RESUMO
BACKGROUND: Post-traumatic cerebral infarction (PTCI) is common after traumatic brain injury (TBI). It is unclear what the occurrence of a PTCI is, how it impacts the long-term outcome, and whether it adds incremental prognostic value to established outcome predictors. METHODS: This was a prospective multicenter cohort study of moderate and severe TBI patients. The primary objective was to evaluate if PTCI was an independent risk factor for the 6-month outcome assessed with the Glasgow Outcome Scale (GOS). We also assessed the PTCI occurrence and if it adds incremental value to the International Mission for Prognosis and Clinical Trial design in TBI (IMPACT) core and extended models. RESULTS: We enrolled 143 patients, of whom 47 (32.9%) developed a PTCI. In the multiple ordered logistic regression, PTCI was retained in both the core and extended IMPACT models as an independent predictor of the GOS. The predictive performances increased significantly when PTCI was added to the IMPACT core model (AUC = 0.73, 95% C.I. 0.66-0.82; increased to AUC = 0.79, 95% CI 0.71-0.83, p = 0.0007) and extended model (AUC = 0.74, 95% C.I. 0.65-0.81 increased to AUC = 0.80, 95% C.I. 0.69-0.85; p = 0.00008). Patients with PTCI showed higher ICU mortality and 6-month mortality, whereas hospital mortality did not differ between the two groups. CONCLUSIONS: PTCI is a common complication in patients suffering from a moderate or severe TBI and is an independent risk factor for long-term disability. The addition of PTCI to the IMPACT core and extended predictive models significantly increased their performance in predicting the GOS. TRIAL REGISTRATION: The present study was registered in ClinicalTrial.gov with the ID number NCT02430324.
Assuntos
Lesões Encefálicas Traumáticas/complicações , Infarto Cerebral/etiologia , Avaliação de Resultados em Cuidados de Saúde/normas , Adulto , Área Sob a Curva , Lesões Encefálicas Traumáticas/epidemiologia , Infarto Cerebral/epidemiologia , Estudos de Coortes , Feminino , Escala de Resultado de Glasgow/estatística & dados numéricos , Humanos , Itália/epidemiologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Avaliação de Resultados em Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Curva ROC , Estatísticas não ParamétricasRESUMO
STUDY OBJECTIVE: To evaluate the effects on systemic hemodynamics of sequential pneumatic compression of the lower limbs in healthy volunteers. DESIGN: Prospective, self-controlled, volunteer study. SETTING: University teaching hospital. PATIENTS: 11 healthy volunteers, aged 25 +/- 1.3 years. INTERVENTIONS AND MEASUREMENTS: After volunteers underwent a 6-hour period of fasting and 15 minutes of rest in the supine position, baseline systemic hemodynamics were assessed using transthoracic electrical bioimpedance. Peripheral venous pressure was measured using a 16-gauge intravenous cannula inserted in the forearm and connected to a pressure monitor. Then sequential pneumatic compression of the lower limbs was activated for a 30-minute period, and systemic hemodynamic measurements were repeated. In each volunteer, measurements were repeated twice in two consecutive days, and average values were calculated for each volunteer. MAIN RESULTS: After activation of sequential pneumatic compression of the lower limbs, mean arterial blood pressure increased from 90 mmHg (79-107 mmHg) to 95 mmHg (79-129 mmHg) (P = 0.02), whereas heart rate decreased from 79 bpm (51-94 bpm) to 75 bpm (53-90 bpm) (P = 0.02). This was associated with a significant increase in peripheral vascular resistance index (from 545 [440-1066] to 613 [369-1280] dynes s cm(-5) m(-2) [P = 0.013]) and reduction in cardiac index (from 3.4 [2.7- 4.5] to 3.2 [2.5-4.0] L/min per m2 [P = 0.034]). CONCLUSIONS: The application of sequential pneumatic compression to the lower limbs is associated with minor increases in mean arterial blood pressure, with moderate reduction of cardiac output and heart rate.
