A population study on the epidemiology and outcome of brain injuries in intensive care.

BACKGROUND: Traumatic Brain Injury (TBI) is characterized by a highly heterogenous profile in terms of pathophysiology, clinical presentation and outcome. OBJECTIVE: This is the first population study investigating the epidemiology and outcomes of moderate-to-severe TBI in Cyprus. Patients treated in the Intensive Care Unit (ICU) of Nicosia General Hospital, the only Level 1 Trauma Centre in the country, were recruited between January 2013 and December 2016. METHODS: This was an observational cohort study, using longitudinal methods and six-month follow-up. Patients (N = 203) diagnosed with TBI were classified by the Glasgow Coma Scale at the Emergency Department as moderate or severe. RESULTS: Compared to international multicentre studies, the current cohort demonstrates a different case mix that includes older age, more motor vehicle collisions and lower mortality rates. There was a significantly higher proportion of injured males. Females were significantly older than males. There were no sex differences in the type, severity or place of injury. Sex did not yield differences in mortality or outcomes or on injury indices predicting outcomes. In contrast, older age was a predictor of higher mortality rates and worse outcomes. CONCLUSION: Trends as described in the study emphasize the importance of continuous evaluation of TBI epidemiology and outcome in different countries.

The effects of ketamine on dopaminergic function: meta-analysis and review of the implications for neuropsychiatric disorders.

Ketamine is a non-competitive antagonist at the N-methyl-d-aspartate receptor. It has recently been found to have antidepressant effects and is a drug of abuse, suggesting it may have dopaminergic effects. To examine the effect of ketamine on the dopamine systems, we carried out a systematic review and meta-analysis of dopamine measures in the rodent, human and primate brain following acute and chronic ketamine administration relative to a drug-free baseline or control condition. Systematic search of PubMed and PsychInfo electronic databases yielded 40 original peer-reviewed studies. There were sufficient rodent studies of the acute effects of ketamine at sub-anaesthetic doses for meta-analysis. Acute ketamine administration in rodents is associated with significantly increased dopamine levels in the cortex (Hedge's g= 1.33, P<0.01), striatum (Hedge's g=0.57, P<0.05) and the nucleus accumbens (Hedge's g=1.30, P<0.05) compared to control conditions, and 62-180% increases in dopamine neuron population activity. Sub-analysis indicated elevations were more marked in in vivo (g=1.93) than ex vivo (g=0.50) studies. There were not enough studies for meta-analysis in other brain regions studied (hippocampus, ventral pallidum and cerebellum), or of the effects of chronic ketamine administration, although consistent increases in cortical dopamine levels (from 88 to 180%) were reported in the latter studies. In contrast, no study showed an effect of anaesthetic doses (>100 mg kg-1) of ketamine on dopamine levels ex vivo, although this remains to be tested in vivo. Findings in non-human primates and in human studies using positron emission tomography were not consistent. The studies reviewed here provide evidence that acute ketamine administration leads to dopamine release in the rodent brain. We discuss the inter-species variation in the ketamine induced dopamine release as well as the implications for understanding psychiatric disorders, in particular substance abuse, schizophrenia, and the potential antidepressant properties of ketamine, and comparisons with stimulants and other NMDA antagonists. Finally we identify future research needs.

Psychological support for families of ICU patients: longitudinal documentation of the service.

This study is the first systematic effort to investigate psychological services provided to relatives of ICU patients at Nicosia General Hospital. Documentation of psychological sessions provided to relatives of ICU patients for the years 2011-2014 was analyzed. To investigate possible differences in the total number of sessions for the referenced years, the records were analyzed using patients' demographics, the outcome of hospitalization and the total number of sessions with relatives. A questionnaire was sent to the ICU staff aiming to identify their perception towards the need for psychological support. A total number of 863 psychological sessions were conducted with 640 relatives of 345 patients hospitalized in the ICU. Results indicate that more sessions are recorded when the outcome of younger patients' condition worsens, whereas the number of sessions decreases for older patients' families. When comparing the personnel's beliefs, regarding the importance of providing psychological services to different age groups, significant difference was found suggesting that the older the patient the less sessions they believe are required indicating a possible ageism bias.

Influence of anesthetic technique on early postoperative hypoxemia.

In the present study we have compared the incidence and degree of hypoxemia during the early postoperative period and for the first 3 nights after operation occurring after the administration of total intravenous anesthesia with propofol versus inhalation anesthesia with nitrous oxide and isoflurane. We studied 50 consecutive non-obese patients, ages 25-65, ASA I-II, who were scheduled for elective cholecystectomy. Patients received randomly either total intravenous anesthesia with propofol (24 patients) or inhalation anesthesia with nitrous oxide and isoflurane (26 patients). Oxygen saturation was continuously recorded on the night before surgery, for 8 hours after extubation (early postoperative period) and during the first, second and third nights after operation. In the early postoperative period we found statistically significant higher values of mean (P<0.05) and minimum (P<0.01) SpO2 in patients who received total intravenous anesthesia compared to patients in whom inhalation anesthesia was used. Moreover, in the early postoperative period, 4 (16.7%) patients of the intravenous anesthesia group versus 11 (42.3%) patients of the inhalation anesthesia group had at least 1 hypoxemic event (P<0.05). We conclude that the incidence and degree of hypoxemia in the early postoperative period is significantly less when total intravenous anesthesia with propofol is used.