Nutrition-related risk factors for pulmonary infection in patients with severe stroke / 中国实用护理杂志

Objective:To explore the effect of nutritional status on pulmonary infection in patients with severe stroke, and to identify the nutrition-related risk factors of pulmonary infection, so as to provide reference for the prevention and treatment of pulmonary infection from the perspective of nutrition.Methods:The clinical data of 122 patients admitted to the neuro-intensive care unit (NICU) of the First Affiliated Hospital of Chongqing Medical University from August 2019 to February 2020 were retrospectively analyzed. Patients with severe stroke were divided into two groups according to whether they had pulmonary infection during hospitalization in NICU, and there were 25 patients in case group and 97 patients in control group. Nutritional Risk Screening (NRS2002), Nutrition Risk in the Critically ill (NUTRIC) score and malnutrition criteria, combined with anthropometry, clinical comprehensively history and laboratory data were used to evaluate the nutritional status of patients. Logistic regression was used to identify nutrition-related risk factors for pulmonary infection in patients with severe stroke.Results:The incidence of pulmonary infection in severe stroke patients was 20.5% (25/122). Univariate analysis showed that the difference of chronic obstructive pulmonary disease, endotracheal intubation, nasogastric tube use, NUTRIC ≥ 5, the Acute Physiology and Chronic Health Evaluation (APACHE) Ⅱ, Sequential Organ Failure Assessment (SOFA), Glasgow Coma Scale (GCS), and creatinine levels, duration of enteral nutrition, length NICU stay, and length of hospital stay between the two groups were statistically significant ( χ2 value was 7.542-34.403, t value was 2.207, Z value was -3.511, 3.083 and 3.115, P<0.05 or 0.01). Multivariate Logistic regression analysis showed that NUTRIC≥5 ( OR= 12.202, 95% CI 2.342-63.568) and nasogastric tube use ( OR=16.990, 95% CI5.343-54.024) were independent risk factors of pulmonary infection in patients with severe stroke ( P<0.01). Conclusions:NUTRIC score≥ 5, high nutritional risk and nasogastric tube use were independent risk factors of pulmonary infection in patients with severe stroke, which should be given early nutritional assessment and individualized care.

Cardiac Complications in Patients Admitted to the Neuro-Intensive Care Unit

Patients admitted to the neuro-intensive care unit experience a number of cardiovascular complications. This is because of common risk factors exist between neurologic and cardiovascular diseases, and also the close interconnection between brain and heart, leading to an increased cardiovascular burden. Although the cardiovascular complications may or may not be clinically significant, the medical team should be aware of these instances, since such cardiac complications often result in fatal and irreversible outcomes. Particularly, unexpected cardiac arrest, acute myocardial infarction, uncontrolled atrial fibrillation, QT prolongation, and Takotsubo cardiomyopathy are common occurrences in the neuro-intensive care unit, and require careful attention. In this article, we review the incidence, clinical significance and management of such neuro-intensive care unit cardiac complications.

Full Outline of Unresponsiveness score and the Glasgow Coma Scale in prediction of pediatric coma / 世界急诊医学杂志（英文）

@#BACKGROUND: This study was done to compare the admission Full Outline of Unresponsiveness (FOUR) score and Glasgow Coma Scale (GCS) as predictors of outcome in children with impaired consciousness. METHODS: In this observational study, children (5–12 years) with impaired consciousness of <7 days were included. Children with traumatic brain injury, on sedatives or neuromuscular blockade; with pre-existing cerebral palsy, mental retardation, degenerative brain disease, vision/hearing impairment; and seizure within last 1 hour were excluded. Primary outcomes: comparison of area under curve (AUC) of receiver operating characteristic (ROC) curve for in-hospital mortality. Secondary outcomes: comparison of AUC of ROC curve for mortality and poor outcome on Pediatric Overall Performance Category Scale at 3 months. RESULTS: Of the 63 children, 20 died during hospital stay. AUC for in-hospital mortality for GCS was 0.83 (CI 0.7 to 0.9) and FOUR score was 0.8 (CI 0.7 to 0.9) [difference between areas –0.0250 (95%CI 0.0192 to 0.0692), Z statistic 1.109, P=0.2674]. AUC for mortality at 3 months for GCS was 0.78 (CI 0.67 to 0.90) and FOUR score was 0.74 (CI 0.62 to 0.87) (P=0.1102) and AUC for poor functional outcome for GCS was 0.82 (CI 0.72 to 0.93) and FOUR score was 0.79 (CI 0.68 to 0.9) (P=0.2377), which were also comparable. Inter-rater reliability for GCS was 0.96 and for FOUR score 0.98. CONCLUSION: FOUR score was as good as GCS in prediction of in-hospital and 3-month mortality and functional outcome at 3 months. FOUR score had a good inter-rater reliability.