Subject(s)
Nerve Block/methods , Salvage Therapy/methods , Stellate Ganglion , Subarachnoid Hemorrhage/complications , Vasospasm, Intracranial/therapy , Anesthetics, Local/administration & dosage , Aneurysm, Ruptured/complications , Arm , Bupivacaine/administration & dosage , Humans , Intracranial Aneurysm/complications , Middle Aged , Nimodipine/therapeutic use , Paresis/diagnosis , Paresis/therapy , Vasodilator Agents/therapeutic use , Vasospasm, Intracranial/diagnostic imaging , Vasospasm, Intracranial/etiologyABSTRACT
Objetivo: Analizar los factores asociados al proceso de limitación del tratamiento de soporte vital (LTSV) en los pacientes de edad avanzada que ingresan en una unidad de cuidados intensivos (UCI) tras un traumatismo. Diseño: Estudio observacional, descriptivo, retrospectivo. Ámbito: UCI. Pacientes: Ciento cuarenta y nueve pacientes con una edad igual o mayor de 65 años ingresados en UCI tras un traumatismo. Se analizó la mortalidad intrahospitalaria, la decisión de LTSV y los factores asociados a dicho proceso. Intervenciones: Ninguna. Resultados: La edad media fue de 76,3±6,36 años. La puntuación media en la escala APACHE II fue de 15,9±7,4 puntos, y en la escala ISS, de 19,6±11,4 puntos. Se decidió LTSV en 37 pacientes (24,8%). Los factores asociados a este proceso fueron la edad (OR 1,16; IC 95% 1,08-1,25), la puntuación en el APACHE II (OR 1,11; IC 95%1,05-1,67), la puntuación en el ISS (OR 1,03; IC 95% 1,01-1,06), el ingreso como consecuencia de un deterioro neurológico (OR 19,17; IC 95% 2,33-157,83) y el traumatismo craneoencefálico (OR 2,89; IC 95% 1,05-7,96). Conclusiones: La LTSV se establece con frecuencia en los pacientes de edad avanzada que ingresan en la UCI tras un traumatismo, y se asocia con la mortalidad intrahospitalaria. Los factores asociados al proceso de LTSV son una mayor edad, una mayor puntuación en las escalas APACHE II e ISS, el ingreso como consecuencia de un deterioro neurológico y la presencia de traumatismo craneoencefálico (AU)
Objective: To analyze the factors associated to limitation of life-sustaining treatment (LLST) measures in elderly patients admitted to an intensive care unit (ICU) due to trauma. Design: A retrospective, descriptive, observational study was carried out. Setting: ICU. Patients: A total of 149 patients aged 65 years or older admitted to the ICU due to trauma. Hospital mortality, the decision to limit life-sustaining treatment and the factors associated to these measures were analyzed. Interventions: None. Results: The mean patient age was 76.3±6.36 years. The average APACHE II and ISS scores were 15.9±7.4 and 19.6±11.4 points, respectively. LLST were used in 37 patients (24.8%). Factors associated to the use of these measures were patient age (OR 1.16; 95% CI 1.08 to 1.25], APACHE II score (OR 1.11; 95% CI 1.05-1.67), ISS score (OR 1.03; 95% CI 1.01 to 1.06), admission due to neurological impairment (OR 19.17; 95% CI 2.33 to 157.83) and traumatic brain injury (OR 2.89; 95% CI 1.05 to 7.96). Conclusions: LLST is frequently established in elderly patients admitted to the ICU due to trauma, and is associated to hospital mortality. Factors associated with the use of these measures are patient age, higher APACHE II and ISS scores, admission due to neurological impairment, and the presence of head injuries (AU)
Subject(s)
Humans , Male , Female , Aged , Aged, 80 and over , Advanced Cardiac Life Support , Multiple Trauma/therapy , Withholding Treatment , Retrospective Studies , Critical Care/methods , Life Support Care , Trauma Severity Indices , APACHE , 50293ABSTRACT
OBJECTIVE: To analyze the factors associated to limitation of life-sustaining treatment (LLST) measures in elderly patients admitted to an intensive care unit (ICU) due to trauma. DESIGN: A retrospective, descriptive, observational study was carried out. SETTING: ICU. PATIENTS: A total of 149 patients aged 65 years or older admitted to the ICU due to trauma. Hospital mortality, the decision to limit life-sustaining treatment and the factors associated to these measures were analyzed. INTERVENTIONS: None. RESULTS: The mean patient age was 76.3±6.36 years. The average APACHE II and ISS scores were 15.9±7.4 and 19.6±11.4 points, respectively. LLST were used in 37 patients (24.8%). Factors associated to the use of these measures were patient age (OR 1.16; 95% CI 1.08 to 1.25], APACHE II score (OR 1.11; 95% CI 1.05-1.67), ISS score (OR 1.03; 95% CI 1.01 to 1.06), admission due to neurological impairment (OR 19.17; 95% CI 2.33 to 157.83) and traumatic brain injury (OR 2.89; 95% CI 1.05 to 7.96). CONCLUSIONS: LLST is frequently established in elderly patients admitted to the ICU due to trauma, and is associated to hospital mortality. Factors associated with the use of these measures are patient age, higher APACHE II and ISS scores, admission due to neurological impairment, and the presence of head injuries.
