ABSTRACT
A proportion of patients surviving severe traumatic brain injury (TBI) have symptoms suggestive of excessive sympathetic discharge, here termed paroxysmal sympathetic hyperactivity (PSH). The goals of this study were: (1) to describe the clinical associations and radiological findings of PSH, its incidence, and features in subjects with severe TBI in the intensive care unit (ICU); (2) to investigate the potential role of increased intracranial pressure in the pathogenesis of PSH; and (3) to determine the prognostic influence of PSH during the ICU stay, on discharge from the ICU, and at 12 months post-injury. A prospective cohort study was undertaken of all ICU admissions with severe TBI older than 14 years over an 18-month period. The PSH symptoms consisted of paroxysmal increases in blood pressure, respiratory rate, and heart rate; worsening level of consciousness; muscle rigidity; and hyperhidrosis. Subjects demonstrating PSH episodes were compared with a group of non-PSH consecutive subjects studied over the first 6 months of the study period. Data were recorded on the clinical variables associated with PSH episodes, early post-injury cerebral CT findings, and neurological status at 1 year. Of 179 severe TBI patients admitted over the study period, 18 (10.1%) experienced PSH. Injury severity-related variables (e.g., initial APACHE II score, admission coma level, and proportion with intracranial hypertension) were similar between the two groups. The PSH group had a longer ICU stay and a greater incidence of infectious complications. At 1 year post-injury, 20% of this group demonstrated ongoing PSH episodes. Over 18 months, 10.1% of admissions following severe TBI demonstrated PSH features in ICU. Subjects with PSH had a longer ICU stay and higher rate of complications, although this did not appear to compromise their long-term neurological recovery.
Subject(s)
Autonomic Nervous System Diseases/physiopathology , Brain Injuries/diagnosis , Brain Injuries/physiopathology , Hypertension/diagnosis , Hypertension/physiopathology , Intracranial Hypertension/physiopathology , Adult , Autonomic Nervous System Diseases/diagnosis , Autonomic Nervous System Diseases/epidemiology , Brain Injuries/epidemiology , Cohort Studies , Comorbidity , Female , Humans , Hypertension/epidemiology , Incidence , Intracranial Hypertension/diagnosis , Intracranial Hypertension/epidemiology , Male , Middle Aged , Prognosis , Prospective Studies , Tachycardia/diagnosis , Tachycardia/epidemiology , Tachycardia/physiopathology , Young AdultABSTRACT
La introducción progresiva de la ventilación mecánica no invasiva (VMNI) en el tratamiento de la insuficiencia respiratoria ha permitido, por un lado, aumentar el número de indicaciones clínicas de esta técnica y, por otro, evitar o reducir las complicaciones derivadas de la ventilación mecánica convencional. Los resultados obtenidos son variables en virtud de las circunstancias y el tipo de enfermedad que motivan su aplicación. Con el propósito de revisar los estudios existentes acerca de su uso y establecer niveles de evidencia a su favor, las diferentes sociedades científicas han elaborado conferencias de consenso que establecen el grado de utilidad de la VMNI en sus múltiples indicaciones (AU)
The progressive introduction of non-invasive mechanical ventilation (NIMV) in the management of respiratory failure has increased the number of clinical indications and has reduced common complication of conventional mechanical ventilation. Results of the technique are variable depending on the disease that causes the respiratory failure. With the purpose of reviewing studies about the use of NIMV and to report levels of evidence, different scientific societies have elaborated consensus conferences to establish the utility of NIMV in different indications (AU)
Subject(s)
Humans , Respiration, Artificial/methods , Respiratory Insufficiency/therapy , Continuous Positive Airway Pressure/methods , Practice Patterns, Physicians'ABSTRACT
The progressive introduction of non-invasive mechanical ventilation (NIMV) in the management of respiratory failure has increased the number of clinical indications and has reduced common complication of conventional mechanical ventilation. Results of the technique are variable depending on the disease that causes the respiratory failure. With the purpose of reviewing studies about the use of NIMV and to report levels of evidence, different scientific societies have elaborated consensus conferences to establish the utility of NIMV in different indications.
