Incidence of hospital-admitted severe traumatic brain injury and in-hospital fatality rates in a Pacific Island country: a 5-year retrospective study.

BACKGROUND: Epidemiology of severe traumatic brain injury (TBI) is poorly defined in the Pacific region, including in New Caledonia. The aim of this study was to assess the incidence, causes and outcome of hospital-admitted severe TBI in the whole population of New Caledonia. METHODS: A retrospective study on patients with severe TBI admitted to the only trauma centre during the 5-year period (2008-2012) was performed. The electronic patient register was searched for diagnoses of intracranial injuries to identify patients. Severe TBI was defined as a Glasgow Coma Scale Score ≤ 8 during the first 24 hours after injury. RESULTS: The annual incidence ranged from 10/100 000 in 2010 to 15/100 000 in 2011. Road traffic accidents (n = 109; 71%), falls (n = 26; 17%) and assaults (n = 19; 12%) were causes of severe TBI. Young Melanesian adults (median age = 26 [19-36]) were the most affected. In ICU, the overall case-fatality rate was 25%. The mortality rate was the highest among victims of assaults (47%). CONCLUSIONS: The high incidence of hospital-admitted patients with severe TBI in this study combined with high in-ICU mortality rates supports the need for targeted public health action to prevent assaults and traffic road accidents in this vulnerable population.

The pulse pressure/heart rate ratio as a marker of stroke volume changes during hemorrhagic shock and resuscitation in anesthetized swine.

BACKGROUND: Emergency physicians and anesthesiologists need accurate estimates of stroke volume when massive unexpected hemorrhage occurs. Using an animal model of hemorrhagic shock under general anesthesia, we hypothesized that the pulse pressure-heart rate ratio (PP/HR) would be an accurate marker of stroke volume changes during hemorrhage and resuscitation. METHODS: In 16 swine under bispectral index-controlled, intravenous propofol-remifentanil anesthesia, pressure-controlled hemorrhagic shock was induced to achieve 30 mm Hg of mean arterial pressure, after which treatment was randomized to fluid (HES, n = 4), norepinephrine (NE, n = 4), both (HES + NE, n = 4), or neither (control, n = 4). Pulmonary artery thermodilution continuous cardiac output, stroke volume, and central arterial pressures were recorded at baseline (T0), after 30 minutes (T30) and 60 (T60) minutes of hemorrhage, during treatment (T90 and T120) and after blood retransfusion (T180). RESULTS: At T60, blood withdrawal was 995 (301) mL (38 [8] mL/kg), resulting in a 70% decrease in stroke volume and a 3.3-fold decrease in PP/HR (each p < 0.01). When stroke volume data pointed at T0, T30 and T60 were plotted against the various hemodynamic variables under study, the PP/HR ratio exhibited the strongest relationship to stroke volume (r = 0.72). The area under the receiver operating characteristic curve set to detect a 15% stroke volume decrease was larger for PP/HR (0.95 [0.94-0.97]) than for mean arterial pressure (0.91 [0.89-0.93]) (p < 0.013). During resuscitation in the HES and NE groups, correlation coefficients were significantly higher between stroke volume and PP/HR (0.75 [0.63-0.84] and 0.79 [0.67-0.86]) than between stroke volume and mean arterial pressure (0.52 [0.32-0.67], p = 0.042, and 0.49 [0.28-0.65], p = 0.0018, respectively). CONCLUSION: The PP/HR ratio was strongly related to stroke volume during hemorrhagic shock and resuscitation in anesthetized swine.

Supraclavicular ultrasound-guided catheterization of the subclavian vein in pediatric and neonatal ICUs: a feasibility study.

OBJECTIVES: To assess the feasibility of ultrasound-guided supraclavicular catheterization of the subclavian vein in pediatric and neonatal ICU. DESIGN: Retrospective cohort. SETTING: Ten-bed pediatric medicosurgical ICU and 15-bed neonatal ICU. PATIENTS: Children and newborns undergoing supraclavicular ultrasound-guided subclavian vein catheterization from March 2010 to September 2010. MEASUREMENTS: The placement of central venous catheter in ICU was carried out either by one of the experts in ultrasound-guided puncture of the unit or by a novice completely supervised by the expert. The success and the early complications were recorded. A comparison between novice and expert operators was also made. RESULTS: Forty-two catheters were placed in 40 children. The median age and median weight were, respectively, 6.5 months and 6.5 kg. The success rate was 97.6% (one failure) and the early complication rate was 4.7% (one pneumothorax and one arterial puncture); 61% of children breathed spontaneously during the catheter placement. No significant difference was found between expert and novice operators. CONCLUSIONS: Supraclavicular ultrasound-guided catheterization of the subclavian vein in pediatric and neonatal ICU seems to be a promising technique in the context of emergency. It is safe, reliable, with few early complications. Furthermore, it does not compromise the airways of the patient owing to the low level of sedation needed for its placement.