Subject(s)
Aneurysm, Ruptured/complications , Hematoma, Subdural, Acute/etiology , Intracranial Aneurysm/complications , Aneurysm, Ruptured/diagnostic imaging , Cerebral Angiography/methods , Computed Tomography Angiography , Female , Hematoma, Subdural, Acute/diagnostic imaging , Humans , Intracranial Aneurysm/diagnostic imaging , Middle AgedSubject(s)
Empyema, Subdural/etiology , Maxillary Sinusitis/complications , Radicular Cyst/complications , Curettage , Drainage , Empyema, Subdural/diagnostic imaging , Humans , Male , Maxillary Sinusitis/diagnostic imaging , Maxillary Sinusitis/surgery , Neurosurgical Procedures , Radicular Cyst/diagnostic imaging , Radicular Cyst/surgery , Tomography, X-Ray Computed , Young AdultSubject(s)
Hernia/diagnostic imaging , Lung Injury/diagnostic imaging , Tomography, X-Ray Computed , Aged , Drainage , Hernia/etiology , Humans , Lung Injury/etiology , Lung Injury/surgery , Male , Multiple Trauma , Pneumothorax/etiology , Respiration, Artificial , Thoracic Injuries/diagnostic imaging , Wounds, Nonpenetrating/diagnostic imagingSubject(s)
Thiamine Deficiency/complications , Wernicke Encephalopathy/diagnosis , Acidosis/etiology , Acute Kidney Injury/etiology , Delayed Diagnosis , Disease Progression , Duodenitis/complications , Female , Gait Disorders, Neurologic/etiology , Glasgow Coma Scale , Humans , Infusions, Intravenous , Magnetic Resonance Imaging , Memory Disorders/etiology , Middle Aged , Neuroimaging , Thalamus/pathology , Thiamine/administration & dosage , Thiamine/therapeutic use , Thiamine Deficiency/diagnosis , Thiamine Deficiency/drug therapy , Third Ventricle/pathology , Wernicke Encephalopathy/diagnostic imaging , Wernicke Encephalopathy/etiologySubject(s)
Thoracic Injuries/diagnostic imaging , Diagnostic Imaging , Humans , Respiration Disorders , RuptureABSTRACT
OBJECTIVE: This study sought to identify clinical variables that may contribute to the development of brain death (BD) in patients with severe supratentorial intracerebral hemorrhage (ICH). METHODS: A prospective observational study was carried out from 2012 to 2014 and included patients with severe supratentorial ICH (Glasgow Coma Score ≤ 8). Exclusion criteria included aneurysmal or traumatic hemorrhage origin and hemorrhagic transformation of previous ischemic stroke. The following data were collected: clinical variables (past medical history, clinical severity at admission), head computed tomography scan findings, laboratory data, neurosurgical procedures, and immediate complications. Univariate tests and logistic regression analyses were performed to assess the predictive ability of these variables and identify patients at high risk of progression to BD. RESULTS: A total of 140 patients with severe supratentorial ICH (median age, 60; 68.6% male) were included. Of these 140 cases, 24 progressed to BD. In the multivariate analysis, the following variables were independently associated with BD outcome after supratentorial ICH: a history of arterial hypertension (odds ratio [OR], 11.254; P = .003), anticoagulant therapy (OR, 3.561; P = .050), presence of photomotor impairment at admission (OR, 7.095; P = .001), rebleeding after supratentorial ICH (OR, 5.613; P = .010), and no neurosurgical hematoma evacuation in ICH (OR, 8.314; P = .001). CONCLUSIONS: Certain clinical variables are predictive of an increased risk for BD development after supratentorial ICH. This information would be useful for transplant coordinators, permitting early identification of at-risk patients and increasing the availability of potential donors.
Subject(s)
Brain Death , Cerebral Hemorrhage/complications , APACHE , Anticoagulants/adverse effects , Cause of Death , Disease Progression , Female , Humans , Hypertension/complications , Logistic Models , Male , Middle Aged , Odds Ratio , Predictive Value of Tests , Prospective Studies , Risk Factors , Tomography, X-Ray ComputedSubject(s)
Anti-Bacterial Agents/adverse effects , Colistin/adverse effects , Muscle Hypotonia/chemically induced , Respiratory Insufficiency/chemically induced , Adult , Coinfection , Combined Modality Therapy , Disease Susceptibility , Drug Substitution , Drug Therapy, Combination , Humans , Kidney Failure, Chronic/complications , Male , Osteomyelitis/drug therapy , Osteomyelitis/surgery , Renal Dialysis , Reoperation , Respiration, Artificial , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Shock, Septic/drug therapy , Spinal Dysraphism/complications , Surgical Wound Infection/drug therapySubject(s)
Basilar Artery/diagnostic imaging , Cerebrovascular Circulation , Ultrasonography, Doppler, Transcranial , Vasospasm, Intracranial/diagnostic imaging , Vertebral Artery/diagnostic imaging , Adult , Basilar Artery/physiopathology , Female , Humans , Vasospasm, Intracranial/physiopathology , Vertebral Artery/physiopathologyABSTRACT
Traumatic injuries represent a major health problem all over the world. In recent years we have witnessed profound changes in the paradigm of severe trauma patient resuscitation, new concepts regarding acute coagulopathy in trauma have been proposed, and there has been an expansion of specific commercial products related to hemostasis, among other aspects. New strategies in severe trauma management include the early identification of those injuries that are life threatening and require surgical hemostasis, tolerance of moderate hypotension, rational intravascular volume replacement, prevention of hypothermia, correction of acidosis, optimization of oxygen carriers, and identification of those factors required by the patient (fresh frozen plasma, platelets, tranexamic acid, fibrinogen, cryoprecipitates and prothrombin complex). However, despite such advances, further evidence is required to improve survival rates in severe trauma patients.
