Predisposing factors, clinical assessment, management andoutcomes of agitation in the trauma intensive care unit / 世界急诊医学杂志（英文）

BACKGROUND: Agitation occurs frequently among criticaly il patients admitted to the intensive care unit (ICU). We aimed to evaluate the frequency, predisposing factors and outcomes of agitation in trauma ICU. METHODS: A retrospective analysis was conducted to include patients who were admitted to the trauma ICU between April 2014 and March 2015. Data included patient's demographics, initial vitals, associated injuries, Ramsey Sedation Scale, Glasgow Coma Scale, head injury lesions, use of sedatives and analgesics, head interventions, ventilator days, and ICU length of stay. Patients were divided into two groups based on the agitation status. RESULTS: A total of 102 intubated patients were enrolled; of which 46 (45％) experienced agitation. Patients in the agitation group were 7 years younger, had significantly lower GCS and sustained higher frequency of head injuries (P<0.05). Patients who developed agitation were more likely to be prescribed propofol alone or in combination with midazolam and to have frequent ICP catheter insertion, longer ventilatory days and higher incidence of pneumonia (P<0.05). On multivariate analysis, use of propofol alone (OR=4.97; 95％CI=1.35–18.27), subarachnoid hemorrhage (OR=5.11; 95％CI=1.38–18.91) and ICP catheter insertion for severe head injury (OR=4.23; 95％CI=1.16–15.35) were independent predictors for agitation (P<0.01). CONCLUSION: Agitation is a frequent problem in trauma ICU and is mainly related to the type of sedation and poor outcomes in terms of prolonged mechanical ventilation and development of nosocomial pneumonia. Therefore, understanding the main predictors of agitation facilitates early risk-stratification and development of better therapeutic strategies in trauma patients.

Primary Hyperparathyroidism and Cardiac Arrest: Case report.

Hyperparathyroidism is a common endocrine disorder characterized by hypersecretion of parathyroid hormones due to abnormal activity of one or more parathyroid glands. Several cardiac abnormalities have been reported due to hyperparathyroidism. In this case report, a case of cardiac arrest due to hyperparathyroidism and hypercalcemia is presented and discussed. A female patient, 73 years old, was admitted to surgical ward (SICU) with malignant goiter extending to the retrosternum. She was a known case of hyperparathyroidism and hypercalcemia. After the operation, the patient was shifted to SICU for further management. Suddenly, the patient had sudden cardiac arrest and was successfully resuscitated within 2 minutes. The ECG showed a new Right Bundle Branch Block (RBBB) changes. Patient remained on ventilator, not obeying commands, and opened her eyes spontaneously with cough reflex. A week after, percutaneous tracheostomy was performed, and patient became hemodynamically stable, weaned from ventilator and allowed to breathe spontaneously. Although cardiac arrest is a rare complication, it should be expected by health care providers when dealing with patients with hyperparathyroidism and hypercalcemia.