Outcome in patients with head injury: Do extra-cranial injuries worsen prognosis?

Introduction: Patient age and severity of brain injury are validated prognostic indicators in patients with polytrauma. This prospective observational study was conducted to study the influence of extracranial injuries on neurological outcome of patients with traumatic brain injury [TBI]

Methodology: Patients with TBI aged 20-60 years were enrolled and categorized into two groups: Group 1- with extracranial injuries; Group 2- without extracranial injuries. Patients with fixed and dilated pupils, brainstem injuries, delay of more than 24 hours for hospitalization, and patients who developed secondary insults were excluded

Results: Complete follow up and data collection was feasible in 33 patients of Group 1 and in 47 patients of Group 2. Severity of head injury, SOFA score, co-morbid conditions, duration of hospital stay, mortality, GCS scores on admission and delta GCS [GCS on admission - GCS at time of discharge] were comparable between the two groups. The duration of mechanical ventilation and the ISS scores were significantly higher in patients with extracranial injuries. Extracranial injuries did not influence the survival rate. Severity of head injury was the prime determinant of survival. Extracranial injuries were shown to have a synergistic effect on morbidity

Conclusion: Presence of extracranial injuries does not influence the outcome of patients with head injuries in which secondary insults like hypoxia, hypercapnia / hypocapnia, hypotension, hyperpyrexia, hypoglycemia / hyperglycemia and intracranial hypertension are avoided

Successful intubation in a child with Lowe syndrome using fiberscope and Glidescope[registered sign]

We report the airway management in anticipated difficult airway of a two year old male child with diagnosis of Lowe syndrome, employing two airway management devices. Fiberscope assisted Glidescope[registered sign] intubation was employed to manage the difficult airway. Lowe syndrome is a rare inherited metabolic disorder with hypotonia, delayed motor and mental milestones, renal dysfunction and hypokalemia. The child had an anticipated difficult airway by virtue of large head circumference with frontal bossing, retrognathia and high arched palate. A careful preanesthetic evaluation and discrete attention to the distinctive components of the syndrome are the essence of successful perioperative management. Airway management in these patients requires standard algorithmic approach to difficult airway with careful selection of ventilation and intubation techniques and aids suitable in these situations to prevent any catastrophes