Neurological Pupil Index and Delayed Cerebral Ischemia after Subarachnoid Hemorrhage: A Retrospective Multicentric Study.

BACKGROUND: Delayed cerebral ischemia (DCI) occurs in around 30% of patients suffering from nontraumatic subarachnoid hemorrhage (SAH) and is associated with poor neurological outcome. Whether the Neurological Pupil index (NPi) derived from the automated pupillometry could help to diagnose the occurrence of DCI remains unknown. The aim of this study was to investigate the association of NPi with the occurrence of DCI in patients with SAH. METHODS: This was a multicenter, retrospective cohort study of consecutive patients with SAH admitted to the intensive care units of five hospitals between January 2018 and December 2020 who underwent daily NPi recordings (every 8 h) during the first 10 days of admission. DCI was diagnosed according to standard definitions (in awake patients) or based on neuroimaging and neuromonitoring (in sedated or unconscious patients). An NPi < 3 was defined as abnormal. The primary outcome of the study was to assess the time course of daily NPi between patients with DCI and patients without DCI. Secondary outcome included the number of patients who had an NPi < 3 before DCI. RESULTS: A total of 210 patients were eligible for the final analysis; DCI occurred in 85 (41%) patients. Patients who developed DCI had similar values of mean and worst daily NPi over time when compared with patients without DCI. Patients with DCI had a higher proportion of at least one NPi < 3 at any moment before DCI when compared with others (39/85, 46% vs. 35/125, 38%, p = 0.009). Similarly, the worst NPi before DCI diagnosis was lower in the DCI group when compared with others (3.1 [2.5-3.8] vs. 3.7 [2.7-4.1], p = 0.05). In the multivariable logistic regression analysis, the presence of NPi < 3 was not independently associated with the development of DCI (odds ratio 1.52 [95% confidence interval 0.80-2.88]). CONCLUSIONS: In this study, NPi measured three times a day and derived from the automated pupillometry had a limited value for the diagnosis of DCI in patients with SAH.

Advanced airway management: a descriptive analysis of complications and factors associated with first-attempt intubation failure in prehospital emergency care. / Análisis descriptivo de pacientes que requirieron manejo avanzado de vía aérea en emergencias prehospitalarias: complicaciones y factores asociados al fracaso en el primer intento de intubación.

OBJECTIVES: To analyze the characteristics of prehospital emergency airway management, including complications; to explore predictors of first-attempt failure of orotracheal intubation. MATERIAL AND METHODS: Observational retrospective cohort study of patients requiring orotracheal intubation by the prehospital emergency services of Castile-La Mancha between June 1, 2017, and January 1, 2021. We analyzed patient and procedure characteristics and complications using logistic regression analysis to detect factors that could predict firstattempt intubation failure. RESULTS: A total of 425 patients were included; 417 (98.1%) were intubated successfully, including 326 (76.7%) on the first attempt. Complications occurred in 183 intubations in 94 patients (22.1%). Predictors of first-attempt failure were age over 55 years (odds ratio [OR], 1.94; 95% CI, 1.10-4.23), body mass index over 30 (OR, 9.14; 95% CI, 4.40-19.00), oxygen saturation less than 90% (OR, 3.33; 95% CI, 1.06-10.58), a Glasgow Coma Score between 9 and 13 (OR, 1.58; 95% CI, 1.28-6.9), intubation in a public place (OR, 2.99; 95% CI, 1.42-6.29), intubation done in any other than standing position (OR, 2.09; 95% CI, 1.08-7.25), direct laryngoscopy (OR, 2.39; 95% CI, 1.20- 6.55), use of a stylet (OR, 1.80; 95% CI, 1.40-3.78), and a Cormack-Lehane classification of 2 or higher (OR, 6.50; 95% CI, 3.96-30.68). CONCLUSION: Orotracheal intubation is generally accomplished on the first attempt. Factors associated with first-attempt failure can facilitate tailored approaches to upper airway management.

OBJETIVO: Analizar las características del manejo de la vía aérea (VA) en emergencias prehospitalarias, sus complicaciones y establecer factores predictores de fracaso en el primer intento de intubación orotraqueal (FIPI). METODO: Estudio observacional de cohortes retrospectivo de pacientes que precisaron intubación orotraqueal por el servicio de emergencias prehospitalarias de Castilla La Mancha, desde el 01-06-2017 hasta el 01-01-2021. Se analizaron características de los pacientes, del procedimiento y sus complicaciones, se realizó una regresión logística para detectar factores predictores de FIPI. RESULTADOS: . Se incluyeron 425 pacientes, 417 (98,1%) fueron intubados con éxito y 326 (76,7%) en el primer intento. Se registraron 183 complicaciones en 94 pacientes (22,1%). Los factores predictores de FIPI fueron la edad > 55 años (OR = 1,94; IC 95% 1,10-4,23), índice de masa corporal > 30 (OR = 9,14; IC 95% 4,40-19,00); saturación de oxígeno 90% (OR = 3,33; IC 95% 1,06-10,58); puntuación en la Glasgow Coma Scale entre 9 y 13 (OR = 1,58; IC 95% 1,28-6,9); intubación realizada en vía pública (OR = 2,99; IC 95% 1,42-6,29); posición distinta a la bipedestación (OR = 2,09; IC 95% 1,08-7,25); laringoscopia directa (OR = 2,39; IC 95% 1,20-6,55); uso de estilete (OR = 1,80; IC 95% 1,40-3,78); y clasificación Cormack-Lehane $ 2 (OR = 6,50; IC 95% 3,96-30,68). CONCLUSIONES: El procedimiento de intubación se realizó de forma habitual en el primer intento. Existen factores asociados a FIPI que permiten individualizar el manejo de la VA.

Acute respiratory distress syndrome in a case of Plasmodium ovale malaria.

Acute respiratory distress syndrome is a well-known complication in Plasmodium falciparum infection. It is less frequently described in Plasmodium vivax, and only one case is reported in Plasmodium ovale. Here we present the second description of this pulmonary complication in a P. ovale acute infection.