[Spontaneous subarachnoid hemorrhage,: is emergency transcranial Doppler sonography useful?]. / Hemorragia subaracnoidea espontánea: ¿ Es útil la ultrasonografía Doppler transcraneal urgente?

OBJECTIVE: To ascertain the value of transcranial Doppler ultrasonography (TCD) in the first 24 hours of hospital admission in patients suffering good-grade spontaneous subarachnoid hemorrhage (SAH) in order to detect a high-risk group for symptomatic vasospasm. METHOD: Forty-nine spontaneous good-grade SAH were included. The first TCD studies were carried out at the Emergency Department. At least one more TCD recording was performed between the 4th and 14th day. Patients were classified according to whether they came to the hospital during the first 72 hours after the haemorrhage (Group 1) or later (Group 2). FINDINGS: Thirty three patients were included in Group 1 and sixteen patients in Group 2. Thirteen patients (26.5%) had sonographic vasospasm. In eight of these patients (61 %), the vasospasm was symptomatic. The initial mean velocity (MV) for Group 1 was normal. The increase in MV/24h (MV/24h) within the first 72 hours after SAH was higher (p< 0.007), in those whose developed sonographic vasospasm. In Group 2, the initial MV was greater (p< 0.001)) in patients who suffered sonographic vasospasm, with or without symptoms. CONCLUSIONS: The ability of TCD recorded in the first 24 hours of hospital admission to detect high-risk vasospasm patients for SAH with low clinical severity helps decide the most efficient patient destination. During the first three days the MV/24h is of value but not the absolute figure of the MV. In contrast, between the 4th and 14th day after SAH, the absolute figure of MV was useful to predict vasospasm.

Early risk factors for sepsis in patients with severe blunt trauma.

We studied 43 patients with blunt trauma (injury severity score, > or =25), age >14 years and length of the intensive care unit (ICU) stay >48 h in order to estimate the frequency of sepsis and to identify early risk factors related to its development. Clinical data were collected during the first 24 h and several inflammatory mediators were determined from serum samples of the first 2 days after injury.Twenty-one patients (48.8%) met sepsis criteria during their ICU stay, 9 (20.9%) fulfilled only criteria for sepsis; 6 (13.9%) fulfilled criteria for severe sepsis and another 6 (13.9%) criteria for septic shock. An APACHE II score > or =14, the presence of hypovolemic shock, the need for three or more units of blood to be transfused and the administration of a total volume of fluids > or =10 l were all factors associated significantly with the development of sepsis. In the multivariant analysis, the need for a total volume of fluids > or =10 l was the only independent risk factor (adjusted odds ratio=10.49, 95% CI, 2.34-47.02; P=0.002). No significant differences were documented in relation to the behaviour of the serum markers.