Gravidez , Nascimento Prematuro/epidemiologia , Recidiva , Natimorto/epidemiologia
11.
Arch Iran Med ; 20(1): 49-54, 2017 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-28112532

RESUMO

BACKGROUND: Tracheostomy is considered the airway management of choice for patients who need prolonged mechanical ventilation support. Percutaneous Dilatational Tracheotomy (PDT) is a technique that can be performed easily and rapidly at bedside and is particularly useful in the intensive care setting. The Griggs percutaneous tracheotomy is unique in its utilization of a guide wire dilator forceps. OBJECTIVE: We aimed to describe the early perioperative and late postoperative complications of PDT using the Griggs technique in patients in the intensive care unit (ICU). PATIENTS AND METHODS: This cross-sectional study was conducted on all patients who underwent tracheostomy in the ICU of the Imam Reza Hospital of Kermanshah, Iran, from June 2011 to June 2015. PDT was performed in 184 patients with the Griggs technique. Demographic variables, as well as perioperative and late postoperative complications were recorded. RESULTS: The mean age of patients was 57.3 ± 15.37 years. The most common primary causes of tracheostomy were hypoxic brain damage disorders (43.2%) and pneumonia (14.8%). Perioperative and early complications occurred in 16.7 % of procedures, of which 9.3% were bleedings (minor, significant and major). Furthermore, the incidence of late complications was 8.6%, including: stomal infection, difficult replace tracheostomy tube, tracheoesophageal fistula, tracheal stenosis, and tracheomalacia. CONCLUSION: PDT via Griggs technique is a safe, quick, and effective method. The low incidence of complications indicates that bedside percutaneous tracheostomy can be performed safely as a routine procedure for daily care implemented in the ICU.


Assuntos
Dilatação/métodos , Hemorragia/epidemiologia , Hipóxia Encefálica/epidemiologia , Pneumonia/epidemiologia , Complicações Pós-Operatórias/epidemiologia , Traqueostomia/métodos , Adulto , Idoso , Estudos Transversais , Dilatação/efeitos adversos , Feminino , Hemorragia/etiologia , Hospitais , Humanos , Hipóxia Encefálica/cirurgia , Unidades de Terapia Intensiva , Irã (Geográfico) , Masculino , Pessoa de Meia-Idade , Pneumonia/cirurgia , Estudos Prospectivos , Traqueostomia/efeitos adversos
12.
BMC Anesthesiol ; 16(1): 107, 2016 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-27793105

RESUMO

BACKGROUND: Cerebral oxygen saturation (rSO2c) decrease from baseline greater than 20 % during infant cardiac surgery was associated with postoperative neurologic changes and neurodevelopmental impairment at 1 year of age. So far, there is no sufficient evidence to support the routine monitoring of rSO2c during general surgical procedures in children. We aimed to find out the frequency of cerebral desaturation 20 % or more from baseline and to identify possible predictors of change in cerebral oxygen saturation during neonatal and infant general surgery. METHODS: Forty-four infants up to 3 months of age were recruited. Before induction of anesthesia, two pediatric cerebral sensors were placed bilaterally to the forehead region and monitoring of regional cerebral saturation of oxygen was started and continued throughout the surgery. Simultaneously, mean arterial blood pressure (MAP), pulse oximetry (SpO2), heart rate (HR), endtidal CO2, expired fraction of sevoflurane and rectal temperature were recorded. The main outcome measure was rSO2c value drop-off ≥20 % from baseline. Mann-Whitney U-test, chi-squared test, simple and multiple linear regression models were used for statistical analysis. RESULTS: Forty-three infants were analyzed. Drop-off ≥20 % in rSO2c from baseline occurred in 8 (18.6 %) patients. There were no differences in basal rSO2c, SpO2, HR, endtidal CO2, expired fraction of sevoflurane and rectal temperature between patients with and without desaturation 20 % or more from baseline. But the two groups differed with regard to gestation, preoperative mechanical ventilation and the use of vasoactive medications and red blood cell transfusions during surgery. Simple linear regression model showed, that gestation, age, preoperative mechanical ventilation and mean arterial pressure corresponding to minimal rSO2c value during anesthesia (MAPminrSO2c) were associated with a change in rSO2c values. Multiple regression model including all above mentioned variables, revealed that only MAPminrSO2c was predictive for a change in rSO2c values (ß (95 % confidence interval) -0.28 (-0.52-(-0.04)) p = 0.02). CONCLUSIONS: Cerebral oxygen desaturation ≥20 % from baseline occurred in almost one fifth of patients. Although different perioperative factors can predispose to cerebral oxygenation changes, arterial blood pressure seems to be the most important. Gestation as another possible risk factor needs further investigation. TRIAL REGISTRATION: The international registration number NCT02423369 . Retrospectively registered on April 2015.


Assuntos
Encéfalo/irrigação sanguínea , Hipóxia Encefálica/epidemiologia , Complicações Intraoperatórias/epidemiologia , Oxigênio/sangue , Feminino , Humanos , Lactente , Recém-Nascido , Lituânia/epidemiologia , Masculino , Estudos Prospectivos , Fatores de Risco
13.
Scand J Trauma Resusc Emerg Med ; 24: 74, 2016 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-27193212

RESUMO

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a useful treatment for refractory out-of-hospital cardiac arrest (OHCA). However, little is known about the predictors of survival and neurologic outcome after ECMO. We analyzed our institution's experience with ECMO for refractory OHCA and evaluated the predictors of survival and neurologic outcome after ECMO. METHODS: This was a retrospective review of the medical records of 23 patients who were treated with ECMO due to OHCA that was unresponsive to conventional cardiopulmonary resuscitation, between January 2009 and January 2014. RESULTS: Our ECMO team was activated within 10 min for refractory OHCA, and the 30-day survival rate was 43.5 %. In a multivariate analysis that evaluated independent factors contributing to mortality, urine output ≤ 0.5 mL · kg(-1) · h(-1) (defined as oliguria) during the 24 h after ECMO was statistically significant (OR, 32.271; 95 % CI, 1.379-755.282; p = 0.031). Just after ECMO implantation, 6 of the 9 patients (66.7 %) who had normal findings on brain computed tomography (CT) survived with a cerebral performance category (CPC) of grade 1. However, only 3 of the 11 patients (27 %) who had evidence of hypoxic brain damage on initial brain CT survived (their CPC grade was 4). CONCLUSIONS: Based on our findings, the survival rate can be improved by rapid implantation of ECMO, and oliguria seen during the first 24 h after ECMO may be an independent predictor of mortality. Furthermore, findings on brain CT just after ECMO and subsequent images may represent an important predictor for neurologic outcome after ECMO.


Assuntos
Reanimação Cardiopulmonar/métodos , Oxigenação por Membrana Extracorpórea/métodos , Hipóxia Encefálica/prevenção & controle , Parada Cardíaca Extra-Hospitalar/terapia , Adulto , Idoso , Feminino , Humanos , Hipóxia Encefálica/epidemiologia , Hipóxia Encefálica/etiologia , Incidência , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Parada Cardíaca Extra-Hospitalar/mortalidade , República da Coreia/epidemiologia , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Resultado do Tratamento
14.
Circulation ; 131(19): 1682-90, 2015 May 12.
Artigo em Inglês | MEDLINE | ID: mdl-25941005

RESUMO

BACKGROUND: Data on long-term function of out-of-hospital cardiac arrest survivors are sparse. We examined return to work as a proxy of preserved function without major neurologic deficits in survivors. METHODS AND RESULTS: In Denmark, out-of-hospital cardiac arrests have been systematically reported to the Danish Cardiac Arrest Register since 2001. During 2001-2011, we identified 4354 patients employed before arrest among 12 332 working-age patients (18-65 years), of whom 796 survived to day 30. Among 796 survivors (median age, 53 years [quartile 1-3, 46-59 years]; 81.5% men), 610 (76.6%) returned to work in a median time of 4 months [quartile 1-3, 1-19 months], with a median time of 3 years spent back at work. A total of 74.6% (N=455) remained employed without using sick leave during the first 6 months after returning to work. This latter proportion of survivors returning to work increased over time (66.1% in 2001-2005 versus 78.1% in 2006-2011; P=0.002). In multivariable Cox regression analysis, factors associated with return to work with ≥6 months of sustainable employment were as follows: (1) arrest during 2006-2011 versus 2001-2005, hazard ratio (HR), 1.38 (95% CI, 1.05-1.82); (2) male sex, HR, 1.48 (95% CI, 1.06-2.07); (3) age of 18 to 49 versus 50 to 65 years, HR, 1.32 (95% CI, 1.02-1.68); (4) bystander-witnessed arrest, HR, 1.79 (95% CI, 1.17-2.76); and (5) bystander cardiopulmonary resuscitation, HR, 1.38 (95% CI, 1.02-1.87). CONCLUSIONS: Of 30-day survivors employed before arrest, 76.6% returned to work. The percentage of survivors returning to work increased significantly, along with improved survival during 2001-2011, suggesting an increase in the proportion of survivors with preserved function over time.


Assuntos
Parada Cardíaca Extra-Hospitalar/epidemiologia , Sistema de Registros , Retorno ao Trabalho , Sobreviventes/estatística & dados numéricos , Adolescente , Adulto , Idoso , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Hipóxia Encefálica/epidemiologia , Hipóxia Encefálica/etiologia , Masculino , Pessoa de Meia-Idade , Parada Cardíaca Extra-Hospitalar/complicações , Modelos de Riscos Proporcionais , Fatores de Risco , Salários e Benefícios , Fatores Socioeconômicos , Adulto Jovem
15.
Sleep Med ; 16(6): 729-35, 2015 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-25959095

RESUMO

OBJECTIVES: Periodic breathing is common in preterm infants, but is thought to be benign. The aim of our study was to assess the incidence and impact of periodic breathing on heart rate (HR), oxygen saturation (SpO2), and brain tissue oxygenation index (TOI) over the first six months after term-equivalent age. STUDY DESIGN: Twenty-four preterm infants (27-36 weeks gestational age) were studied with daytime polysomnography in quiet sleep (QS) and active sleep (AS) and in both the prone and supine positions at 2-4 weeks, 2-3 months, and 5-6 months post-term corrected age. HR, SpO2, and TOI (NIRO-200 spectrophotometer) were recorded. Periodic breathing episodes were defined as greater than or equal to three sequential apneas each lasting ≥3 s. RESULTS: A total 164 individual episodes of periodic breathing were recorded in 19 infants at 2-4 weeks, 62 in 12 infants at 2-3 months, and 35 in 10 infants at 5-6 months. There was no effect of gestational age on periodic breathing frequency or duration. Falls in HR (-21.9 ± 2.7%) and TOI (-13.1 ± 1.5%) were significantly greater at 2-3 months of age compared to 2-4 weeks of age. CONCLUSIONS: The majority of preterm infants discharged home without clinical respiratory problems had persistent periodic breathing. Although in most infants periodic breathing was not associated with significant falls in SpO2 or TOI, several infants had significant desaturations and reduced cerebral oxygenation especially during AS. The clinical significance of this on neurodevelopmental outcome is unknown and warrants further investigations.


Assuntos
Hipóxia Encefálica/diagnóstico , Hipóxia Encefálica/epidemiologia , Doenças do Prematuro/diagnóstico , Doenças do Prematuro/epidemiologia , Apneia do Sono Tipo Central/diagnóstico , Apneia do Sono Tipo Central/epidemiologia , Encéfalo/fisiopatologia , Estudos Transversais , Feminino , Seguimentos , Idade Gestacional , Frequência Cardíaca/fisiologia , Humanos , Hipóxia Encefálica/fisiopatologia , Lactente , Recém-Nascido , Doenças do Prematuro/fisiopatologia , Estudos Longitudinais , Masculino , Oxigênio/sangue , Consumo de Oxigênio/fisiologia , Polissonografia , Apneia do Sono Tipo Central/fisiopatologia
16.
BJOG ; 122(2): 228-36, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-25546047

RESUMO

OBJECTIVE: To quantify the burden of maternal and neonatal conditions in low- and middle-income countries (LMICs) that could be averted by full access to quality first-level obstetric surgical procedures. DESIGN: Burden of disease and epidemiological modelling. SETTING: LMICs from all global regions. POPULATION: The entire population in 2010. METHODS: We included five conditions in our analysis: maternal haemorrhage; obstructed labour; obstetric fistula; abortion(1) ; and neonatal encephalopathy. Demographic and epidemiological data were obtained from the Global Burden of Disease 2010 study. We split the disability-adjusted life years (DALYs) of these conditions into surgically 'avertable' and 'non-avertable' burdens. We applied the lowest age-specific fatality rates from all global regions to each LMIC region to estimate the avertable deaths, assuming that the differences of death rates between each region and the lowest rates reflect the gap in surgical care. MAIN OUTCOME MEASURES: Deaths and DALYs avertable. RESULTS: Of the estimated 56.6 million DALYs (i.e. 56.6 million years of healthy life lost) of the selected five conditions, 21.1 million DALYs (37%) are avertable by full coverage of quality obstetric surgery in LMICs. The avertable burden in absolute term is substantial given the size of burden of these conditions in LMICs. Neonatal encephalopathy constitutes the largest portion of avertable burden (16.2 million DALYs) among the five conditions, followed by abortion (2.1 million DALYs). CONCLUSIONS: Improving access to quality surgical care at first-level hospitals could reduce a tremendous burden of maternal and neonatal conditions in LMICs.


Assuntos
Traumatismos do Nascimento/prevenção & controle , Efeitos Psicossociais da Doença , Países em Desenvolvimento , Expectativa de Vida , Modelos Estatísticos , Complicações na Gravidez/cirurgia , Fístula Vesicovaginal/cirurgia , Traumatismos do Nascimento/complicações , Traumatismos do Nascimento/epidemiologia , Parto Obstétrico , Feminino , Procedimentos Cirúrgicos em Ginecologia , Acesso aos Serviços de Saúde , Humanos , Hipóxia Encefálica/epidemiologia , Hipóxia Encefálica/etiologia , Hipóxia Encefálica/prevenção & controle , Recém-Nascido , Gravidez , Complicações na Gravidez/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Fístula Vesicovaginal/epidemiologia
17.
Neurol Res ; 36(1): 92-4, 2014 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24405229

RESUMO

OBJECTIVE: We examined whether the type of brain injury impacts the psychopathological profile and quality of life in children with cerebral palsy (CP). METHODS: We assessed 18 children with CP [9 premature, 9 asphyxia at term] and 16 siblings using parent forms of the child behavior checklist (CBCL), disruptive behavior disorder rating scale (DBDRS), and pediatric quality of life inventory (PEDSQL). RESULTS: Children with CP demonstrated more emotional and behavioral symptoms (depression, anxiety, and social, thought, and attention problems) and lower quality of life than their siblings. The pathopsychological profile of children with CP due to prematurity and asphyxia was similar. CONCLUSION: Etiology does not impact the psychopathology in children with CP.


Assuntos
Paralisia Cerebral/epidemiologia , Paralisia Cerebral/psicologia , Adolescente , Sintomas Afetivos/epidemiologia , Isquemia Encefálica/complicações , Isquemia Encefálica/epidemiologia , Paralisia Cerebral/etiologia , Criança , Transtornos do Comportamento Infantil/epidemiologia , Feminino , Idade Gestacional , Humanos , Hipóxia Encefálica/complicações , Hipóxia Encefálica/epidemiologia , Masculino , Pais , Psicopatologia , Qualidade de Vida , Fatores de Risco , Índice de Gravidade de Doença , Irmãos/psicologia , Inquéritos e Questionários , Adulto Jovem
18.
J Matern Fetal Neonatal Med ; 27(14): 1491-4, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-24199646

RESUMO

UNLABELLED: Many authors have discussed the effects of visual stimulations on visual functions, but there is no research about the effects on using vision in everyday activities (i.e. functional vision). Children with perinatal brain damage can develop cerebral visual impairment with preserved visual functions (e.g. visual acuity, contrast sensitivity) but poor functional vision. OBJECTIVE: Our aim was to discuss the importance of assessing and stimulating functional vision in children with perinatal brain damage. METHODS: We assessed visual functions (grating visual acuity, contrast sensitivity) and functional vision (the ability of maintaining visual attention and using vision in communication) in 99 children with perinatal brain damage and visual impairment. All children were assessed before and after the visual stimulation program. RESULTS: Our first assessment results showed that children with perinatal brain damage had significantly more problems in functional vision than in basic visual functions. During the visual stimulation program both variables of functional vision and contrast sensitivity improved significantly, while grating acuity improved only in 2.7% of children. We also found that improvement of visual attention significantly correlated to improvement on all other functions describing vision. CONCLUSIONS: Therefore, functional vision assessment, especially assessment of visual attention is indispensable in early monitoring of child with perinatal brain damage.


Assuntos
Hipóxia Encefálica/fisiopatologia , Doenças do Recém-Nascido/fisiopatologia , Acuidade Visual/fisiologia , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Feminino , Humanos , Hipóxia Encefálica/epidemiologia , Lactente , Recém-Nascido , Doenças do Recém-Nascido/epidemiologia , Masculino , Estimulação Luminosa , Testes Visuais/métodos
19.
Laryngoscope ; 123(10): 2544-53, 2013 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-23595509

RESUMO

OBJECTIVE/HYPOTHESIS: To report data on death or permanent disability after tonsillectomy. STUDY DESIGN: Electronic mail survey. METHODS: A 32-question survey was disseminated via the American Academy of Otolaryngology-Head and Neck Surgery electronic newsletter. Recipients were queried regarding adverse events after tonsillectomy, capturing demographic data, risk factors, and detailed descriptions. Events were classified using a hierarchical taxonomy. RESULTS: A group of 552 respondents reported 51 instances of post-tonsillectomy mortality, and four instances of anoxic brain injury. These events occurred in 38 children (71%), 15 adults (25%), and two patients of unstated age (4%). The events were classified as related to medication (22%), pulmonary/cardiorespiratory factors (20%), hemorrhage (16%), perioperative events (7%), progression of underlying disease (5%), or unexplained (31%). Of unexplained events, all but one occurred outside the hospital. One or more comorbidities were identified in 58% of patients, most often neurologic impairment (24%), obesity (18%), or cardiopulmonary compromise (15%). A preoperative diagnosis of obstructive sleep apnea was not associated with increased risk of death or anoxic brain injury. Most events (55%) occurred within the first 2 postoperative days. Otolaryngologists who reported performing <200 tonsillectomies per year were more likely to report an event (P < .001). CONCLUSIONS: This study, the largest collection of original reports of post-tonsillectomy mortality to date, found that events unrelated to bleeding accounted for a preponderance of deaths and anoxic brain injury. Further research is needed to establish best practices for patient admission, monitoring, and pain management. LEVEL OF EVIDENCE: N/A.


Assuntos
Complicações Pós-Operatórias/epidemiologia , Tonsilectomia , Adolescente , Adulto , Criança , Pré-Escolar , Comorbidade , Feminino , Humanos , Hipóxia Encefálica/epidemiologia , Masculino , Pessoa de Meia-Idade , Obesidade/epidemiologia , Complicações Pós-Operatórias/mortalidade , Complicações Pós-Operatórias/prevenção & controle , Fatores de Risco , Apneia Obstrutiva do Sono/epidemiologia , Tonsilectomia/efeitos adversos , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA