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Ho DR, Cheng CT, Ouyang CH, Lin WC, Liao CH. Validation of continuous intraabdominal pressure measurement: feasibility and accuracy assessment using a capsular device in in-vivo studies. World J Emerg Surg 2024; 19:25. [PMID: 38926694 PMCID: PMC11201848 DOI: 10.1186/s13017-024-00553-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Accepted: 06/14/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND Monitoring Intraabdominal Pressure (IAP) is essential in critical care, as elevated IAP can lead to severe complications, including Abdominal Compartment Syndrome (ACS). Advances in technology, such as digital capsules, have opened new avenues for measuring IAP non-invasively. This study assesses the feasibility and effectiveness of using a capsular device for IAP measurement in an animal model. METHOD In our controlled experiment, we anesthetized pigs and simulated elevated IAP conditions by infusing CO2 into the peritoneal cavity. We compared IAP measurements obtained from three different methods: an intravesical catheter (IAPivp), a capsular device (IAPdot), and a direct peritoneal catheter (IAPdir). The data from these methods were analyzed to evaluate agreement and accuracy. RESULTS The capsular sensor (IAPdot) provided continuous and accurate detection of IAP over 144 h, with a total of 53,065,487 measurement triplets recorded. The correlation coefficient (R²) between IAPdot and IAPdir was excellent at 0.9241, demonstrating high agreement. Similarly, IAPivp and IAPdir showed strong correlation with an R² of 0.9168. CONCLUSION The use of capsular sensors for continuous and accurate assessment of IAP marks a significant advancement in the field of critical care monitoring. The high correlation between measurements from different locations and methods underscores the potential of capsular devices to transform clinical practices by providing reliable, non-invasive IAP monitoring.
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Affiliation(s)
- Dong-Ru Ho
- Department of Urology, Chang Gung Memorial Hospita ChiaYi, 8, west section of Jiapu Road, Puzi, Chiayi, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chi-Tung Cheng
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Chun-Hsiang Ouyang
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Cheng Lin
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Chang Gung University, Taoyuan, Taiwan
- Department of Electrical Engineering, Chang Gung University, Taoyuan, Taiwan
| | - Chien-Hung Liao
- Department of Trauma and Emergency Surgery, Chang Gung Memorial Hospital Linkou, Chang Gung University, Taoyuan, Taiwan.
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Jang H, Lee N, Jeong E, Park Y, Jo Y, Kim J, Kim D. Abdominal compartment syndrome in critically ill patients. Acute Crit Care 2023; 38:399-408. [PMID: 38052507 DOI: 10.4266/acc.2023.01263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Accepted: 11/13/2023] [Indexed: 12/07/2023] Open
Abstract
Intra-abdominal hypertension can have severe consequences, including abdominal compartment syndrome, which can contribute to multi-organ failure. An increase in intra-abdominal hypertension is influenced by factors such as diminished abdominal wall compliance, increased intraluminal content, and certain systemic conditions. Regular measurement of intra-abdominal pressure is essential, and particular attention must be paid to patient positioning. Nonsurgical treatments, such as decompression of intraluminal content using a nasogastric tube, percutaneous drainage, and fluid balance optimization, play crucial roles. Additionally, point-of-care ultrasonography aids in the diagnosis and treatment of intra-abdominal hypertension. Emphasizing the importance of regular measurements, timely decompressive laparotomy is a definitive, but complex, treatment option. Balancing the urgency of surgical intervention against potential postoperative complications is challenging.
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Affiliation(s)
- Hyunseok Jang
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Naa Lee
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Euisung Jeong
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Yunchul Park
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Younggoun Jo
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Jungchul Kim
- Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
| | - Dowan Kim
- Department of Thoracic and Cardiovascular Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea
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Kölbel B, Novotny A, Willms A, Kehl V, Meyer B, Mauer UM, Krieg SM. Study protocol for a multicenter randomized controlled pilot study on decompressive laparotomy vs. decompressive craniectomy for intractable intracranial pressure after traumatic brain injury: The SCALPEL study. BRAIN & SPINE 2023; 3:102677. [PMID: 37822567 PMCID: PMC10562836 DOI: 10.1016/j.bas.2023.102677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 09/05/2023] [Accepted: 09/17/2023] [Indexed: 10/13/2023]
Abstract
Introduction Decompressive craniectomy (DC) is the ultimate intervention to lower intracranial pressure (ICP) following severe traumatic brain injury (TBI). However, this intervention is associated with considerable adverse events and a higher proportion of survivors with poor functional outcomes. Research question In a multicompartment system ICP is associated with intraabdominal pressure (IAP) due to cerebral venous outflow from the brain. This is the rationale for decompressive laparotomy (DL) to control ICP after TBI as reported by experimental and retrospective clinical data. The safety profile of DL is superior to DC. This study aims to randomly assign patients with intractable high ICP after severe TBI to DL or DC. Material and methods Among other inclusion criteria, ICP must be above 20 mmHg (1-12 h) despite sedation and all other measures according to current guidelines. The primary outcome is the Extended Glasgow Outcome Scale assessed after twelve months. Further secondary outcome measures are compartmental pressure values, complications, etc. After 20 initial patients, results will be reviewed by the ethics committees and safety monitoring board to decide on the enrolment of 80 additional patients. Results The study is designed to provide not only high-quality prospective data for the first time on this treatment approach, its two-stage design (20 + 80 pts) also provides maximum patient safety. This protocol conforms with the SPIRIT 2013 Statement. Ethics approval was granted by our but also 5 other university ethics committees (registration 473/18S). Conclusion Registration was performed prior to study initiation in November 2021 (registration number NCT05115929).
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Affiliation(s)
- Benny Kölbel
- Department of Surgery, Bundeswehrkrankenhaus Ulm, Germany
| | - Alexander Novotny
- Department of Surgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Arnulf Willms
- Department of Surgery, Bundeswehrkrankenhaus Hamburg, Germany
| | - Victoria Kehl
- Münchner Studienzentrum, School of Medicine, Technical University of Munich, Munich, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Uwe-Max Mauer
- Department of Neurosurgery, Bundeswehrkrankenhaus Ulm, Germany
| | - Sandro M. Krieg
- Department of Neurosurgery, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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4
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Okida LF, Salimi T, Aleman R, Funes DR, Frieder J, Gutierrez D, Montorfano L, Lo Menzo E, Szomstein S, Rosenthal RJ. Midterm benefits of metabolic surgery on symptom remission and medication use in patients with pseudotumor cerebri. Surgery 2023; 173:904-911. [PMID: 36549974 DOI: 10.1016/j.surg.2022.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 11/22/2022] [Accepted: 11/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Pseudotumor cerebri is a serious obesity-related disorder that can result in severe complications. The aim of this study was to compare metabolic surgery with medical management of pseudotumor cerebri at a single bariatric center. METHODS After institutional review board approval, a retrospective review was conducted of individuals with severe obesity and pseudotumor cerebri (nonbariatric group) and patients with preoperative pseudotumor cerebri (bariatric group). The variables included demographic characteristics, comorbidities, and pseudotumor cerebri-related risk factors. Symptoms, medication use, and body mass index were analyzed during a 4-year follow-up. RESULTS A total of 86 patients with pseudotumor cerebri were included in the analysis. In the nonbariatric group (n = 77), the mean age was 34.1 ± 10.5 years and initial body mass index 37.2 ± 6.5 kg/m2. Initially, the most common symptom was headache (90.9%; n = 70), with a mean lumbar opening pressure of 341.94 ± 104.50 mm H2O. In the bariatric group (n = 9), the mean age was 36.1 ± 8.9 years and preoperative body mass index 46.1 ± 5.5 kg/m2. The most common preoperative symptom was headache (100%; n = 9), with a lumbar opening pressure of 320 ± 44.27 mm H2O. During the 4-year follow-up, both groups presented with a significant decrease in pseudotumor cerebri-related symptoms at 3 months (P < .0001). Additionally, pseudotumor cerebri medication use significantly decreased after 3 months in the bariatric group (P = .0406), whereas in the nonbariatric group decreased at 18 months (P = .023). Bariatric patients presented with a significant decrease in body mass index in ≤3 months of surgery (P = .0380), which was not observed in nonbariatric patients (P = .6644). CONCLUSION Metabolic surgery seems to provide a greater decrease in pseudotumor cerebri symptoms and medication use in a shorter period of time compared with medical management alone.
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Affiliation(s)
- Luis Felipe Okida
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/felipeokidamd
| | - Tara Salimi
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
| | - Rene Aleman
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/Ralemanmd
| | - David Romero Funes
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/DRfunesmd
| | - Joel Frieder
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/joelfrieder
| | - David Gutierrez
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/dgutierrezb
| | - Lisandro Montorfano
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/montorl89
| | - Emanuele Lo Menzo
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL
| | - Samuel Szomstein
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL. https://twitter.com/yankeedoc44
| | - Raul J Rosenthal
- Bariatric and Metabolic Institute, Department of General Surgery, Ellen Leifer Shulman and Steven Shulman Digestive Disease Center, Cleveland Clinic Florida, Weston, FL.
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Abiri A, Patel TR, Nguyen E, Birkenbeuel JL, Tajudeen BA, Choby G, Wang EW, Schlosser RJ, Palmer JN, Adappa ND, Kuan EC. Postoperative protocols following endoscopic skull base surgery: An evidence-based review with recommendations. Int Forum Allergy Rhinol 2023; 13:42-71. [PMID: 35678720 DOI: 10.1002/alr.23041] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/30/2022] [Accepted: 05/31/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND Postoperative management strategies for endoscopic skull base surgery (ESBS) vary widely because of limited evidence-based guidance. METHODS The PubMed, EMBASE, and Cochrane databases were systematically reviewed from January 1990 through February 2022 to examine 18 postoperative considerations for ESBS. Nonhuman studies, articles written in a language other than English, and case reports were excluded. Studies were assessed for levels of evidence, and each topic's aggregate grade of evidence was evaluated. RESULTS A total of 74 studies reporting on 18 postoperative practices were reviewed. Postoperative pain management, prophylactic antibiotics, and lumbar drain use had the highest grades of evidence (B). The literature currently lacks high quality evidence for a majority of the reviewed ESBS precautions. There were no relevant studies to address postoperative urinary catheter use and medical intracranial pressure reduction. CONCLUSION The evidence for postoperative ESBS precautions is heterogeneous, scarce, and generally of low quality. Although this review identified the best evidence available in the literature, it suggests the urgent need for more robust evidence. Therefore, additional high-quality studies are needed in order to devise optimal postoperative ESBS protocols.
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Affiliation(s)
- Arash Abiri
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Tirth R Patel
- Department of Otolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Emily Nguyen
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Jack L Birkenbeuel
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
| | - Bobby A Tajudeen
- Department of Otolaryngology, Head and Neck Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Garret Choby
- Department of Otolaryngology, Head and Neck Surgery and Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric W Wang
- Department of Otolaryngology, Head and Neck Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Rodney J Schlosser
- Department of Otolaryngology, Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - James N Palmer
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Nithin D Adappa
- Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Edward C Kuan
- Department of Otolaryngology, Head and Neck Surgery, University of California Irvine, Orange, California, USA
- Department of Neurological Surgery, University of California Irvine, Orange, California, USA
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6
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De Bernardo M, Vitiello L, De Luca M, La Marca A, Rosa N. Optic Nerve Changes Detected with Ocular Ultrasonography during Different Surgical Procedures: A Narrative Review. J Clin Med 2022; 11:jcm11185467. [PMID: 36143114 PMCID: PMC9500847 DOI: 10.3390/jcm11185467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/23/2022] Open
Abstract
Ultrasonographic appraisal of the optic nerve sheath diameter has become popular in recent years as a useful diagnostic tool to detect intracranial pressure variations. Intracranial hypertension is a life-threatening disease with possible poor clinical outcomes and can be caused by a variety of neurological and non-neurological conditions. Considering the latter, increases in intracranial pressure have also been described during several surgical procedures. Ocular ultrasonography might be utilized to identify intracranial pressure increases by evaluating optic nerve sheath diameter variations. The aim of this review is to provide a wide overview on the use of the optic nerve ultrasound evaluation to detect intracranial pressure changes during surgical procedures, also discussing the pitfalls of the B-scan technique, the most widely used for such a purpose. PubMed medical database, Web of Science and Scopus were used to carry out this review. The present review showed that ocular ultrasonography could be considered a valuable diagnostic tool in the surgical setting to indirectly assess intracranial pressure. However, the use of the B-scan ultrasound should always be coupled with the standardized A-scan technique for a more accurate, precise and trustworthy ultrasound assessment.
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7
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Graziano M, Di Paola I, Marotta G, Cornetta P, Capasso L. Letter to Editor: The Cushing reflex and the vasopressin-mediated hemodynamic response to increased intracranial pressure during acute elevations in intraabdominal pressure. Surgery 2022; 172:777. [DOI: 10.1016/j.surg.2022.01.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 01/31/2022] [Indexed: 10/18/2022]
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8
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Sleeve gastrectomy in subjects with severe obesity and baseline chronic kidney disease improves kidney function independently of weight loss. A propensity score matched analysis. Surg Obes Relat Dis 2022; 18:772-778. [DOI: 10.1016/j.soard.2022.02.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Revised: 01/25/2022] [Accepted: 02/05/2022] [Indexed: 12/25/2022]
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9
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Montorfano L, Yu Q, Bordes SJ, Sivanushanthan S, Rosenthal RJ, Montorfano M. Mean value of B-mode optic nerve sheath diameter as an indicator of increased intracranial pressure: a systematic review and meta-analysis. Ultrasound J 2021; 13:35. [PMID: 34215966 PMCID: PMC8253877 DOI: 10.1186/s13089-021-00235-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 06/22/2021] [Indexed: 11/14/2022] Open
Abstract
Objectives Timely diagnosis and treatment of increased intracranial pressure can decrease morbidity and prevent mortality. The present meta-analysis aims to determine the mean value of the ONSD measured in patients with various elevated ICP etiologies under different clinical settings, as well as comparing the value of ONSD between patients with and without elevated ICP. Methods This meta-analysis complied with the Preferred Reporting Items for Systematic Reviews and Meta-analysis Statement8. PubMed, Embase, and Cochrane Library were searched to identify ONSD measured by US for patients with increased ICP from establishment to October 2020. Results A total of 779 patients with elevated ICP among 22 studies were included in the present meta-analysis. Studies were published between 2003 and 2020. Eighteen were comparative (18/22, 81.8%), and four were single-armed study (4/22, 18.2%). Twenty were prospective studies (20/22, 90.9%). There was moderate-to-high heterogeneity based on the prediction ellipse area and variance logit of sensitivity and specificity. Conclusions The mean value of the ONSD among patients diagnosed with increased ICP was 5.82 mm (95% CI 5.58–6.06 mm). Variations were observed based on etiology of intracranial hypertension, clinical settings where ONSD was measured, and standards for diagnosing intracranial hypertension. The US-ONSD among patient with elevated ICP was significantly higher than the normal control. Although a cut-off value is not clearly determined, these mean values can be implemented to evaluate the sensitivity and specificity of US-ONSD in diagnosing intracranial hypertension in future studies.
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Affiliation(s)
- Lisandro Montorfano
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | - Qian Yu
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | - Stephen J Bordes
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | | | - Raul J Rosenthal
- Department of General Surgery, Cleveland Clinic Florida, 2950 Cleveland Clinic Blvd, Weston, FL, USA
| | - Miguel Montorfano
- Department of Ultrasound and Vascular Doppler, Hospital de Emergencias "Dr. Clemente Alvarez", Av. Pellegrini 3205, Rosario, Santa Fe, Argentina.
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Brazdzionis J, Patchana T, Savla P, Podkovik S, Browne J, Ohno A, Taka TM, Modi A, Wacker MR, Cortez V, Miulli DE. Medical Comorbidities Associated With Outcomes in Patients With Traumatic Epidural Hematomas. Cureus 2021; 13:e15514. [PMID: 34277158 PMCID: PMC8269989 DOI: 10.7759/cureus.15514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 06/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Traumatic brain injury (TBI) is a frequently encountered neurosurgical pathology with significant morbidity and mortality. One such subtype is the epidural hematoma. Literature regarding the effects of comorbidities in TBI and epidural hematomas is limited. Methodology This was a single-center retrospective review of 50 consecutive patients admitted to a level two trauma center with epidural hematomas. Patients were identified using an internal trauma database. Patients were included if they were 18 years of age with a diagnosed epidural hematoma. Outcome variables of Glasgow coma scale (GCS), length of stay in the intensive care unit (ICU) and hospital, and requirement of a neurosurgical procedure were analyzed. Identification of the presence of diagnosed comorbidities was performed including common comorbidities such as obesity, diabetes, hypertension, hyperlipidemia, drug use, tobacco use, cancer, psychiatric disease, and renal disease. Correlations were evaluated using two-sided bivariate analysis (p < 0.05). Results A total of 50 patients were included for analysis. Significant correlations with a p-value less of than 0.05 were noted in initial GCS and cancer (r = -0.357, p = 0.011), requirements of an intracranial procedure with a history of gastrointestinal disease (r = 0.377, p = 0.007), and younger age (r = -0.306, p = 0.031). Increased ICU length of stay was related to a history of cancer (r = 0.494, p < 0.001), a history of respiratory disease (r = 0.427, p = 0.002), and a history of psychiatric disease (r = 0.297, p = 0.036). Increased hospital length of stay was related to psychiatric disorders (r = 0.285, p = 0.045). Discharge GCS was negatively associated with a history of hypertension (r = -0.374, p = 0.008), tobacco use (r = -0.417, p = 0.003), drug use (r = -0.294, p = 0.037), and history of cancer (r = -0.303, p = 0.032). Discussion and Conclusions In our 50 consecutive patient subset, selected comorbidities demonstrated significant relationships with outcome measures of GCS, need for a procedure, and lengths of stay in the hospital and ICU. Obtaining comorbidity information when available from families can better allow the clinician to optimize treatment and educate loved ones about the potential effects of these comorbidities on the overall health of the patient. Understanding these correlations may allow for a better understanding of the systemic effects of the pathophysiology of injury in epidural hematomas.
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Affiliation(s)
- James Brazdzionis
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Tye Patchana
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Stacey Podkovik
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Jonathan Browne
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Ai Ohno
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Taha M Taka
- Neurosurgery, University of California Riverside, Riverside, USA
| | - Arnav Modi
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | | | - Vladimir Cortez
- Neurosurgery, Desert Regional Medical Center, Palm Springs, USA
| | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
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11
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Intra-abdominal hypertension and abdominal compartment syndrome: a current review. Curr Opin Crit Care 2021; 27:164-168. [PMID: 33480617 DOI: 10.1097/mcc.0000000000000797] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Intra-abdominal hypertension (IAH) and its deleterious effects are present in at least one-third of ICU patients. Increased recognition of IAH has led to significant reduction in the incidence of abdominal compartment syndrome (ACS). Many questions remain regarding what therapeutic interventions truly reduce morbidity and mortality associated with IAH/ACS. Recent research sheds new light on the effects of IAH in individual organ systems and unique disease states. This paper will review recent research in IAH/ACS recognition, treatment, and management. RECENT FINDINGS Recent research on IAH/ACS includes an improved understanding of the prevalence of IAH/ACS and confirmation of its independent association with organ failure. Specifically, new research adds clarity to the effects of IAH/ACS on individual organ systems and specific disease states. These results combine to improve the clinical ability to diagnose, monitor, and treat IAH/ACS. SUMMARY There is significant research on the broad impact of IAH/ACS in the ICU setting. Focus on IAH/ACS has gone beyond the purview of intensivists and surgeons to include outstanding work by specialists in multiple sub-specialties. These advances have generated improvements in current treatment algorithms. We review recent IAH/ACS literature and have categorized the most pertinent results into organ system-specific contributions.
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12
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A-scan ultrasonography and optic nerve sheath diameter assessment during acute elevations in intra-abdominal pressure. Surgery 2020; 167:1023-1024. [DOI: 10.1016/j.surg.2020.01.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 01/02/2020] [Indexed: 11/18/2022]
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