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Newey C, Skaar JR, O'Hara M, Miao B, Post A, Kelly T. Systematic Literature Review of the Association of Fever and Elevated Temperature with Outcomes in Critically Ill Adult Patients. Ther Hypothermia Temp Manag 2024; 14:10-23. [PMID: 37158862 DOI: 10.1089/ther.2023.0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023] Open
Abstract
Although most commonly associated with infection, elevated temperature and fever also occur in a variety of critically ill populations. Prior studies have suggested that fever and elevated temperature may be detrimental to critically ill patients and can lead to poor outcomes, but the evidence surrounding the association of fever with outcomes is rapidly evolving. To broadly assess potential associations of elevated temperature and fever with outcomes in critically ill adult patients, we performed a systematic literature review focusing on traumatic brain injury, stroke (ischemic and hemorrhagic), cardiac arrest, sepsis, and general intensive care unit (ICU) patients. Searches were conducted in Embase® and PubMed® from 2016 to 2021, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, including dual-screening of abstracts, full texts, and extracted data. In total, 60 studies assessing traumatic brain injury and stroke (24), cardiac arrest (8), sepsis (22), and general ICU (6) patients were included. Mortality, functional, or neurological status and length of stay were the most frequently reported outcomes. Elevated temperature and fever were associated with poor clinical outcomes in patients with traumatic brain injury, stroke, and cardiac arrest but not in patients with sepsis. Although a causal relationship between elevated temperature and poor outcomes cannot be definitively established, the association observed in this systematic literature review supports the concept that management of elevated temperature may factor in avoidance of detrimental outcomes in multiple critically ill populations. The analysis also highlights gaps in our understanding of fever and elevated temperature in critically ill adult patients.
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Affiliation(s)
- Christopher Newey
- Department of Neurocritical Care, Sanford USD Medical Center, Sioux Falls, South Dakota, USA
| | | | | | | | - Andrew Post
- Trinity Life Sciences, Waltham, Massachusetts, USA
| | - Tim Kelly
- Becton Dickinson, Franklin Lakes, New Jersey, USA
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Lee CH, Kim YH, Oh BK, Lee CH, Kim CH, Sung SK, Lee SW, Song GS. Does the COVID-19 Screening Test Affect the Postoperative Prognosis of Patients Who Undergo Emergency Surgery for Cerebral Hemorrhage? Korean J Neurotrauma 2022; 18:198-207. [PMID: 36381433 PMCID: PMC9634325 DOI: 10.13004/kjnt.2022.18.e48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has affected all medical fields, including neurosurgery. Particularly, performing preoperative screening tests has become mandatory, potentially extending the time from admission to the emergency room and operating room, thus possibly affecting patients' prognosis. This study aimed to determine the influence of COVID-19 screening time on patients' postoperative prognosis. Methods From September 10, 2020, to May 31, 2021, we retrospectively evaluated 54 patients with cerebral hemorrhage who underwent emergency surgery in the emergency room after the screening test. The control group included 89 patients with cerebral hemorrhage who underwent emergency surgery between January 2019 and March 2020, i.e., the period before the COVID-19 pandemic. Prognosis was measured using the Glasgow Coma Scale scores, which were obtained preoperatively, postoperatively, and at discharge, and the modified Rankin Scale (mRS). Additionally, unfavorable outcomes (mRS score 3-6) and in-hospital mortality rates were investigated for postoperative prognostic assessments. Results No remarkable differences were observed in the time to surgical intervention and prognostic evaluation scores between patients with cerebral hemorrhage who underwent COVID-19 screening tests and subjects in the control group. Conclusion This study confirmed that patient treatment and prognosis were not significantly affected by additional preoperative screening testing times during the pandemic. We believe that our results are informative for the evaluation and performance of emergency neurosurgery during the pandemic.
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Affiliation(s)
- Chang Ho Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Bu Kwang Oh
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Chi Hyung Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Chang Hyeun Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
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Kulesza B, Mazurek M, Nogalski A, Rola R. Factors with the strongest prognostic value associated with in-hospital mortality rate among patients operated for acute subdural and epidural hematoma. Eur J Trauma Emerg Surg 2020; 47:1517-1525. [PMID: 32776246 PMCID: PMC8476473 DOI: 10.1007/s00068-020-01460-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 08/05/2020] [Indexed: 12/21/2022]
Abstract
INTRODUCTION Traumatic brain injury (TBI) still remains a serious health problem and is called a "silent epidemic". Each year in Europe 262 per 100,000 individuals suffer from TBI. The most common consequence of severe head injuries include acute subdural (SDH) and epidural hematomas (EDH), which usually require immediate surgically treatment. The aim of our study is to identify factors which have the strongest prognostic value in relation to in-hospital mortality rate among of patients undergoing surgery for EDH and SDH. PATIENTS AND METHODS Cohort included 128 patients with isolated craniocerebral injuries who underwent surgery for EDH (28 patients) and SDH (100 patients) in a single, tertiary care Department of Neurosurgery. The data were collected on admission of patients to the Emergency Department and retrospectively analyzed. The following factors were analyzed: demographic data, physiological parameters, laboratory variables, computed tomography scan characteristics and the time between trauma and surgery. Likewise, we have investigated the in-hospital mortality of patients at the time of discharge. RESULTS We found that the factors with the strongest prognostic values were: the initial GCS score, respiratory rate, glycaemia, blood saturation, systolic blood pressure, midline shift and type of hematoma. Additionally, we proved that a drop by one point in the GCS score almost doubles the risk of in-hospital death while the presence of coagulopathy increases the risk of in-hospital death almost six times. CONCLUSION Most of the factors with the strongest prognostic value are factors that the emergency team can treat prior to the hospital admission. Coagulopathy, however that has the strongest influence on in-hospital death rate can only be efficiently treated in a hospital setting.
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Affiliation(s)
- Bartłomiej Kulesza
- Chair and Department of Neurosurgery and Paediatric Neurosurgery, Medical University in Lublin, Independent Public Clinical Hospital No. 4 in Lublin, Jaczewskiego 8, 20-954, Lublin, Poland.
| | - Marek Mazurek
- Chair and Department of Neurosurgery and Paediatric Neurosurgery, Medical University in Lublin, Independent Public Clinical Hospital No. 4 in Lublin, Jaczewskiego 8, 20-954, Lublin, Poland
| | - Adam Nogalski
- Chair and Department of Trauma Surgery and Emergency Medicine, Medical University in Lublin, Independent Public Clinical Hospital No. 1 in Lublin Poland, Stanisława Sztaszica 16, 20-400, Lublin, Poland
| | - Radosław Rola
- Chair and Department of Neurosurgery and Paediatric Neurosurgery, Medical University in Lublin, Independent Public Clinical Hospital No. 4 in Lublin, Jaczewskiego 8, 20-954, Lublin, Poland
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Surgical Closed Suction Drain Use After Craniotomy for Evacuation of Supratentorial Epidural Hematomas: A Case Series of Radiographic and Clinical Outcomes. World Neurosurg 2019; 134:e460-e468. [PMID: 31669243 DOI: 10.1016/j.wneu.2019.10.098] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 10/15/2019] [Accepted: 10/16/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Surgical closed suction drain (SCSDs) are used in a variety of surgical disciplines to prevent postoperative fluid collections. Use of SCSDs has not been well studied in the neurosurgical literature. Practice patterns have varied within our institution with respect to SCSDs after craniotomies for neurotrauma. In this study we describe SCSD use for patients undergoing evacuation of supratentorial epidural hematomas (EDHs) and examine the effect on patient outcomes and length of hospital stay. METHODS We performed a retrospective review of craniotomies for supratentorial EDH performed at our Level I trauma center between May 2015 and May 2018. Imaging and clinical data were obtained from chart review. RESULTS Fifty-two patients with EDH received operations from 8 attending surgeons. The number of drains used was 0 or 1 in 36 cases and 2 or more in 16 cases. Drain location was subgaleal in 25 cases, epidural in 8 cases, and both subgaleal and epidural in 13 cases. Attending preference (P < 0.001) but not hematoma size was associated with use of an epidural drain and use of 2 or more drains. After controlling for age, initial neurologic exam, and presence of other injuries, use of more drains was associated with longer intensive care unit lengths of stay. Drain use pattern was not associated with patient outcome measures, and no return to the operating room was necessary for residual or recurrent EDH. CONCLUSIONS Use of fewer SCSDs did not affect radiographic outcome after evacuation of epidural hematomas but was associated with decreased intensive care unit length of stay.
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The Association Between Early Discharge and Long-Term Outcome of Patients with Traumatic Intracranial Hemorrhage Admitted to Emergency Departments. Trauma Mon 2018. [DOI: 10.5812/traumamon.63976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Eseonu CI, Rincon-Torroella J, ReFaey K, Lee YM, Nangiana J, Vivas-Buitrago T, Quiñones-Hinojosa A. Awake Craniotomy vs Craniotomy Under General Anesthesia for Perirolandic Gliomas: Evaluating Perioperative Complications and Extent of Resection. Neurosurgery 2018; 81:481-489. [PMID: 28327900 DOI: 10.1093/neuros/nyx023] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 09/07/2016] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND A craniotomy with direct cortical/subcortical stimulation either awake or under general anesthesia (GA) present 2 approaches for removing eloquent region tumors. With a reported higher prevalence of intraoperative seizures occurring during awake resections of perirolandic lesions, oftentimes, surgery under GA is chosen for these lesions. OBJECTIVE To evaluate a single-surgeon's experience with awake craniotomies (AC) vs surgery under GA for resecting perirolandic, eloquent, motor-region gliomas. METHODS Between 2005 and 2015, a retrospective analysis of 27 patients with perirolandic, eloquent, motor-area gliomas that underwent an AC were case-control matched with 31 patients who underwent surgery under GA for gliomas in the same location. All patients underwent direct brain stimulation with neuromonitoring and perioperative risk factors, extent of resection, complications, and discharge status were assessed. RESULTS The postoperative Karnofsky Performance Score (KPS) was significantly lower for the GA patients at 81.1 compared to the AC patients at 93.3 ( P = .040). The extent of resection for GA patients was 79.6% while the AC patients had an 86.3% resection ( P = .136). There were significantly more 100% total resections in the AC patients 25.9% compared to the GA group (6.5%; P = .041). Patients in the GA group had a longer mean length of hospitalization of 7.9 days compared to the AC group at 4.2 days ( P = .049). CONCLUSION We show that AC can be performed with more frequent total resections, better postoperative KPS, shorter hospitalizations, as well as similar perioperative complication rates compared to surgery under GA for perirolandic, eloquent motor-region glioma.
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Affiliation(s)
- Chikezie I Eseonu
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Jordina Rincon-Torroella
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Karim ReFaey
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Young M Lee
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Jasvinder Nangiana
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Tito Vivas-Buitrago
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
| | - Alfredo Quiñones-Hinojosa
- Department of Neurological Surgery and Oncology Outcomes Lab, Johns Hopkins University, Baltimore, Maryland
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Abdelgadir J, Punchak M, Smith ER, Tarnasky A, Muhindo A, Nickenig Vissoci JR, Haglund MM, Kitya D. Pediatric traumatic brain injury at Mbarara Regional Referral Hospital, Uganda. J Clin Neurosci 2018; 47:79-83. [DOI: 10.1016/j.jocn.2017.10.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 10/01/2017] [Indexed: 12/20/2022]
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Benefit on optimal cerebral perfusion pressure targeted treatment for traumatic brain injury patients. J Crit Care 2017; 41:49-55. [PMID: 28477510 DOI: 10.1016/j.jcrc.2017.04.029] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 04/02/2017] [Accepted: 04/20/2017] [Indexed: 12/17/2022]
Abstract
PURPOSE The maintenance of patient-specific optimal cerebral perfusion pressure (CPPopt) is crucial for patients with traumatic brain injury (TBI). The goal of the study was to explore the influence of CPP declination from CPPopt value on the TBI patients' outcome. METHODS The CPP and cerebrovascular autoregulation (CA) monitoring of 52 TBI patients was performed. Patient-specific CPPopt has been identified and the associations between the patients' outcome and complex influence of time of CPP declination from CPPopt value, age, and the duration of CA impairment episodes has been analyzed. RESULTS The multiple correlation coefficient between the Glasgow outcome scale (GOS), duration of CA impairment events and percentage time, when 0<ΔCPPopt<10mmHg was r=-0.643 (P<0.001). The multiple correlation coefficients between GOS, age, and percentage time of ΔCPPopt when 0<ΔCPPopt<10mmHg was r=-0.587 (P<0.001). CONCLUSION The CPPopt-targeted patient-specific management might be useful for stabilizing CA in TBI patients as well as for improving their outcome. Better outcomes were obtained by maintaining CPP in light hyperperfusion condition (up to 10mmHg above CPPopt) when CPPopt is in the range of 60-80mmHg, and keeping CPP within the range of CPPopt +/-5mmHg when CPPopt is above 80mmHg.
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Shangkuan WC, Lin HC, Shih CP, Cheng CA, Fan HC, Chung CH, Lin FH, Tsao CH, Chien WC. Increased long-term risk of hearing loss in patients with traumatic brain injury: A nationwide population-based study. Laryngoscope 2017; 127:2627-2635. [PMID: 28322446 DOI: 10.1002/lary.26567] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 02/01/2017] [Accepted: 02/07/2017] [Indexed: 12/16/2022]
Abstract
OBJECTIVES/HYPOTHESIS We investigated incidences of hearing loss among patients with traumatic brain injury (TBI) to evaluate whether they had a higher risk of hearing loss than the general population. STUDY DESIGN Cohort study. METHODS Inpatient data from the Taiwan National Health Insurance Research Database from January 1, 2000 to December 31, 2010 were recorded. Patients with TBI and a retrospective comparison cohort were analyzed. Each subject was individually traced from their index date to identify subjects who subsequently received a diagnosis of hearing loss. Cox regression analyses were applied to determine the risk of TBI-related hearing loss. RESULTS Follow-up data from the TBI and comparison cohorts were collected over 10 years for 553,286 and 1,106,572 patients, respectively. Multivariate analyses demonstrated that TBI significantly increased the risk of hearing loss (adjusted hazard ratio = 2.125, 95% confidence interval = 2.045-2.546, P = .027). In our subgroup analyses by type of injury, patients with TBI due to traffic injury had the highest associated risk of hearing loss compared with the risk of non-TBI traffic injury patients, followed by patients with crushing/cutting/piercing injuries and falls. CONCLUSIONS Our study shows that TBI led to a higher risk of long-term hearing loss. Traffic injuries were the most common injury related to hearing loss. Prevention, rather than treatment, may be the best policy for preventing hearing loss. LEVEL OF EVIDENCE 2b. Laryngoscope, 127:2627-2635, 2017.
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Affiliation(s)
| | - Hung-Che Lin
- National Defense Medical Center, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Cheng-Ping Shih
- National Defense Medical Center, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Chun-An Cheng
- National Defense Medical Center, Taipei, Taiwan.,Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Hueng-Chuen Fan
- National Defense Medical Center, Taipei, Taiwan.,Department of Pediatrics, Tungs' Taichung MetroHarbor Hospital, Taichung City, Taiwan
| | - Chi-Hsiang Chung
- National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
| | - Fu-Huang Lin
- National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - Chang-Huei Tsao
- National Defense Medical Center, Taipei, Taiwan.,Department of Microbiology and Immunology, National Defense Medical Center, Taipei, Taiwan
| | - Wu-Chien Chien
- National Defense Medical Center, Taipei, Taiwan.,School of Public Health, National Defense Medical Center, Taipei, Taiwan.,Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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