Comas non traumatiques chez l'adulte à l'Unité de soins intensifs du Centre Hospitalier Universitaire Sylvanus Olympio: à propos de 484 cas / Non-traumatic comas with the adult in the intensise care unit of the Sylvanus Olympio Teaching Hospital: concerning 484 cases

Introduction : Le coma non traumatique est une urgence médicale, relativement fréquente dont les différents aspects restent encore obscurs dans les services de réanimation en Afrique. Objectif : Cette étude avait pour but de décrire les aspects épidémiologiques, étiologiques et pronostiques des comas non traumatiques (CNT). Méthodes : Il s'était agi d'une étude rétrospective descriptive menée au Centre Hospitalier Universitaire Sylvanus Olympio à l'Unité des Soins Intensifs (USI) de janvier 2018 à décembre 2019. Résultats : L'étude avait concerné 484 patients hospitalisés pour comas non traumatiques sur un total de 1835 patients. Les comas non traumatiques de l'adulte représentaient 26,4% des admissions à l'USI. L'âge moyen des patients était de 52,8 ans (extrêmes de 18 et 92 ans) avec une sex-ratio (H/F) de 0,94. Plus de la moitié des patients avait été référée de structures sanitaires périphériques (55,4%). L'hypertension artérielle (HTA) était l'antécédent le plus retrouvé dans 36,4% ; suivi du diabète et de l'infection au virus de l'immunodéficience acquise (VIH) dans 14,9% chacun. Le coma était de survenue brutale dans 77,7% des cas. Les étiologies des comas étaient dominées par les causes vasculaires dans 32,2% des cas, puis les causes infectieuses dans 27,3% des cas et les comas urémiques dans 14,1% des cas. Le pronostic était défavorable avec une mortalité de 68,6%. La première étiologie de décès concernait les causes vasculaires. Conclusion : L'amélioration du pronostic des comas non traumatiques passe nécessairement par une amélioration du plateau technique pour une meilleure prise en charge des patients

Introduction: The non-traumatic coma is a medical emergency relatively frequent which different aspects remain obscure in intensive care units in Africa. Goals: The aim of this study was therefore to describe the epidemiological, etiological and prognostic aspects of non-traumatic comas. Methodology: This was a retrospective descriptive study carried out at the Sylvanus Olympio Teaching Hospital in the Intensive Care Unit (USI) from January 2018 to December 2019. Results: The study involved 484 patients hospitalized for non-traumatic comas out of 1835 patients. Non-traumatic comas in adults were 26.4% of admissions in the Intensive Care Unit. The mean age of patients was 52.8 years of a sex ratio (M / F) of 0.94. More than half of patients (55.4%) were referred from peripheral care centers. Arterial hypertension was the most common antecedent found in 36.4%, followed by diabetes and the infection of human immunodeficiency virus (HIV) at 14.9% each. The coma was sudden aspect in 77.7% of the cases. Aetiologies of the comas were dominated by vascular causes in 32.2% of causes, then infectious in 27.3% of cases and uremic comas in 14.1% of cases. The prognosis was unfavorable with 68.6% mortality. The first etiology of death was related to vascular cases. Conclusion: The Improving of the prognosis of non-traumatic comas needs an improvement of modern medical technology for a better patient care.

Effect of auditory stimulation on traumatic coma duration in intensive care unit of medical sciences university of Mazandarn, Iran

Sensory deprivation is one of the common complications of coma patients in the intensive care unit [ICU]. The purpose of this study was to investigate the impact of a familiar voice to consciousness level in coma patients. A total of 13 patients with traumatic coma [8 >/= Glasgow's coma scale [GCS]] admitted in ICU ward were randomly assigned to control and experimental groups. The experimental group was treated twice a daily each time 15 min with a familiar recorded MP3 sound for 2 weeks. The control group received only natural voices of environment. GCS applied to evaluate patients' level of consciousness. Findings showed that duration to reach GCS = 15 was significantly shorter in the experimental group [X[2] = 12/96, P < 0/001]. These findings imply that providing familiar auditory stimulation programs for coma patients in the ICU could be effective

Intensive insulin therapy versus conventional insulin therapy for critically ill trauma patients admitted to ICU

The objective of our study was to evaluate the beneficial effect of IIT in reducing mortality and morbidity in critically ill trauma patients admitted to ICU. Nested cohort study within a Randomized Controlled Trial. All trauma patients with GCS

Coma metabólico / Methabolic coma

Coma pode ser definido como um estado de não-responsividade e não-reatividade do organismo, e o seu diagnóstico é feito quando temos uma Escala de Coma de Glasgow menor ou igual a 7. De acordo com a literatura médica, aproximadamente 60 por cento dos casos de coma têm origem em desordens metabólicas, que levam a alterações no suprimento de metabólitos ou modificações da excitabilidade neuronal.

Effect of arousal methods for 175 cases of prolonged coma after severe traumatic brain injury and its related factors / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To determine the effect of arousal methods for prolonged coma of 175 patients with severe traumatic brain injury and related factors.</p><p><b>METHODS</b>There were 175 cases with persistent coma longer than 1 month after severe traumatic brain injury. Coma lasted 1-12 months. Arousal procedures included hyperbaric oxygen, physical therapy and arousal drugs.</p><p><b>RESULTS</b>In the 175 prolonged coma patients 110 got recovery of consciousness; in 118 cases with coma of 1-3 months, 86 cases recovered consciousness (72.9%); in 42 cases with coma of 4-6 months, 20 cases recovered consciousness (47.6); and in 15 cases with coma of longer than 6 months, only 4 cases recovered consciousness (26.7%). The recovery of consciousness depended on patient's primary brain stem damage, cerebral hernia, GCS score, and age.</p><p><b>CONCLUSIONS</b>Application of appropriate arousal procedures improves recovery of consciousness in patients with prolonged coma.</p>

Clinical Analysis on 34 Diffuse Axonal Injured Cases Under 8 on the GCS

Thirty four patients with diffuse axonal injury, defined as post-traumatic coma for over 24 hours with Glasgow Coma Scale(GCS) score of 8 or less following nonsurgical resuscitation, admitted to Inha Hospital from January to December 1991, were studied in order to identify clinical analysis. The aim of this study was to find out the effects of barbiturates or other intensive therapy or head elevation on the intracranial pressure(ICP), arteriovenous oxygen difference(AVDO2) and outcome. The results were as follows; The ratio of male to female was about 6 to 1. 2) In clinical signs at the emergency room, abnormal pupil size was shown 17 cases(61%) under 8-5 on the GCS, but all cases under 5 on the GCS showed abnormal pupil size. 3) Ventricular compression was shown in 29 cases(85%), 17 cases(50%) was showed the ventricular compression & cisternal obliteration. 4) Post-traumatic cerebral infarction was developed 59% of DAI and occurred in 88% of ventricular compression and cisternal obliteration. 5) On admission, above 5 ml/100 ml in AVDO2 was developed in 32 cases(94%) under 8 on the GCS, but in all cases under 5 on the GCS. Recording of ICP showed above 20 mmHg in 15 cases(44%). On coagulopathy, our cases showed that decrease of platelet was involved in 5 cases(15%), prothrombin time(PT) prolongation in 11 cases(32%), activated partial thromboplastin time(APTT) in 4 cases, fibrinogen in 5 cases. 6) The mean ICP was slightly lower when the patient's head was elevated at 30 degree than at 0 degree. The mean ICP was moderately lower when the patients were taken barbiturates therapy. ICP tends to increase from the 1st to 3rd day after injury. 7) The mean AVDO2 was significantly lower when the patients were taken barbiturates therapy, especially at the 1st day. 8) On the relation between Glasgow Outcome Scale(GOS) and Neurological grading(NG), GOS IV was developed in 8 cases(NG score 3-6), GOS III in 5 cases(NG score 7-9), GOS II in 2 cases(NG score 10). Total mortality rate was 56%.

Prognostic Factors in Diffuse Axonal Injuries of Brain

Sixty-seven patients with moderate to severe cerebral diffused sxonal injuries(that is, in post-traumatic coma for over 24 hours without mass lesions or ischemic insults) were admitted during past four years and four months period ending April 30, 1991. A retrospective study of these patients was done for identification of prognostic factor. The ratio of male to female was 2.7 to 1 and the peak incidence was at the second decade. The most common cause of trauma was traffic accident and pedestrian trauma was the most common event among that. Forty-nine patients(73%) recovered from coma, nine(13%) remained in vegetative state and another nine(13%) died. The median duration of coma was 13 days. The age, initial Glasgow Coma scale(GCS), prolonged duration of coma, initial motor reactivities, signs of hypothalamic damage, corpus callosum and brain stem lesions on brain MRI were proved as adverse factors for prognosis.