ABSTRACT
BACKGROUND: Hyperglycemia after traumatic brain injury (TBI) is associated with poor outcome. In this study, we examined the incidence and risk factors for perioperative hyperglycemia in children with TBI. METHODS: A retrospective cohort study of children Subject(s)
Blood Glucose/metabolism
, Brain Injuries/surgery
, Craniotomy/adverse effects
, Hyperglycemia/etiology
, Age Factors
, Blood Glucose/drug effects
, Brain Injuries/complications
, Brain Injuries/metabolism
, Child
, Child, Preschool
, Cohort Studies
, Female
, Glasgow Coma Scale
, Hematoma, Subdural/complications
, Humans
, Hyperglycemia/drug therapy
, Hyperglycemia/epidemiology
, Hyperglycemia/metabolism
, Hypoglycemia/etiology
, Hypoglycemia/metabolism
, Hypoglycemic Agents/administration & dosage
, Incidence
, Infant
, Infant, Newborn
, Injections, Intravenous
, Insulin/administration & dosage
, Logistic Models
, Male
, Odds Ratio
, Retrospective Studies
, Risk Assessment
, Risk Factors
ABSTRACT
Management of pain in critically ill patients can be very difficult. In the attempt to provide comfort with adequate levels of opioids and sedatives, respiratory depression and cardiovascular instability may become difficult to control in patients with labile hemodynamics and poor cardiopulmonary reserve. The use of medications like ketamine, an anesthetic agent that in subanesthetic doses has been reported to be effective in preventing opioid-induced tolerance and to have analgesic properties, may be of help, especially in patients who develop tolerance, leading to rapidly escalating doses of opioids and sedatives. The case report presented here shows how a very low dose of ketamine can be helpful for the management of pain and sedation in critically ill patients, especially when they are ready to be weaned from mechanical ventilation, and very high doses of opiods and sedatives do not permit it.
Subject(s)
Excitatory Amino Acid Antagonists/therapeutic use , Hypnotics and Sedatives/therapeutic use , Ketamine/therapeutic use , Pain/drug therapy , Receptors, N-Methyl-D-Aspartate/antagonists & inhibitors , Humans , Intensive Care Units , Male , Middle AgedABSTRACT
The diseases and virulence genes associated with Shiga toxin-producing Escherichia coli (STEC) are characterized incompletely. We analyzed, by polymerase chain reaction, 82 STEC isolates collected prospectively in Montana and profiled associated illnesses by patient chart review. All E. coli O157:H7 contained stx2-group genes, as well as eae, iha, espA, and ehxA; 84% contained stx1. Non-O157:H7 STEC less frequently contained stx1 (P=.046), stx2 (P<.001), iha (P<.001), eae, and espA (P=.039 for both), were isolated less often from patients treated in emergency departments (P=.022), and tended to be associated less frequently with bloody diarrhea (P=.061). There were no significant associations between stx genotype and bloody diarrhea, but isolates containing stx2c or stx(2d-activatable) were recovered more often from patients who underwent diagnostic or therapeutic procedures (P=.033). Non-O157:H7 STEC are more heterogeneous and cause bloody diarrhea less frequently than do E. coli O157:H7. Bloody diarrhea cannot be attributed simply to the stx genotype of the infecting organism.