A study of etiological profile of acute confusional state

Background: ACS (Acute confusional states) are on the rise taking the shape of an epidemic. These states are common among the elderly, but young individuals are also not spared. Prompt diagnosis and management of these states can decrease the associated morbidity and mortality.Methods: In this prospective observational study, etiological profile of ACS was evaluated in a total 100 patients, selected over a period of one year, after they fulfilled the CAM (Confusion Assessment Method) criteria.Results: Among 100 patients of ACS, mean age was 54.77�.50 years, males were 66% and 34% were females. The most common diagnosis provisionally made on the basis of history and clinical examination was metabolic encephalopathy in 37% patients, meningoencephalitis (24%), CVA (Cerebrovascular accident) (18%), seizures (9%), sepsis (6%), poisoning (6%). Whereas the final diagnosis made after subjecting the patients to relevant investigations, was metabolic encephalopathy in 37% of patients, meningoencephalitis (20%), CVA (18%), sepsis (12%), unprovoked seizures (6%), poisoning (6%) and undetermined in 1%. The final diagnosis matched the provisional diagnosis in most of the patients except sepsis as a provisional diagnosis was underdiagnosed. The mean duration of hospital stay was 7.6�67days and the hospital stay was most commonly complicated by aspiration pneumonia and acute kidney injury.Conclusions: This study emphasizes that the ACS is an emergency medical situation, where prompt identification, workup and treatment should be done parallelly and urgently to prevent the morbidity and mortality.

Septic encephalopathy:diagnosis faces confusion / 中国小儿急救医学

Septic encephalopathy( SE) is defined as diffuse brain dysfunction that related to systemic inflammatory response and without clinical or laboratory evidence of central nervous system infection.SE is one of the most common complications of patients with severe sepsis.Its pathogenesis is very complex and is not yet clear.The clinical manifestations of SE varied and have no specificity, mainly for changes of con-sciousness and mental status.The performance of electroencephalography is more sensitive,and is associated with prognosis.Somatosensory evoked potentials could display the damage of cortical or subcortical path-ways.Brain MRI has a more accurate assessment of the nature and the extent of brain damage.SE is a diag-nosis of exclusion.Before the diagnosis of SE,we need to exclude other encephalitis and encephalopathy.The morbidity and mortality of SE are high.It requires close attention,early detection and timely treatment.

Clinical Study of Xingnaojing Injection for Treatment of Septic Encephalopathy / 广州中医药大学学报

Objective To observe the therapeutic effect of Xingnaojing Injection ( XI) combined western medicine for the treatment of septic encephalopathy (SE) . Methods A total of 60 SE patients were evenly randomized into treatment group and control group. Both groups were given routine western medicine therapy such as anti-inflammation, immunological and cerebral preventive treatment, or even mechanical ventilation, sub-hypothermia therapy, and insulin intensification therapy if necessary. Additionally, the treatment group was given intravenous drip of XI. The treatment for both groups lasted one week. Glasgow Coma Scale ( GCS) scores were observed before and after treatment for the evaluation of therapeutic effect of both groups. Moreover, the serum levels of C-reactive protein (CRP) and procalcitonin (PCT) , and the hospitalization fee and time in Intensive Care Unit were compared in both groups. Results ( 1) After treatment for one week, the improvement of GCS scores in the treatment group was superior to that in the control group ( P<0.05); the total effective rate was 90.0% in the treatment group and was 56.7% in the control group, the difference being significant ( P<0.05). ( 2) After treatment for 24 hours, serum CRP and PCT levels were decreased obviously in both groups (P<0.05), and the decrease in the treatment group after treatment for 24, 48, and 72 hours and for one week was superior to that in the control group ( P<0.05). ( 3) Hospitalization fee was less and hospitalization time in ICU was shorter in the treatment group than those in the control group ( P<0.05). Conclusion XI shows satisfactory effect on relieving illness and increasing cure rate, and on decreasing hospitalization fee and time in ICU.

Importância da monitorização do delirium na unidade de terapia intensiva / The importance of delirium monitoring in the intensive care unit

O delirium é um estado confusional agudo associado a maior mortalidade na unidade de terapia intensiva e comprometimento da recuperação funcional em longo prazo. Apesar de sua elevada incidência e relevante impacto nos desfechos de pacientes criticamente enfermos, o delirium continua sendo sub-diagnosticado. Atualmente existem instrumentos validados para diagnosticar e monitorar o delirium, permitindo a detecção precoce dessa disfunção orgânica e início precoce do tratamento. Além dos fatores de risco não modificáveis do paciente, existem aspectos clínicos e ambientais modificáveis que devem ser avaliados para reduzir a ocorrência e gravidade do delirium. Conforme demonstrado por estudos recentes, intervenções para reduzir a exposição a sedatição excessiva e melhorar a orientação do paciente podem estar associadas a redução da incidência de delirium. Baixa incidência de delirium deve ser almejada e considerada como uma medida da qualidade nas unidades de terapia intensiva.

Delirium is an acute confusional state associated with increased mortality in the intensive care unit and long-term impaired functional recovery. Despite its elevated incidence and major impact in the outcomes of critically ill patients, delirium remains under-diagnosed. Presently, there are validated instruments to diagnose and monitor delirium, allowing the detection of early organ dysfunction and treatment initiation. Beyond patient's non-modifiable risk factors, there are modifiable clinical and environmental aspects that should be accessed to reduce the occurrence and severity of delirium. As recent studies demonstrate that interventions aiming to reduce sedative exposure and to improve patients' orientation associated with early mobility have proved to reduce delirium, a low incidence of delirium should be targeted and considered as a measure of quality of care in the intensive care unit (ICU).

Comprehensive Assessment of Septic Encephalopathy in Children / 实用儿科临床杂志

Objective To investigate the clinical features and characteristics of imaging,cerebral hemodynamics and electrophysiology of septic encephalopathy in children.Methods The clinical data and examination result of computerized tomography(CT),ultrasound and electroencephalogram(EEG) on encephalon of the 44 consecutive children with septic encephalopathy from Jan.2003 to Jun.2006 were reviewed retrospectively.According to the prognosis and the etiology,the totally 44 patients were divided into survival group,death group and pneumonia group,enteritis group,septicemia group,appendicular perforation group,skin gangrene group as well as EBV infection group,respectively.Fi-sher′s exact test was used to compare the differences of ratio.Results 1.Clinical manifestations:loss of consciousness was observed in all 44 cases,convulsions in 29 cases,upper-right-limb paralysis in 1 case,cerebral hernia in 1 case,and 14 cases resulted in death.2.Forteen cases were detected by CT scanning.Multiple local and diffuse lower density in cerebral parenchyma was observed in 3 cases and 2 cases respectively.Intracranial hemorrhage was found in the latter 2 cases.3.Color doppler ultrasound was detected in 11 cases.Diffuse brain edema was found in 5 cases,and among them intracranial hemorrhage was found in 1 case.4.EEG was detected in 10 cases.Flat-to-isoelectric EEG was found in 3 cases.Diffuse slow wave activities and sharp wave with sharp-slow wave complex were found in 5 cases and 2 cases,respectively.5.Between the sharp wave group and the flat-to-isoelectric EEG group,the number of cases who was less than 7 with Glasgow coma scale was significant(P