ABSTRACT
OBJECTIVE: To assess the effect of timing and techniques of tracheostomy on morbidity, mortality, and the burden of resources in patients with acute traumatic spinal cord injuries (SCls) undergoing mechanical ventilation. DESIGN: Review of a prospectively collected database. SETTING: Intensive and intermediate care units of a monographic hospital for the treatment of SCI. PARTICIPANTS: Consecutive patients admitted to the intensive care unit (ICU) during their first inpatient rehabilitation for cervical and thoracic traumatic SCI. A total of 323 patients were included: 297 required mechanical ventilation and 215 underwent tracheostomy. OUTCOME MEASURES: Demographic data, data relevant to the patients' neurological injuries (level and grade of spinal cord damage), tracheostomy technique and timing, duration of mechanical ventilation, length of stay at ICU, incidence of pneumonia, incidence of perioperative and early postoperative complications, and mortality. RESULTS: Early tracheostomy (<7 days after orotracheal intubation) tracheostomy was performed in 101 patients (47%) and late (> or = 7 days) in 114 (53%). Surgical tracheostomy was employed in 119 cases (55%) and percutaneous tracheostomy in 96 (45%). There were 61 complications in 53 patients related to all tracheostomy procedures. Two were qualified as serious (tracheoesophageal fistula and mediastinal abscess). Other complications were mild. Bleeding was moderate in one case (late, percutaneous tracheostomy). Postoperative infection rate was low. Mortality of all causes was also low. CONCLUSION: Early tracheostomy may have favorable effects in patients with acute traumatic SC. Both techniques, percutaneous and surgical tracheostomy, can be performed safely in the ICU.
Subject(s)
Outcome Assessment, Health Care , Respiration, Artificial/mortality , Spinal Cord Injuries/mortality , Spinal Cord Injuries/therapy , Tracheostomy/mortality , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Cervical Vertebrae/injuries , Databases, Factual , Female , Humans , Male , Middle Aged , Morbidity , Multiple Trauma/mortality , Multiple Trauma/surgery , Multiple Trauma/therapy , Spinal Cord Injuries/surgery , Time Factors , Young AdultABSTRACT
INTRODUCTION AND OBJECTIVE: There is little information available regarding the course of alcohol withdrawal syndrome in a general hospital. The aim of this study was to analyse the timing of the most important clinical features attributed to alcohol withdrawal, as well as their prognostic implications. MATERIAL AND METHOD: A cohort study of patients with a diagnosis of alcohol withdrawal syndrome was carried out at the Xeral Hospital in Lugo (Spain) between 1987 and 2003, in accordance with DSM IV-TR criteria. Data on clinical characteristics and course were collected, with special attention to the timing of significant events. RESULTS: A total of 539 episodes were studied in 436 patients: 156 cases of alcohol withdrawal syndrome and 383 of alcohol withdrawal delirium. Mean time of abstinence until the diagnosis of alcohol withdrawal syndrome was 54 hours (D.T. = 31.1). Seizures occurred at 35 hours (D.T. = 23.3) after abstinence. The alcohol withdrawal syndrome lasted for 46.4 hours (D.T. = 23.1) after diagnosis. In cases in which delirium tremens developed, this occurred at 46.4 hours (D.T. = 23.1), and lasted 73.9 hours (D.T. = 41.5). Patients needing intensive care were admitted to the ICU 40.8 hours (D.T. = 60) after the diagnosis of alcohol withdrawal syndrome. The clinical features of alcohol withdrawal syndrome tended to be more prolonged in patients admitted with a medical or surgical diagnosis other than withdrawal syndrome than in those admitted because of withdrawal syndrome itself. CONCLUSIONS: The natural history of alcohol withdrawal syndrome in a general hospital setting and the timings of its principal events follow a clearly recognizable pattern. This knowledge can help to provide better assessment in relation to the monitoring and treatment of these patients.
Subject(s)
Alcohol Withdrawal Delirium/diagnosis , Ethanol/adverse effects , Substance Withdrawal Syndrome/diagnosis , Adult , Aged , Cohort Studies , Female , Hospitals, General , Humans , Male , Middle Aged , Prognosis , Retrospective Studies , Young AdultABSTRACT
Introducción y objetivo: Existe poca información sobre el curso temporal del síndrome de abstinencia alcohólica en el ámbito de un hospital general. El objetivo de este estudio es saber qué manifestaciones son atribuibles a la abstinencia y en qué momento de su evolución, así como sus implicaciones pronósticas. Material y método: estudio de cohortes sobre los enfermos diagnosticados de síndrome de abstinencia alcohólica en el Hospital Xeral de Lugo entre 1987 y 2003, según criterios del manual DSM IV-TR. Para cada caso se registraron datos clínicos y de seguimiento, con especial atención a los intervalos temporales de aparición y duración de sus manifestaciones. Resultados: Se estudiaron 539 episodios en 436 pacientes: 156 casos de síndrome de abstinencia no complicado y 383 casos de delirium tremens. El tiempo medio de abstinencia hasta el diagnóstico de síndrome de abstinencia alcohólica fue 54,4 horas (D.T. = 31,1). Las crisis comiciales aparecieron 35 horas (D.T. = 23,3) desde el cese de la ingesta. La duración del síndrome de abstinencia no complicado desde el diagnóstico fue 46,4 horas (D.T. = 23,1). Cuando evolucionaron a delirium tremens, estese diagnosticó a las 40,2 horas (D.T. = 29,4), y se prolongó durante 73,9 horas (D.T. = 41,5). Cuando fue preciso el traslado a la UCI, éste se produjo a las 40,8 horas (D.T. = 60) desde el diagnóstico de síndrome de abstinencia. Los enfermos en los que el síndrome de abstinencia alcohólica complicó un ingreso por otro motivo, presentaron manifestaciones clínicas más prolongadas que los que ingresaron por abstinencia. Conclusiones: las manifestaciones clínicas del síndrome de abstinencia alcohólica siguen una pauta evolutiva claramente reconocible. Su conocimiento puede ayudar a una mejor planificación de su atención y tratamiento (AU)
Introduction and objective: There is little information available regarding the course of alcohol withdrawal syndrome in a general hospital. The aim of this study was to analyse the timing of the most important clinical features attributed to alcohol withdrawal, as well as their prognostic implications. Material and method: A cohort study of patients with a diagnosis of alcohol withdrawal syndrome was carried out at the Xeral Hospital in Lugo (Spain) between 1987 and 2003, in accordance with DSM IV-TR criteria. Data on clinical characteristics and course were collected, with special attention to the timing of significant events. Results: A total of 539 episodes were studied in 436 patients: 156 cases of alcohol withdrawal syndrome and 383 of alcohol withdrawal delirium. Mean time of abstinence until the diagnosis of alcohol withdrawal syndrome was 54 hours (D.T. = 31.1). Seizures occurred at 35 hours (D.T. =23.3) after abstinence. The alcohol withdrawal syndrome lasted for 46.4 hours (D.T. = 23.1) after diagnosis. In cases in which delirium tremens developed, this occurred at 46.4 hours (D.T. = 23.1), and lasted 73.9 hours (D.T. = 41.5). Patients needing intensive care were admitted to the ICU40.8 hours (D.T. = 60) after the diagnosis of alcohol withdrawal syndrome. The clinical features of alcohol withdrawal syndrome tended to be more prolonged in patients admitted with a medical or surgical diagnosis other than withdrawal syndrome than in those admitted because of withdrawal syndrome itself. Conclusions: The natural history of alcohol withdrawal syndrome in a general hospital setting and the timings of its principal events follow a clearly recognizable pattern. This knowledge can help to provide better assessment in relation to the monitoring and treatment of these patients (AU)
