Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury.

OBJECTIVE: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD: Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION: The GOS-HD was indicator of prognosis in patients with severe TBI.

Glasgow outcome scale at hospital discharge as a prognostic index in patients with severe traumatic brain injury / Escala de resultados de Glasgow por ocasião da alta hospitalar como indicador prognóstico em pacientes com traumatismo cranioencefálico grave

OBJECTIVE: Evaluate the Glasgow outcome scale (GOS) at discharge (GOS-HD) as a prognostic indicator in patients with traumatic brain injury (TBI). METHOD: Retrospective data were collected of 45 patients, with Glasgow coma scale <8, age 25±10 years, 36 men, from medical records. Later, at home visit, two measures were scored: GOS-HD (according to information from family members) and GOS LATE (12 months after TBI). RESULTS: At discharge, the ERG showed: vegetative state (VS) in 2 (4%), severe disability (SD) in 27 (60%), moderate disability (MD) in 15 (33%) and good recovery (GR) in 1 (2%). After 12 months: death in 5 (11%), VS in 1 (2%), SD in 7 (16%), MD in 9 (20%) and GR in 23 (51%). Variables associated with poor outcome were: worse GOS-HD (p=0.03), neurosurgical procedures (p=0.008) and the kind of brain injury (p=0.009). CONCLUSION: The GOS-HD was indicator of prognosis in patients with severe TBI.

OBJETIVO: Avaliar a escala de resultados de Glasgow (ERG) à alta hospitalar (ERG-ALTA) como indicador prognóstico em pacientes com traumatismo cranioencefálico (TCE). MÉTODO: Dados retrospectivos de 45 pacientes (36 homens), com escala de coma de Glasgow <8, idade 25±10 anos, foram coletados do prontuário médico. Posteriormente, em visita domiciliar, foram pontuadas duas medidas: ERG-ALTA (de acordo com informações de familiares) e ERG TARDIA (após 12 meses do TCE). RESULTADOS: Por ocasião da alta hospitalar, a ERG evidenciou: estado vegetativo (EV) em 2 (4%); incapacidade grave (IG) em 27 (60%), incapacidade moderada (IM) em 15 (33%) e boa recuperação (BR) em 1 (2%). Após 12 meses: morte em 5 (11%), EV em 1 (2%), IG em 7 (16%), IM em 9 (20%) e BR em 23 (51%). Variáveis associadas com má evolução foram: pior ERG-ALTA (p=0,03); procedimentos neurocirúrgicos (p=0,008) e o tipo de lesão cerebral (p=0,009). CONCLUSÃO: A ERG-ALTA foi indicador adequado de prognóstico tardio em pacientes com TCE grave.

Continuous positive airway pressure increases inspiratory capacity of COPD patients.

BACKGROUND AND OBJECTIVE: Hyperinflation with a decrease in inspiratory capacity (IC) is a common presentation for both unstable and stable COPD patients. As CPAP can reduce inspiratory load, possibly secondary to a reduction in hyperinflation, this study examined whether CPAP would increase IC in stable COPD patients. METHODS: Twenty-one stable COPD patients (nine emphysema, 12 chronic bronchitis) received a trial of CPAP for 5 min at 4, 7 and 11 cmH(2)O. Fast and slow VC (SVC) were measured before and after each CPAP trial. In patients in whom all three CPAP levels resulted in a decreased IC, an additional trial of CPAP at 2 cmH(2)O was conducted. For each patient, a 'best CPAP' level was defined as the one associated with the greatest IC. This pressure was then applied for an additional 10 min followed by spirometry. RESULTS: Following application of the 'best CPAP', the IC and SVC increased in 15 patients (nine emphysema, six chronic bronchitis). The mean change in IC was 159 mL (95% CI: 80-237 mL) and the mean change in SVC was 240 mL (95% CI: 97-386 mL). Among these patients, those with emphysema demonstrated a mean increase in IC of 216 mL (95% CI: 94-337 mL). Six patients (all with chronic bronchitis) did not demonstrate any improvement in IC. CONCLUSIONS: The best individualized CPAP can increase inspiratory capacity in patients with stable COPD, especially in those with emphysema.

Ventilacao Mecanica em pacientes com fistula broncopleural relato de 2 casos / -

A fístula broncopleural se traduz por fuga aérea para dentro do espaço pleural. Dentre as causas mais comuns de fístula, podemos citar as cirurgias, as pneumonias, a radioterapia e a ventilaçäo mecânica. O uso da ventilaçäo por pressäo positiva (VPPI) exerce uma força na sutura brônquica, acentuando o mecanismo de mola e aumentando a tendência das bordas a se distanciarem. Além disso, o uso da VPPI pode se prolongar diante da instabilidade hemodinâmica, do déficit neurológic e das infecções nosocomiais, pois esses fatores dificultam ou impedem o desmame ventilatório. considerando-se a necessidade de cuidados ventilatório. Considerando-se a necessidade de cuidados ventilatórios otimizados, o presente estudo relata a evoluçäo de dois pacientes cujas abordagens ventilatórias foram diferentes. No primeiro caso, utilizou-se a modalidade pressäo controlada e PEEP otimizada, aceitando-se a hipercabia acentuada. No segundo caso, utilizou-se a modalidade volume controlado e a ventilaçäo mecânica näo invasiva. Na conduta do paciente com fístula broncopleural podem ser usadas várias modalidades ventilatórias, desde que se trabalhe com volume corrente, PEEP e pressäo intratorácica baixos, além da hipercabia permissiva

Parents as direct contributors to the medical record: validation of their electronic input.

STUDY OBJECTIVES: We assessed the validity and completeness of data in the past medical history (PMH) obtained electronically from parents and examined effects of the human-computer interface and sociodemographic variables on electronic parental report. METHODS: We compared parents' electronic report of PMH data with a criterion standard, structured face-to-face interview by a pediatrician blinded to the electronic data. The electronic medical record interface enabled parents to provide 5 elements of the PMH: birth status, allergies, current medications, immunization status, and previous hospitalizations. The setting was the emergency department waiting room in an academic, urban children's hospital; parents of infants up to 12 months old participated. Outcome measures were validity of the PMH data obtained using the electronic medical record interface and odds of having an invalid or incomplete response using the electronic medical record interface. RESULTS: One hundred parents were enrolled (69.4% of eligible subjects). Study subjects did not differ from nonenrollees on demographic variables and visit characteristics. The validity of the electronic medical record interface data was high across the PMH elements (94% to 99%). Two demographic features predicted invalid response: parental primary language other than English or Spanish (odds ratio [OR] 11.4, 95% confidence interval CI 1.7 to 76.3), and Asian ethnicity (OR 14. 6, 95% CI 1.2 to 182.4). Incomplete responses were predicted by limited previous experience with computers; computer-naive subjects had an eightfold increased odds of skipping a question (OR 7.9, 95% CI 1.8 to 34.6). CONCLUSION: Parents are accurate independent reporters of their infants' general PMH using the electronic medical record interface. Their participation in care may be enhanced by allowing them to contribute medical information directly to the electronic medical record.

Transmembrane calcium influx induced by ac electric fields.

Exogenous electric fields induce cellular responses including redistribution of integral membrane proteins, reorganization of microfilament structures, and changes in intracellular calcium ion concentration ([Ca2+]i). Although increases in [Ca2+]i caused by application of direct current electric fields have been documented, quantitative measurements of the effects of alternating current (ac) electric fields on [Ca2+]i are lacking and the Ca2+ pathways that mediate such effects remain to be identified. Using epifluorescence microscopy, we have examined in a model cell type the [Ca2+]i response to ac electric fields. Application of a 1 or 10 Hz electric field to human hepatoma (Hep3B) cells induces a fourfold increase in [Ca2+]i (from 50 nM to 200 nM) within 30 min of continuous field exposure. Depletion of Ca2+ in the extracellular medium prevents the electric field-induced increase in [Ca2+]i, suggesting that Ca2+ influx across the plasma membrane is responsible for the [Ca2+]i increase. Incubation of cells with the phospholipase C inhibitor U73122 does not inhibit ac electric field-induced increases in [Ca2+]i, suggesting that receptor-regulated release of intracellular Ca2+ is not important for this effect. Treatment of cells with either the stretch-activated cation channel inhibitor GdCl3 or the nonspecific calcium channel blocker CoCl2 partially inhibits the [Ca2+]i increase induced by ac electric fields, and concomitant treatment with both GdCl3 and CoCl2 completely inhibits the field-induced [Ca2+]i increase. Since neither Gd3+ nor Co2+ is efficiently transported across the plasma membrane, these data suggest that the increase in [Ca2+]i induced by ac electric fields depends entirely on Ca2+ influx from the extracellular medium.