RESUMO
CME: Dehydration and Artificial Hydration for Terminally Ill Patients Abstract. Parenteral hydration in dying patients is a controversial therapy and leads to different attitudes in caregivers as well as in relatives. A reduced liquid intake should be understood as part of the natural dying process. An artificial hydration can lead to adverse effects in some situations, but also to a benefit in others. Nevertheless, there are indications that justify artificial hydration and others that rather forbid it. In case of uncertainty about hydration, there is the option for a limited trial of therapy. Subcutaneous application is the preferred way of hydration.
Assuntos
Desidratação , Cuidados Paliativos , Assistência Terminal , Desidratação/terapia , Hidratação , Humanos , Doente TerminalRESUMO
BACKGROUND: The use of anticoagulants and older age are the main risk factors for chronic subdural hematoma (CSDH). Because the age of the population and use of anticoagulants are increasing, a growing number of CSDH cases is expected. To address this issue, we analyzed the impact of anticoagulants on postsurgical outcome in patients in the intensive care unit (ICU). METHODS: Demographic data, coagulation parameters, surgical details, radiologic appearance of hematoma, Glasgow Coma Scale (GCS) score on admission, and Glasgow Outcome Scale (GOS) score on discharge were retrieved and retrospectively analyzed in 98 patients with CSDH treated in the neurosurgical ICU using correlation coefficient tests and multivariate analysis test. RESULTS: Overall outcome was good (GOS score 4 and 5) in 55.1% of patients. Overall mortality was 9.1%. There was a correlation between GCS score on admission and GOS score. There was no correlation between hematoma thickness/radiologic appearance and impaired coagulation. Disturbance in thrombocyte function (usually resulting from aspirin intake) correlated with improved outcome, whereas warfarin-related coagulopathy correlated with poor recovery. Nevertheless, patients with thrombocytopathy presented with better initial GCS scores. Neither hematoma size nor recurrence rate affected the outcome. CONCLUSIONS: The size of CSDH was not associated with poor outcome and is not necessarily determined by the use of anticoagulants. Coagulopathy does not rule out a good outcome, but the impact of anticoagulation on treatment results in CSDH varies between the main groups of drugs (warfarin vs. antiplatelet drugs). Patients in good neurologic condition on ICU admission have better chances of recovery.
