ABSTRACT
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.
Subject(s)
Brain Injuries/rehabilitation , Disability Evaluation , Glasgow Outcome Scale/statistics & numerical data , Patient Discharge/statistics & numerical data , Adolescent , Adult , Brain Injuries/diagnosis , Female , Humans , Male , Prognosis , Prospective Studies , Recovery of Function , Retrospective Studies , Severity of Illness Index , Young AdultABSTRACT
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.
Subject(s)
Adolescent , Adult , Female , Humans , Male , Young Adult , Brain Injuries/rehabilitation , Disability Evaluation , Glasgow Outcome Scale/statistics & numerical data , Patient Discharge/statistics & numerical data , Brain Injuries/diagnosis , Prognosis , Prospective Studies , Recovery of Function , Retrospective Studies , Severity of Illness IndexABSTRACT
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.
Subject(s)
Continuous Positive Airway Pressure , Inhalation/physiology , Pulmonary Disease, Chronic Obstructive/physiopathology , Pulmonary Disease, Chronic Obstructive/therapy , Aged , Bronchitis, Chronic/physiopathology , Bronchitis, Chronic/therapy , Female , Humans , Male , Middle Aged , Peak Expiratory Flow Rate/physiology , Pulmonary Emphysema/physiopathology , Pulmonary Emphysema/therapy , SpirometryABSTRACT
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
