1
|
Lui HCH, He Z, Zhuang TF, Ng CF, Wong GKC. Tracheostomy decannulation outcomes in 131 consecutive neurosurgical patients. Br J Neurosurg 2024; 38:884-888. [PMID: 34730454 DOI: 10.1080/02688697.2021.1995591] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/02/2021] [Accepted: 10/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES This study was a retrospective study to investigate factors related to difficult tracheostomy decannulation, and to evaluate outcomes of tracheostomized neurosurgical patients. METHODS All consecutive tracheostomized neurosurgical patients in the Prince of Wales Hospital between 1st September 2016 and 31st August 2019 were reviewed retrospectively. Patients were grouped into easy decannulation and difficult decannulation groups using 3 months as cut-off time. Risk factors were analysed and outcomes were compared. RESULTS One hundred thirty-one patients were included. In univariate analyses, male gender, GCS less than or equal to 8 on admission, the presence of vocal cord palsy at 3 months, and pneumonia within 1-month post-tracheostomy were associated with difficult decannulation. In multivariable logistic regression for difficult decannulation, GCS on admission, the presence of vocal cord palsy at 3 months, and the presence of pneumonia within 1-month post-tracheostomy remained statistically significant. The easy decannulation group had a shorter length of in-patient stay, higher survival rate, and more favourable neurological outcome (GOS 4-5) than the difficult decannulation group at both 6 months and 1 year. The majority of easy decannulation group patients (54%) were discharged to home, while the majority of the difficult decannulation group (42%) of patients were discharged to the infirmary. CONCLUSION GCS less than or equal to 8 on admission, the presence of vocal cord palsy, and the presence of pneumonia were associated with difficult tracheostomy decannulation in neurosurgical patients. Difficult decannulation is associated with a longer length of in-patient stay and poor neurological outcomes.
Collapse
Affiliation(s)
- Hannaly Cheuk-Hang Lui
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Zhexi He
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Neurosurgery, Tuen Mun Hospital, Hong Kong SAR, China
| | - Tin Fong Zhuang
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Neurosurgery, Queen Mary Hospital, Hong Kong SAR, China
| | - Chat Fong Ng
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
- Department of Neurosurgery, Queen Elizabeth Hospital, Hong Kong SAR, China
| | - George Kwok-Chu Wong
- Division of Neurosurgery, Department of Surgery, The Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
2
|
Hu A, Qin H, Wu S, Zhao X, Li Y, Chen F, Liu T. Development and validation of a clinical prediction model for prognostic factors in patients with primary pontine hemorrhage. Braz J Med Biol Res 2024; 57:e13359. [PMID: 38656075 PMCID: PMC11027180 DOI: 10.1590/1414-431x2024e13359] [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] [Received: 12/29/2023] [Accepted: 02/26/2024] [Indexed: 04/26/2024] Open
Abstract
We aimed to develop a prognostic model for primary pontine hemorrhage (PPH) patients and validate the predictive value of the model for a good prognosis at 90 days. A total of 254 PPH patients were included for screening of the independent predictors of prognosis, and data were analyzed by univariate and multivariable logistic regression tests. The cases were then divided into training cohort (n=219) and validation cohort (n=35) based on the two centers. A nomogram was developed using independent predictors from the training cohort to predict the 90-day good outcome and was validated from the validation cohort. Glasgow Coma Scale score, normalized pixels (used to describe bleeding volume), and mechanical ventilation were significant predictors of a good outcome of PPH at 90 days in the training cohort (all P<0.05). The U test showed no statistical difference (P=0.892) between the training cohort and the validation cohort, suggesting the model fitted well. The new model showed good discrimination (area under the curve=0.833). The decision curve analysis of the nomogram of the training cohort indicated a great net benefit. The PPH nomogram comprising the Glasgow Coma Scale score, normalized pixels, and mechanical ventilation may facilitate predicting a 90-day good outcome.
Collapse
Affiliation(s)
- Anquan Hu
- Department of Geriatric Center, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Heyan Qin
- Department of Neurology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Shina Wu
- Department of Neurology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Xiaolin Zhao
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Yumeng Li
- Department of Neurology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Feng Chen
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| | - Tao Liu
- Department of Neurology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, China
| |
Collapse
|
3
|
Ahmad M, Ayaz Z, Sinha T, Soe TM, Tutwala N, Alrahahleh AA, Arrey Agbor DB, Ali N. Risk Factors for the Development of Pneumonia in Stroke Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e57077. [PMID: 38681338 PMCID: PMC11052642 DOI: 10.7759/cureus.57077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2024] [Indexed: 05/01/2024] Open
Abstract
Pneumonia is one of the most prevalent medical complications post-stroke. It can have negative impacts on the prognosis of stroke patients. This study aimed to determine the predictors of pneumonia in stroke patients. The authors devised, reviewed, and enhanced the search strategy in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies were gathered from various electronic databases, including Medline, CINAHL, Cochrane, Embase, and Web of Science, from January 1st, 2011, to February 25th, 2024. The review encompassed studies involving patients aged 18 years and older who were hospitalized for acute stroke care. Inclusion criteria required patients to have received a clinical diagnosis of stroke, confirmed via medical imaging (CT or MRI), hospital primary diagnosis International Classification of Diseases 10th Revision discharge codes, or pathology reporting. A total of 35 studies met the criteria and were included in our pooled analysis. Among them, 23 adopted a retrospective design, while the remaining 12 were prospective. The pooled incidence of pneumonia among patients with stroke was found to be 14% (95% confidence interval = 13%-15%). The pooled analysis reported that advancing age, male gender, a history of chronic obstructive pulmonary disease (COPD), the presence of a nasogastric tube, atrial fibrillation, mechanical ventilation, stroke severity, dysphagia, and a history of diabetes were identified as significant risk factors for pneumonia development among stroke patients. Our results underscore the importance of proactive identification and management of these factors to mitigate the risk of pneumonia in stroke patients.
Collapse
Affiliation(s)
| | - Zeeshan Ayaz
- Medicine, Rehman Medical Institute, Peshawar, PAK
| | - Tanya Sinha
- Medical Education, Tribhuvan University, Kirtipur, NPL
| | - Thin M Soe
- Medicine, University of Medicine 1, Yangon, Yangon, MMR
| | - Nimish Tutwala
- Obstetrics and Gynaecology, Topiwala National Medical College & B. Y. L. Nair Charitable Hospital, Mumbai, IND
| | | | - Divine Besong Arrey Agbor
- Clinical Research and Internal Medicine, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA
- Internal Medicine, Richmond University Medical Center, Staten Island, USA
| | - Neelum Ali
- Internal Medicine, University of Health Sciences, Lahore, PAK
| |
Collapse
|
4
|
Ho UC, Hsieh CJ, Lu HY, Huang APH, Kuo LT. Predictors of extubation failure and prolonged mechanical ventilation among patients with intracerebral hemorrhage after surgery. Respir Res 2024; 25:19. [PMID: 38178114 PMCID: PMC10765847 DOI: 10.1186/s12931-023-02638-5] [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] [Received: 08/04/2023] [Accepted: 12/14/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Spontaneous intracerebral hemorrhage (ICH) is a condition associated with high mortality and morbidity. Survivors may require prolonged intubation with mechanical ventilation (MV). The aim of this study was to analyze the predictors of extubation failure and prolonged MV in patients who undergo surgical evacuation. METHODS This retrospective study was conducted on adult patients with ICH who underwent MV for at least 48 h and survived > 14 days after surgery. The demographics, clinical characteristics, laboratory tests, and Glasgow Coma Scale score were analyzed. RESULTS A total of 134 patients with ICH were included in the study. The average age of the patients was 60.34 ± 15.59 years, and 79.9% (n = 107) were extubated after satisfying the weaning parameters. Extubation failure occurred in 11.2% (n = 12) and prolonged MV in 48.5% (n = 65) patients. Multivariable regression analysis revealed that a white blood cell count > 10,000/mm3 at the time of extubation was an independent predictor of reintubation. Meanwhile, age and initial Glasgow Coma Scale scores were predictors of prolonged MV. CONCLUSIONS This study provided the first comprehensive characterization and analysis of the predictors of extubation failure and prolonged MV in patients with ICH after surgery. Knowledge of potential predictors is essential to improve the strategies for early initiation of adequate treatment and prognosis assessment in the early stages of the disease.
Collapse
Affiliation(s)
- Ue-Cheung Ho
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch No. 579, Sec. 2, Yunlin Rd, Yunlin, 640, Taiwan
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, 100, Taiwan
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Chia-Jung Hsieh
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
| | - Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, 640, Taiwan
| | - Abel Po-Hao Huang
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan
- Institute of Polymer Science and Engineering, National Taiwan University, Taipei, 100, Taiwan
| | - Lu-Ting Kuo
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Yunlin Branch No. 579, Sec. 2, Yunlin Rd, Yunlin, 640, Taiwan.
- Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei, 100, Taiwan.
| |
Collapse
|
5
|
Sonneville R, Mazighi M, Collet M, Gayat E, Degos V, Duranteau J, Grégoire C, Sharshar T, Naim G, Cortier D, Jost PH, Foucrier A, Bagate F, de Montmollin E, Papin G, Magalhaes E, Guidet B, Ben Hadj Salem O, Benghanem S, le Guennec L, Delpierre E, Legriel S, Megarbane B, Toumert K, Tran M, Geri G, Monchi M, Bodiguel E, Mariotte E, Demoule A, Zarka J, Diehl JL, Roux D, Barré E, Tanaka S, Osman D, Pasquier P, Lamara F, Crassard I, Boursin P, Ruckly S, Staiquly Q, Timsit JF, Woimant F. One-Year Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation. Stroke 2023; 54:2328-2337. [PMID: 37497675 DOI: 10.1161/strokeaha.123.042910] [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] [Received: 02/14/2023] [Accepted: 06/22/2023] [Indexed: 07/28/2023]
Abstract
BACKGROUND Long-term outcomes of patients with severe stroke remain poorly documented. We aimed to characterize one-year outcomes of patients with stroke requiring mechanical ventilation in the intensive care unit (ICU). METHODS We conducted a prospective multicenter cohort study in 33 ICUs in France (2017-2019) on patients with consecutive strokes requiring mechanical ventilation for at least 24 hours. Outcomes were collected via telephone interviews by an independent research assistant. The primary end point was poor functional outcome, defined by a modified Rankin Scale score of 4 to 6 at 1 year. Multivariable mixed models investigated variables associated with the primary end point. Secondary end points included quality of life, activities of daily living, and anxiety and depression in 1-year survivors. RESULTS Among the 364 patients included, 244 patients (66.5% [95% CI, 61.7%-71.3%]) had a poor functional outcome, including 190 deaths (52.2%). After adjustment for non-neurological organ failure, age ≥70 years (odds ratio [OR], 2.38 [95% CI, 1.26-4.49]), Charlson comorbidity index ≥2 (OR, 2.01 [95% CI, 1.16-3.49]), a score on the Glasgow Coma Scale <8 at ICU admission (OR, 3.43 [95% CI, 1.98-5.96]), stroke subtype (intracerebral hemorrhage: OR, 2.44 [95% CI, 1.29-4.63] versus ischemic stroke: OR, 2.06 [95% CI, 1.06-4.00] versus subarachnoid hemorrhage: reference) remained independently associated with poor functional outcome. In contrast, a time between stroke diagnosis and initiation of mechanical ventilation >1 day was protective (OR, 0.56 [95% CI, 0.33-0.94]). A sensitivity analysis conducted after exclusion of patients with early decisions of withholding/withdrawal of care yielded similar results. We observed persistent physical and psychological problems at 1 year in >50% of survivors. CONCLUSIONS In patients with severe stroke requiring mechanical ventilation, several ICU admission variables may inform caregivers, patients, and their families on post-ICU trajectories and functional outcomes. The burden of persistent sequelae at 1 year reinforces the need for a personalized, multi-disciplinary, prolonged follow-up of these patients after ICU discharge. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03335995.
Collapse
Affiliation(s)
- Romain Sonneville
- Université de Paris, INSERM UMR 1148, F-75018 Paris, France (R.S., M. Mazighi)
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | - Mikael Mazighi
- Université de Paris, INSERM UMR 1148, F-75018 Paris, France (R.S., M. Mazighi)
- APHP, Department of Neurology, Lariboisière University Hospital, Paris, France (M. Mazighi)
- APHP, Department of Neuroradiology, Rothschild Hospital Foundation, Paris, France (M. Mazighi, P.B.)
| | - Magalie Collet
- APHP.Nord, Department of Anesthesiology and Critical Care, DMU Parabol, Université de Paris, France (M.C., E.G.)
- UMR-S 942 "MASCOT," Inserm, Paris, France (M.C., E.G.)
| | - Etienne Gayat
- APHP.Nord, Department of Anesthesiology and Critical Care, DMU Parabol, Université de Paris, France (M.C., E.G.)
- UMR-S 942 "MASCOT," Inserm, Paris, France (M.C., E.G.)
| | - Vincent Degos
- APHP, Department of Critical Care, Anesthesia and Perioperative Medicine, Pitié-Salpétrière University Hospital and Sorbonne Université, Paris, France (V.D.)
- GRC ARPE, Sorbonne Université, Paris, France (V.D.)
| | - Jacques Duranteau
- APHP, Department of Anesthesiology and Critical Care, Bicêtre University Hospitals, Le Kremlin Bicêtre, France (J.D.)
| | - Charles Grégoire
- Department of Intensive Care, Rothschild Hospital Foundation, Paris, France (C.G.)
| | - Tarek Sharshar
- Department of Neuroanesthesiology and Intensive Care, Saint Anne Hospital, Paris, France (T.S., G.N.)
| | - Giulia Naim
- Department of Neuroanesthesiology and Intensive Care, Saint Anne Hospital, Paris, France (T.S., G.N.)
| | - David Cortier
- Department of Intensive Care, Foch Hospital, Paris, France (D.C.)
| | - Paul-Henri Jost
- APHP, Department of Anesthesiology and Critical Care, Henri Mondor University Hospital, Créteil, France (P.-H.J.)
| | - Arnaud Foucrier
- APHP, Department of Anesthesiology and Critical Care, Beaujon University Hospital, Clichy, France (A.F.)
| | - François Bagate
- APHP, Department of Intensive Care Medicine, Henri Mondor University Hospital and Université de Paris Est Créteil, France (F.B.)
| | - Etienne de Montmollin
- Department of Intensive Care Medicine, Delafontaine Hospital, Saint-Denis, France (E.d.M.)
| | - Gregory Papin
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | - Eric Magalhaes
- Department of Intensive Care Medicine, Sud Francilien Hospital, Corbeil, France (E.M.)
| | - Bertrand Guidet
- APHP, Department of Intensive Care Medicine, Saint Antoine University Hospital, Paris, France (B.G.)
| | - Omar Ben Hadj Salem
- Department of Intensive Care Medicine, Poissy-Saint Germain en Laye Hospital, Paris, France (O.B.H.S.)
| | - Sarah Benghanem
- APHP, Medical ICU, Cochin University Hospital and Université Paris Cité, France (S.B.)
| | - Loïc le Guennec
- APHP, Department of Intensive Care Medicine, La Pitié-Salpêtrière University Hospital and Sorbonne Université, Paris, France (L.l.G.)
| | - Eric Delpierre
- Department of Intensive Care Medicine, Meaux Hospital, France (E.D.)
| | - Stephane Legriel
- Department of Intensive Care Medicine, Versailles Hospital, Le Chesnay, and Paris-Saclay University UVSQ, INSERM, CESP, Villejuif, France (S.L.)
| | - Bruno Megarbane
- APHP, Department of Medical and Toxicological Critical Care, Lariboisière Hospital and INSERM UMRS-1144, Université Paris Cité, France (B.M.)
| | - Karim Toumert
- Department of Intensive Care Medicine, Gonesse Hospital, France (K.T.)
| | - Marc Tran
- Department of Intensive Care Medicine, Paris Saint-Joseph Hospital, Paris, France (M.T.)
| | - Guillaume Geri
- APHP, Department of Intensive Care Medicine, Ambroise Paré University Hospital, Boulogne, France (G.G.)
| | - Mehran Monchi
- Department of Intensive Care Medicine, Melun-Senart Hospital, France (M. Monchi)
| | - Eric Bodiguel
- APHP, Emergency Department, Georges Pompidou University Hospital, Paris, France (E. Bodiguel)
| | - Eric Mariotte
- APHP, Department of Intensive Care Medicine, Saint Louis University Hospital, Paris, France (E.M.)
| | - Alexandre Demoule
- APHP, Department of Intensive Care Medicine (R3S) and Sorbonne Université, INSERM, UMRS1158, Pitié-Salpétrière University Hospital, Paris, France (A.D.)
| | - Jonathan Zarka
- Department of Intensive Care Medicine, Lagny Hospital, France (J.Z.)
| | - Jean-Luc Diehl
- APHP, Department of Intensive Care Medicine, Georges Pompidou University Hospital and INSERM UMR_S 1140 Paris, France (J.-L.D.)
| | - Damien Roux
- APHP, Medico-Surgical ICU, Louis Mourier University Hospital, Colombes and Université Paris Cité, IAME, INSERM, UMR1137, France (D.R.)
| | - Eric Barré
- Department of Intensive Care Medicine, Mantes-la-Jolie Hospital, France (E. Barré)
| | - Sebastien Tanaka
- APHP, Department of Anesthesia and Critical Care Medicine, Bichat-Claude Bernard University Hospital and INSERM UMR 1188 DéTROI, Université de la Réunion, Saint-Denis de la Réunion, France (S.T.)
| | - David Osman
- APHP, Department of Intensive Care Medicine, Bicêtre University Hospital, Le Kremlin Bicêtre, France (D.O.)
| | - Pierre Pasquier
- Department of Anesthesiology and Critical Care, Percy Military Training Hospital, Clamart, France (P.P.)
| | - Fariza Lamara
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | | | - Perrine Boursin
- APHP, Department of Neuroradiology, Rothschild Hospital Foundation, Paris, France (M. Mazighi, P.B.)
| | - Stéphane Ruckly
- Department of Biostatistics, ICUREsearch, Paris, France (S.R., Q.S.)
| | - Quentin Staiquly
- Department of Biostatistics, ICUREsearch, Paris, France (S.R., Q.S.)
| | - Jean-François Timsit
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, F75018 Paris, France (R.S., G.P., F.L., J.-F.T.)
| | - France Woimant
- Agence Régionale de Santé Ile-de-France, Paris, France (I.C., F.W.)
| |
Collapse
|
6
|
Thotamgari SR, Babbili A, Bucchanolla P, Thakkar S, Patel HP, Spaseski MB, Graff-Radford J, Rabinstein AA, Asad ZUA, Asirvatham SJ, Holmes DR, Deshmukh A, DeSimone CV. Impact of Atrial Fibrillation on Outcomes in Patients Hospitalized With Nontraumatic Intracerebral Hemorrhage. Mayo Clin Proc Innov Qual Outcomes 2023; 7:222-230. [PMID: 37304065 PMCID: PMC10250577 DOI: 10.1016/j.mayocpiqo.2023.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023] Open
Abstract
Objective To assess the effect of atrial fibrillation (AF) on outcomes in hospitalizations for non-traumatic intracerebral hemorrhage (ICH). Patients and Methods We queried the National Inpatient Sample database between January 1, 2016, and December 31, 2019, to identify hospitalizations with an index diagnosis of non-traumatic ICH using ICD-10 code I61. The cohort was divided into patients with and without AF. Propensity score matching was used to balance the covariates between AF and non-AF groups. Logistic regression was used to analyze the association. All statistical analyses were performed using weighted values. Results Our cohort included 292,725 hospitalizations with a primary discharge diagnosis of non-traumatic ICH. From this group, 59,005 (20%) recorded a concurrent diagnosis of AF, and 46% of these patients with AF were taking anticoagulants. Patients with AF reported a higher Elixhauser comorbidity index (19.8±6.0 vs 16.6±6.4; P<.001) before propensity matching. After propensity matching, the multivariate analysis reported that AF (aOR, 2.34; 95% CI, 2.26-2.42; P<.001) and anticoagulation drug use (aOR, 1.32; 95% CI, 1.28-1.37; P<.001) were independently associated with all-cause in-hospital mortality. Moreover, AF was significantly associated with respiratory failure requiring mechanical ventilation (odds ratio, 1.57; 95% CI, 1.52-1.62; P<.001) and acute heart failure (odds ratio, 1.26; 95% CI, 1.19-1.33; P<.001) compared with the absence of AF. Conclusion These data suggest that non-traumatic ICH hospitalizations with coexistent AF are associated with worse in-hospital outcomes such as higher mortality and acute heart failure.
Collapse
Affiliation(s)
| | - Akhilesh Babbili
- Department of Internal Medicine, Louisiana State University Health, Shreveport
| | | | | | - Harsh P. Patel
- Division of Cardiology, Southern Illinois University, Springfield, IL
| | - Maja B. Spaseski
- Department of Internal Medicine, Weiss Memorial Hospital, Chicago, IL
| | | | | | - Zain Ul Abideen Asad
- Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City
| | | | - David R. Holmes
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | | | | |
Collapse
|
7
|
Gong Y, Qiao J, Huang Y, Zhang Q, Dou Z. Mealcoach: Contact Microphone-Based Meal Supervision For Post-Stroke Dysphagia Patients. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2023; 2023:1-5. [PMID: 38083131 DOI: 10.1109/embc40787.2023.10340832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Meal supervision for post-stroke dysphagia patients significantly improves prognosis during rehabilitation. Aspiration often occurs during meals, which may further incur aspiration pneumonia. Therefore, it's necessary to know the patient's swallowing ability as well as the occurrence of cough. Recently, some researchers have detected swallowing or coughing with audio signals and have made remarkable achievements. However, the users need to stay in quiet environments or wear uncomfortable cervical auscultation devices because the signals generated by swallowing are weak. In this work, we present MealCoach, a system that utilizes a contact microphone to collect high-quality signals to identify the events during meals. We take advantage of the insensitivity of contact microphones to ambient noise for free-living environment supervision. After balancing the wearing experience and identification accuracy, we elaborately select the optimal site to leverage the unique characteristics of cricoid cartilage movement during meals to accurately identify swallowing, coughing, speaking, and other events during meals. We collected data from thirty PSD patients in the hospital and evaluated our system, and the results demonstrate that MealCoach achieves a mean classification accuracy of 95.4%.
Collapse
|
8
|
Anaesthetic and peri-operative management for thrombectomy procedures in stroke patients. Anaesth Crit Care Pain Med 2023; 42:101188. [PMID: 36599377 DOI: 10.1016/j.accpm.2022.101188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/15/2022] [Indexed: 01/02/2023]
Abstract
PURPOSE To provide recommendations for the anaesthetic and peri-operative management for thrombectomy procedure in stroke patients DESIGN: A consensus committee of 15 experts issued from the French Society of Anaesthesia and Intensive Care Medicine (Société Française d'Anesthésie et Réanimation, SFAR), the Association of French-language Neuro-Anaesthetists (Association des Neuro-Anesthésistes Réanimateurs de Langue Francaise, ANARLF), the French Neuro-Vascular Society (Société Francaise de Neuro-Vasculaire, SFNV), the French Neuro-Radiology Society (Société Francaise de Neuro-Radiologie, SFNR) and the French Study Group on Haemostasis and Thrombosis (Groupe Français d'Études sur l'Hémostase et la Thrombose, GFHT) was convened, under the supervision of two expert coordinators from the SFAR and the ANARLF. A formal conflict-of-interest policy was developed at the outset of the process and enforced throughout. The entire guideline elaboration process was conducted independently of any industry funding. The authors were required to follow the principles of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) system to guide their assessment of quality of evidence. METHODS Four fields were defined prior to the literature search: (1) Peri-procedural management, (2) Prevention and management of secondary brain injuries, (3) Management of antiplatelet and anticoagulant treatments, (4) Post-procedural management and orientation of the patient. Questions were formulated using the PICO format (Population, Intervention, Comparison, and Outcomes) and updated as needed. Analysis of the literature was then conducted and the recommendations were formulated according to the GRADE methodology. RESULTS The SFAR/ANARLF/SFNV/SFNR/GFHT guideline panel drew up 18 recommendations regarding anaesthetic management of mechanical thrombectomy procedures. Due to a lack of data in the literature allowing to conclude with high certainty on relevant clinical outcomes, the experts decided to formulate these guidelines as "Professional Practice Recommendations" (PPR) rather than "Formalized Expert Recommendations". After two rounds of rating and several amendments, a strong agreement was reached on 100% of the recommendations. No recommendation could be formulated for two questions. CONCLUSIONS Strong agreement among experts was reached to provide a sizable number of recommendations aimed at optimising anaesthetic management for thrombectomy in patients suffering from stroke.
Collapse
|
9
|
Gkantzios A, Kokkotis C, Tsiptsios D, Moustakidis S, Gkartzonika E, Avramidis T, Aggelousis N, Vadikolias K. Evaluation of Blood Biomarkers and Parameters for the Prediction of Stroke Survivors' Functional Outcome upon Discharge Utilizing Explainable Machine Learning. Diagnostics (Basel) 2023; 13:diagnostics13030532. [PMID: 36766637 PMCID: PMC9914778 DOI: 10.3390/diagnostics13030532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/25/2023] [Accepted: 01/29/2023] [Indexed: 02/04/2023] Open
Abstract
Despite therapeutic advancements, stroke remains a leading cause of death and long-term disability. The quality of current stroke prognostic models varies considerably, whereas prediction models of post-stroke disability and mortality are restricted by the sample size, the range of clinical and risk factors and the clinical applicability in general. Accurate prognostication can ease post-stroke discharge planning and help healthcare practitioners individualize aggressive treatment or palliative care, based on projected life expectancy and clinical course. In this study, we aimed to develop an explainable machine learning methodology to predict functional outcomes of stroke patients at discharge, using the Modified Rankin Scale (mRS) as a binary classification problem. We identified 35 parameters from the admission, the first 72 h, as well as the medical history of stroke patients, and used them to train the model. We divided the patients into two classes in two approaches: "Independent" vs. "Non-Independent" and "Non-Disability" vs. "Disability". Using various classifiers, we found that the best models in both approaches had an upward trend, with respect to the selected biomarkers, and achieved a maximum accuracy of 88.57% and 89.29%, respectively. The common features in both approaches included: age, hemispheric stroke localization, stroke localization based on blood supply, development of respiratory infection, National Institutes of Health Stroke Scale (NIHSS) upon admission and systolic blood pressure levels upon admission. Intubation and C-reactive protein (CRP) levels upon admission are additional features for the first approach and Erythrocyte Sedimentation Rate (ESR) levels upon admission for the second. Our results suggest that the said factors may be important predictors of functional outcomes in stroke patients.
Collapse
Affiliation(s)
- Aimilios Gkantzios
- Department of Neurology, School of Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
- Department of Neurology, Korgialeneio—Benakeio “Hellenic Red Cross” General Hospital of Athens, 11526 Athens, Greece
- Correspondence:
| | - Christos Kokkotis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Dimitrios Tsiptsios
- Department of Neurology, School of Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| | - Serafeim Moustakidis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
- AIDEAS OÜ, Narva mnt 5, 10117 Tallinn, Estonia
| | - Elena Gkartzonika
- School of Philosophy, University of Ioannina, 45110 Ioannina, Greece
| | - Theodoros Avramidis
- Department of Neurology, Korgialeneio—Benakeio “Hellenic Red Cross” General Hospital of Athens, 11526 Athens, Greece
| | - Nikolaos Aggelousis
- Department of Physical Education and Sport Science, Democritus University of Thrace, 69100 Komotini, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, School of Medicine, University Hospital of Alexandroupolis, Democritus University of Thrace, 68100 Alexandroupolis, Greece
| |
Collapse
|
10
|
Zou J, Chen H, Liu C, Cai Z, Yang J, Zhang Y, Li S, Lin H, Tan M. Development and validation of a nomogram to predict the 30-day mortality risk of patients with intracerebral hemorrhage. Front Neurosci 2022; 16:942100. [PMID: 36033629 PMCID: PMC9400715 DOI: 10.3389/fnins.2022.942100] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/15/2022] [Indexed: 12/28/2022] Open
Abstract
Background Intracerebral hemorrhage (ICH) is a stroke syndrome with an unfavorable prognosis. Currently, there is no comprehensive clinical indicator for mortality prediction of ICH patients. The purpose of our study was to construct and evaluate a nomogram for predicting the 30-day mortality risk of ICH patients. Methods ICH patients were extracted from the MIMIC-III database according to the ICD-9 code and randomly divided into training and verification cohorts. The least absolute shrinkage and selection operator (LASSO) method and multivariate logistic regression were applied to determine independent risk factors. These risk factors were used to construct a nomogram model for predicting the 30-day mortality risk of ICH patients. The nomogram was verified by the area under the receiver operating characteristic curve (AUC), integrated discrimination improvement (IDI), net reclassification improvement (NRI), and decision curve analysis (DCA). Results A total of 890 ICH patients were included in the study. Logistic regression analysis revealed that age (OR = 1.05, P < 0.001), Glasgow Coma Scale score (OR = 0.91, P < 0.001), creatinine (OR = 1.30, P < 0.001), white blood cell count (OR = 1.10, P < 0.001), temperature (OR = 1.73, P < 0.001), glucose (OR = 1.01, P < 0.001), urine output (OR = 1.00, P = 0.020), and bleeding volume (OR = 1.02, P < 0.001) were independent risk factors for 30-day mortality of ICH patients. The calibration curve indicated that the nomogram was well calibrated. When predicting the 30-day mortality risk, the nomogram exhibited good discrimination in the training and validation cohorts (C-index: 0.782 and 0.778, respectively). The AUCs were 0.778, 0.733, and 0.728 for the nomogram, Simplified Acute Physiology Score II (SAPSII), and Oxford Acute Severity of Illness Score (OASIS), respectively, in the validation cohort. The IDI and NRI calculations and DCA analysis revealed that the nomogram model had a greater net benefit than the SAPSII and OASIS scoring systems. Conclusion This study identified independent risk factors for 30-day mortality of ICH patients and constructed a predictive nomogram model, which may help to improve the prognosis of ICH patients.
Collapse
Affiliation(s)
- Jianyu Zou
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Huihuang Chen
- Department of Rehabilitation, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Cuiqing Liu
- Department of Nursing, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Zhenbin Cai
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Jie Yang
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Yunlong Zhang
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Shaojin Li
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Hongsheng Lin
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
- *Correspondence: Hongsheng Lin,
| | - Minghui Tan
- Department of Orthopaedics, The First Affiliated Hospital of Jinan University, Guangzhou, China
- Minghui Tan,
| |
Collapse
|
11
|
Naito Y, Morishima N, Oyama H, Iwai K. Inhibitors of early mobilization in the acute phase of intracerebral hemorrhage: A retrospective observational study. J Stroke Cerebrovasc Dis 2022; 31:106592. [PMID: 35780720 DOI: 10.1016/j.jstrokecerebrovasdis.2022.106592] [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: 05/02/2022] [Revised: 05/30/2022] [Accepted: 06/01/2022] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVES The association between early mobilization and functional prognosis in the acute phase of intracerebral hemorrhage has been reported, but only a few studies have investigated the inhibitors of early mobilization in the acute phase of intracerebral hemorrhage. This study aimed to investigate the inhibitors of early mobilization. MATERIALS AND METHODS The study enrolled 322 patients with intracerebral hemorrhage. In the early mobilization group, mobilization was started within 72 h from onset, and in the delayed mobilization group, mobilization was started at or after 72 h from onset. The association between the start of mobilization timing and baseline characteristics was investigated using univariate and multivariate analyses to clarify the inhibitors of early mobilization in the acute phase of intracerebral hemorrhage. RESULTS Significant differences between the early mobilization and delayed mobilization groups were observed in the lesion site, leukocyte count at admission, neutrophil count at admission, C-reactive protein level at admission, surgery, use of mechanical ventilation, consciousness level at admission, hematoma volume, and hematoma growth. In the multiple logistic regression analysis, five items were adopted, namely, low consciousness level at admission, lesion below the tent, surgery, C-reactive protein at admission, and hematoma growth. CONCLUSIONS In this study, low consciousness level at admission, lesion below the tent, surgery, C-reactive protein level at admission, and hematoma growth affected delayed mobilization. Therefore, it is recommended to judge the start of mobilization timing by a systematic evidenced-based assessment for each case.
Collapse
Affiliation(s)
| | | | - Hirohumi Oyama
- Department of Neurosurgery, Toyohashi Municipal Hospital.
| | | |
Collapse
|
12
|
Zhang JZ, Chen H, Wang X, Xu K. Risk factors of mortality and severe disability in the patients with cerebrovascular diseases treated with perioperative mechanical ventilation. World J Clin Cases 2022; 10:5230-5240. [PMID: 35812679 PMCID: PMC9210878 DOI: 10.12998/wjcc.v10.i16.5230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 01/07/2022] [Accepted: 04/04/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The prognosis of cerebrovascular diseases treated with mechanical ventilation during perioperative has not been clearly reported.
AIM To analyze mortality and functional disability and to determine predictors of unfavorable outcome in the patients with cerebrovascular diseases treated with mechanical ventilation.
METHODS A retrospective follow-up study of 111 cerebrovascular disease patients who underwent mechanical ventilation during the perioperative period in the First Hospital of Jilin University from June 2016 to June 2019 was performed. Main measurements were mortality and functional outcome in-hospital and after 3-month follow-up. According to the modified rankin scale (mRS), the functional outcome was divided into three groups: Good recovery (mRS ≤ 3), severe disability (mRS = 4 or 5) and death (mRS = 6). Univariate analysis was used to compare the differences between three functional outcomes. Multivariate logistic regression analysis was used to for risk factors of mortality and severe disability.
RESULTS The average age of 111 patients was 56.46 ± 12.53 years, 59 (53.15%) were males. The mortality of in-hospital and 3-month follow-up were 36.9% and 45.0%, respectively. Of 71 discharged patients, 46.47% were seriously disabled and 12.67% died after three months follow-up. Univariate analysis showed that preoperative glasgow coma scale, operation start time and ventilation reasons had statistically significant differences in different functional outcomes. Multiple logistic regression analysis showed that the cause of ventilation was related to the death and poor prognosis of patients with cerebrovascular diseases. Compared with brainstem compression, the risk of death or severe disability of pulmonary disease, status epilepticus, impaired respiratory center function, and shock were 0.096 (95%CI: 0.028-0.328), 0.026 (95%CI: 0.004-0.163), 0.095 (95%CI: 0.013-0.709), 0.095 (95%CI: 0.020-0.444), respectively.
CONCLUSION The survival rate and prognostic outcomes of patients with cerebrovascular diseases treated with mechanical ventilation during the perioperative period were poor. The reason for mechanical ventilation was a statistically significant predictor for mortality and severe disability.
Collapse
Affiliation(s)
- Jin-Zhu Zhang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Hao Chen
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xin Wang
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Kan Xu
- Department of Neurosurgery, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
13
|
Picard JM, Schmidt C, Sheth KN, Bösel J. Critical Care of the Patient With Acute Stroke. Stroke 2022. [DOI: 10.1016/b978-0-323-69424-7.00056-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
High In-Hospital Mortality Incidence Rate and Its Predictors in Patients with Intracranial Hemorrhage Undergoing Endotracheal Intubation. Neurol Int 2021; 13:671-681. [PMID: 34940750 PMCID: PMC8707604 DOI: 10.3390/neurolint13040064] [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: 10/17/2021] [Revised: 11/16/2021] [Accepted: 11/19/2021] [Indexed: 11/18/2022] Open
Abstract
(1) Background: The goal of this study was to determine the incidence of in-hospital mortality and to investigate its predictors in patients with a primary intracranial hemorrhage (ICH) undergoing endotracheal intubation. (2) Methods: This retrospective study, between July 2018 to July 2019, recruited patients who were diagnosed with a primary ICH and who were intubated during treatment in our institution. The outcome variable was in-hospital mortality, known as 30-day mortality, in patients with ICH undergoing endotracheal intubation. Multivariable analyses were performed to identify the prediction of in-hospital mortality. (3) Results: A total of 180 patients with ICH undergoing endotracheal intubation were included, with a mean (SD) age of 62.64 (13.82) years. A total of 73.33% were female, and 71.11% of the patients were indicated for intubation due to neurological reasons. The in-hospital mortality rate, following endotracheal intubation, was 58.33%. In a reduced model using a stepwise backward selection strategy with p values < 0.2, independent predictors of in-hospital mortality were brain herniations on cranial CT scans (OR: 10.268, 95% CI: 2.749–38.344), lower Glasgow coma scale (CGS) scores before intubation (OR: 0.614, 95% CI: 0.482–0.782), and the loss of the vertical oculocephalic reflex before intubation (OR: 6.288, 95% CI: 2.473–15.985). Conclusions: The in-hospital mortality rate was comparable to that in the early evidence, but was significantly higher compared to recent reports. We infer that brain herniations on cranial CT imaging, lower CGS scores before intubation, and the loss of the vertical oculocephalic reflex before intubation could be used to approximately predict in-hospital mortality in patients with primary ICH undergoing endotracheal intubation. These considerations can help guide clinical decisions and community stroke discussions.
Collapse
|
15
|
Wu C, Zhang Y, Yang L, Shen F, Ma C, Shen M. Effect of Capsaicin Atomization-Induced Cough on Sputum Excretion in Tracheotomized Patients After Hemorrhagic Stroke: A Randomized Controlled Trial. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:4085-4095. [PMID: 34694869 DOI: 10.1044/2021_jslhr-21-00151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Background Timely and effective removal of respiratory secretions is of great significance for tracheotomized patients. The purpose of this study is to investigate the effectiveness of capsaicin nebulization to stimulate cough to promote early clearance of respiratory secretions in tracheotomized patients after hemorrhagic stroke. Method This study implemented a randomized controlled design. Sixty-three patients who were tracheotomized following a hemorrhagic stroke completed this randomized controlled trial. In the control group, 33 cases were given a routine care after tracheotomy. In the intervention group, 30 cases were given a capsaicin solution nebulization in addition to the routine care. The daily sputum output and the number of sputum suctioning were observed. The differences in sputum viscosity, cough function, and Clinical Pulmonary Infection Score (CPIS) were compared between the two groups before and after the intervention. Vital sign changes during capsaicin nebulization and suctioning were compared between the two groups in a pilot study. Results The daily sputum output of the capsaicin intervention group was significantly higher than that of the control group (p < .05). The number of sputum suctioning of capsaicin group was less than that of the control group after intervention (p < .05). The CPIS score of the capsaicin group was lower than that of the control group (p < .05) after a 1-week intervention. Patients' heart rate, respiratory rate, and oxygen saturation during capsaicin nebulization were not statistically different from those during routine sputum suctioning (p > .05). Conclusions Capsaicin atomization-induced cough can effectively promote sputum excretion of hemorrhagic stroke patients undergoing tracheotomy and has a good safety profile. The Clinical Trial registration number of this study is ChiCTR2000037772 (http://www.chictr.org.cns). Supplemental Material https://doi.org/10.23641/asha.16821352.
Collapse
Affiliation(s)
- Chao Wu
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yijie Zhang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Li Yang
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Fang Shen
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Chen Ma
- Department of Neurosurgery, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Meifen Shen
- Nursing Department, Dushu Lake Affiliated Hospital of Soochow University, Suzhou, China
| |
Collapse
|
16
|
Huang C, Chen JC. The Long-Term Survival of Intracranial Hemorrhage Patients Successfully Weaned from Prolonged Mechanical Ventilation. Int J Gen Med 2021; 14:1197-1203. [PMID: 33854361 PMCID: PMC8039841 DOI: 10.2147/ijgm.s304228] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 03/12/2021] [Indexed: 12/30/2022] Open
Abstract
Background Ninety-one intracranial hemorrhage prolonged mechanical ventilation patients were successfully weaned from the ventilator. No article had discussed the factors related to 1-year survival in successfully weaned prolonged mechanical ventilation patients with intracranial hemorrhage. This study aimed to evaluate the factors influencing the one-year survival of successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients. The identification of patients with a poor long-term prognosis could guide long-term care decisions after discharge in such patients. Patients and Methods We performed this retrospective study on the respiratory care center of Dalin Tzu Chi hospital and enrolled all successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients between 1 January 2012 and 31 December 2017. We analyzed data including age, gender, comorbidities, intracranial hemorrhage type, spontaneous or traumatic intracranial hemorrhage, location of intracerebral hemorrhage, presence or not of an intraventricular hemorrhage, Glasgow Coma Scale, receipt or not of intracranial hemorrhage surgery, receipt or not of tracheostomy, long-term survival, and end-of-life decisions. Results We had long-term follow-up data on 69 of these successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients. The 1-year survival rate of successfully weaned patients was 43.5%. The factors unrelated to the 1-year survival rate were comorbidities, intracranial hemorrhage type, spontaneous or traumatic intracranial hemorrhage, location of the intracerebral hemorrhage, presence or not of an intraventricular hemorrhage, intracranial hemorrhage surgery, and tracheostomy. Four factors were independently associated with the 1-year survival rate of these patients: Glasgow Coma Scale score at discharge from the respiratory care center, age ≥ 65 years, signed do-not-resuscitate and do-not-intubate orders, and the absence of comorbidity. Conclusion This study emphasizes an important key factor in terms of the survival of successfully weaned intracranial hemorrhage prolonged mechanical ventilation patients. The patient’s Glasgow Coma Scale score at discharge from the respiratory care center is an important predictor of outcomes. These results can help physician better plan the clinical course for intracranial hemorrhage prolonged mechanical ventilation patients.
Collapse
Affiliation(s)
- Chienhsiu Huang
- Department of Internal Medicine, Division of Chest Medicine, Dalin Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Chiayi, Taiwan
| | - Jin-Cherng Chen
- Department of Surgery, Division of Neurosurgery, Dalin Tzu Chi Hospital, Chiayi, Taiwan.,School of Medicine, Tzuchi University, Hualien, Taiwan
| |
Collapse
|
17
|
Sonneville R, Mazighi M, Bresson D, Crassard I, Crozier S, de Montmollin E, Degos V, Faugeras F, Gayat E, Josse L, Lamy C, Magalhaes E, Maldjian A, Ruckly S, Servan J, Vassel P, Vigué B, Timsit JF, Woimant F. Outcomes of Acute Stroke Patients Requiring Mechanical Ventilation: Study Protocol for the SPICE Multicenter Prospective Observational Study. Neurocrit Care 2021; 32:624-629. [PMID: 32026446 DOI: 10.1007/s12028-019-00907-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Care pathways and long-term outcomes of acute stroke patients requiring mechanical ventilation have not been thoroughly studied. METHODS AND RESULTS Stroke Prognosis in Intensive Care (SPICE) is a prospective multicenter cohort study which will be conducted in 34 intensive care units (ICUs) in the Paris, France area. Patients will be eligible if they meet all of the following inclusion criteria: (1) age of 18 years or older; (2) acute stroke (i.e., ischemic stroke, intracranial hemorrhage, or subarachnoid hemorrhage) diagnosed on neuroimaging; (3) ICU admission within 7 days before or after stroke onset; and (4) need for mechanical ventilation for a duration of at least 24 h. Patients will be excluded if they meet any of the following: (1) stroke of traumatic origin; (2) refusal to participate; and (3) privation of liberty by administrative or judicial decision. The primary endpoint is poor functional outcome at 1 year, defined by a score of 4 to 6 on the modified Rankin scale (mRS), indicating severe disability or death. Main secondary endpoints will include decisions to withhold or withdraw care, mRS scores at 3 and 6 months, and health-related quality of life at 1 year. CONCLUSIONS The SPICE multicenter study will investigate 1-year outcomes, ethical issues, as well as care pathways of acute stroke patients requiring invasive ventilation in the ICU. Gathered data will delineate human resources and facilities needs for adequate management. The identification of prognostic factors at the acute phase will help to identify patients who may benefit from prolonged intensive care and rehabilitation. TRIAL REGISTRATION NCT03335995.
Collapse
Affiliation(s)
- R Sonneville
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France. .,APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
| | - M Mazighi
- INSERM UMR1148, Team 6, Université de Paris, 75018, Paris, France.,Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Department of Neuroradiology, Rothschild Hospital, Paris, France
| | - D Bresson
- Department of Neurosurgery, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - I Crassard
- Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Agence Régionale de Santé, Paris, France
| | - S Crozier
- Department of Neurology, Pitié-Salpétrière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - E de Montmollin
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - V Degos
- Department of Critical Care, Anesthesia and Perioperative Medicine, Pitié-Salpétrière Hospital, Assistance Publique - Hôpitaux de Paris-Sorbonne University, Paris, France.,GRC ARPE, Sorbonne University, Paris, France
| | - F Faugeras
- Department of Neurology, Henri Mondor University Hospital, Assistance Publique - Hôpitaux de Paris, Créteil, France.,INSERM U955, Institut Mondor de Recherche Biomédicale, EQuipe E01 Neuropsychologie Interventionnelle, 94000, Créteil, France
| | - E Gayat
- Department of Anesthesiology and Critical Care, DMU Parabol, APHP Nord, Université de Paris, Paris, France.,UMR-S 942, Inserm, MASCOT, Paris, France
| | - L Josse
- Department of Rehabilitation Medicine, Fernand Widal University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - C Lamy
- Department of Neurology, Saint Anne Hospital, Paris, France.,INSERM U1266, Université Paris Descartes, Paris, France
| | - E Magalhaes
- Department of Intensive Care Medicine, Sud Francilien Hospital, Corbeil, France
| | - A Maldjian
- Department of Rehabilitation Medicine, 317 Lostihuel Braz, 56250, Sulniac, France
| | - S Ruckly
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - J Servan
- Department of Neurology, André Mignot Hospital, Le Chesnay, France
| | - P Vassel
- Department of Rehabilitation Medicine, Le Parc, Pontault-Combault, France
| | - B Vigué
- Department of Anesthesiology and Critical Care, Kremlin Bicêtre University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France
| | - J-F Timsit
- APHP, Department of Intensive Care Medicine, Bichat-Claude Bernard University Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,INSERM UMR1137, Team 6, Université de Paris, 75018, Paris, France
| | - F Woimant
- Department of Neurology, Lariboisière University Hospital, Assistance Publique - Hôpitaux de Paris, Paris, France.,Agence Régionale de Santé, Paris, France
| | | |
Collapse
|
18
|
Savla P, Toor H, Podkovik S, Mak J, Kal S, Soliman C, Ku A, Majeed G, Miulli DE. A Reassessment of Weaning Parameters in Patients With Spontaneous Intracerebral Hemorrhage. Cureus 2021; 13:e12539. [PMID: 33564535 PMCID: PMC7863057 DOI: 10.7759/cureus.12539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Background and purpose Patients with spontaneous intracerebral haemorrhage have significant morbidity and mortality. One aspect of their care is the need for mechanical ventilation. Extubating a patient safely and efficiently is important in advancing their care; however, traditional extubation criteria using the rapid shallow breathing index and negative inspiratory force do not predict success in these patients as well as they do in other intubated patients. This study aimed to evaluate these criteria in patients with spontaneous intracerebral haemorrhage to improve the extubation success rate. Methods We conducted a retrospective chart review of patients with spontaneous intracerebral haemorrhage (sICH) who underwent spontaneous breathing trials from 2018 to 2020. Twenty-nine patients met the inclusion criteria, and of these 29, 20 had a trial of extubation. Rapid shallow breathing index (RSBI), negative inspiratory force (NIF), and cuff leak were recorded to analyze breathing parameters at the time of extubation. Patients who required reintubation were noted. Results All trials of extubation required a cuff leak. Using RSBI, patients with values <105 or <85, as the only other extubation criteria, were associated with a 70.6% and 71.4% success rate, respectively. With RSBI <105 and NIF <-25 cm water, the success rate was 88.9%. Any patient with a cuff leak that had a NIF <-30 had a success rate of 100%, regardless of RSBI. Conclusion The RSBI was not a reliable isolated measure to predict 100% extubation success. Using a NIF <-30 predicts a 100% extubation success rate if a cuff leak is present. This demonstrates that the NIF may be a more useful metric in sICH patients, as it accounts for patient participation and innate ability to draw a breath spontaneously. Future studies are warranted to evaluate further and optimize the extubation criteria in these patients.
Collapse
Affiliation(s)
- Paras Savla
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Harjyot Toor
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Stacey Podkovik
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Joseph Mak
- Internal Medicine, University of California Riverside School of Medicine, Riverside, USA
| | - Sarala Kal
- Neurosurgery, St. George's University School of Medicine, St. George, GRD
| | - Chantal Soliman
- Neurosurgery, St. George's University School of Medicine, St. George, GRD
| | - Andrew Ku
- Neurosurgery, California University of Science and Medicine, Colton, USA
| | - Gohar Majeed
- Neurosurgery, Riverside University Health System Medical Center, Moreno Valley, USA
| | - Dan E Miulli
- Neurosurgery, Arrowhead Regional Medical Center, Colton, USA
| |
Collapse
|
19
|
Cheng W, Chen L, Yu H, Lu D, Yu R, Chen J. Value of Combining of the NLR and the Fibrinogen Level for Predicting Stroke-Associated Pneumonia. Neuropsychiatr Dis Treat 2021; 17:1697-1705. [PMID: 34093013 PMCID: PMC8169056 DOI: 10.2147/ndt.s311036] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 05/14/2021] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To evaluate the value of the NLR (neutrophil-to-lymphocyte ratio) and the fibrinogen level in predicting stroke-associated pneumonia (SAP) in acute ischemic stroke (AIS) patients. PATIENTS AND METHODS In total, we enrolled 734 medical-ward patients with AIS in this retrospective study. Patients were divided into SAP (n=52) and non-SAP (n=682) groups according to the diagnostic criteria of SAP. Binary logistic regression analysis was used to analyze the relationship between the NLR, serum fibrinogen concentration and SAP. Receiver operating characteristic (ROC) curves were generated to identify the optimal cutoff points and assess the diagnostic value of the NLR, serum fibrinogen and the combination of NLR and fibrinogen in predicting SAP. RESULTS SAP occurred in 52 (7.08%) patients among the enrolled AIS patients. Binary logistic regression analysis showed that the NLR (odds ratio [OR]: 2.802, 95% confidence interval [CI]: 1.302-6.032, P=0.008) and serum fibrinogen concentration (OR: 7.850, 95% CI: 3.636-16.949, P=0.000) were independently associated with a higher risk of SAP incidence after adjusting for age, sex, ASPECT score, atrial fibrillation, nasogastric tube feeding, LDL-C and TC, temperature at admission and mechanical ventilation. The optimal cutoff points of the NLR and serum fibrinogen to distinguish SAP among AIS patients were 3.603 (AUC, 0.690; NPV, 95.78; PPV, 19.01) and 4.595 (AUC, 0.727; NPV, 95.60; PPV, 24.49), respectively. When the combination of NLR and fibrinogen was used to predict SAP, the optimal cutoff points were >2.436 for NLR and >3.24 for fibrinogen (AUC, 0.758; NPV, 98.50; PPV, 11.80). CONCLUSION The NLR and serum fibrinogen might have greater negative diagnostic value in predicting SAP among AIS patients. Combining the NLR and serum fibrinogen showed an increased AUC for predicting SAP among AIS patients.
Collapse
Affiliation(s)
- Wei Cheng
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Lichang Chen
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Huapeng Yu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Dongzhu Lu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Rong Yu
- Department of Respiratory Medicine, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| | - Jian Chen
- Department of Neurology, Zhujiang Hospital, Southern Medical University, Guangzhou, People's Republic of China
| |
Collapse
|
20
|
Prevalence, Predictors, and Outcomes of Prolonged Mechanical Ventilation After Endovascular Stroke Therapy. Neurocrit Care 2020; 34:1009-1016. [PMID: 33089433 PMCID: PMC7577519 DOI: 10.1007/s12028-020-01125-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 09/30/2020] [Indexed: 11/09/2022]
Abstract
Background To investigate the rates, predictors, and outcomes of prolonged mechanical ventilation (≥ 96 h) following endovascular treatment (EVT) of ischemic stroke. Methods Hospitalizations with acute ischemic stroke and EVT were identified using validated codes in the National Inpatient Sample (2010–2015). The primary outcome was prolonged mechanical ventilation defined as ventilation ≥ 96 consecutive hours. We compared hospitalizations involving prolonged ventilation following EVT with those that did not involve prolonged ventilation. Propensity score matching was used to adjust for differences between groups. Clinical predictors of prolonged ventilation were assessed using multivariable conditional logistic regression analyses. Results Among the 34,184 hospitalizations with EVT, 5087 (14.9%) required prolonged mechanical ventilation. There was a decline in overall intubation and prolonged ventilation during the study period. On multivariable analysis, history of heart failure [OR 1.28 (95% CI 1.05–1.57)] and diabetes [OR 1.22 (95% CI 1–1.50)] was independent predictors of prolonged ventilation following EVT. In a sensitivity analysis of anterior circulation stroke only, heart failure [OR 1.3 (95% CI 1.10–1.61)], diabetes [OR 1.25 (95% CI 1.01–1.57)], and chronic lung disease [OR 1.31 (95% CI 1.03–1.66)] were independent predictors of prolonged ventilation. The weighted proportions of in-hospital mortality, post-procedural shock, acute renal failure, and intracerebral hemorrhage were higher in the prolonged ventilation group. Conclusions Among a nationally representative sample of hospitalizations, nearly one-in-six patients had prolonged mechanical ventilation after EVT. Heart failure and diabetes were significantly associated with prolonged mechanical ventilation following EVT. Prolonged ventilation was associated with significant increase in in-hospital mortality and morbidity. Electronic supplementary material The online version of this article (10.1007/s12028-020-01125-9) contains supplementary material, which is available to authorized users.
Collapse
|
21
|
de Montmollin E, Terzi N, Dupuis C, Garrouste-Orgeas M, da Silva D, Darmon M, Laurent V, Thiéry G, Oziel J, Marcotte G, Gainnier M, Siami S, Sztrymf B, Adrie C, Reignier J, Ruckly S, Sonneville R, Timsit JF. One-year survival in acute stroke patients requiring mechanical ventilation: a multicenter cohort study. Ann Intensive Care 2020; 10:53. [PMID: 32383104 PMCID: PMC7205929 DOI: 10.1186/s13613-020-00669-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Accepted: 04/26/2020] [Indexed: 12/15/2022] Open
Abstract
Background Most prognostic studies in acute stroke patients requiring invasive mechanical ventilation are outdated and have limitations such as single-center retrospective designs. We aimed to study the association of ICU admission factors, including the reason for intubation, with 1-year survival of acute stroke patients requiring mechanical ventilation. Methods We conducted a secondary data use analysis of a prospective multicenter database (14 ICUs) between 1997 and 2016 on consecutive ICU stroke patients requiring mechanical ventilation at admission. We excluded patients with stroke of traumatic origin, subdural hematoma or cerebral venous thrombosis. The primary outcome was survival 1 year after ICU admission. Factors associated with the primary outcome were identified using a multivariable Cox model stratified on inclusion center. Results We identified 419 patients (age 68 [58–76] years, males 60%) with a Glasgow coma score (GCS) of 4 [3–8] at admission. Stroke subtypes were acute ischemic stroke (AIS, 46%), intracranial hemorrhage (ICH, 42%) and subarachnoid hemorrhage (SAH, 12%). At 1 year, 96 (23%) patients were alive. Factors independently associated with decreased 1-year survival were ICH and SAH stroke subtypes, a lower GCS score at admission, a higher non-neurological SOFA score. Conversely, patients receiving acute-phase therapy had improved 1-year survival. Intubation for acute respiratory failure or coma was associated with comparable survival hazard ratios, whereas intubation for seizure was not associated with a worse prognosis than for elective procedure. Survival did not improve over the study period, but patients included in the most recent period had more comorbidities and presented higher severity scores at admission. Conclusions In acute stroke patients requiring mechanical ventilation, the reason for intubation and the opportunity to receive acute-phase stroke therapy were independently associated with 1-year survival. These variables could assist in the decision process regarding the initiation of mechanical ventilation in acute stroke patients.
Collapse
Affiliation(s)
- Etienne de Montmollin
- Université de Paris, UMR 1137, IAME, Paris, France. .,APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris, France.
| | - Nicolas Terzi
- Medical Intensive Care Unit, Grenoble University Hospital, La Tronche, France
| | - Claire Dupuis
- Medical Intensive Care Unit, Gabriel Montpied University Hospital, Clermont-Ferrand, France
| | | | - Daniel da Silva
- Intensive Care Unit, Delafontaine Hospital, Saint-Denis, France
| | - Michaël Darmon
- Medical Intensive Care Unit, Saint-Louis Hospital, Paris, France
| | | | | | - Johana Oziel
- APHP, Intensive Care Unit, Avicenne Hospital, Bobigny, France
| | | | - Marc Gainnier
- Intensive Care Unit, La Timone Hospital, Marseille, France
| | - Shidasp Siami
- Intensive Care Unit, Sud-Essonne Hospital, Etampes, France
| | - Benjamin Sztrymf
- APHP, Intensive Care Unit, Antoine Béclère Hospital, Clamart, France
| | | | - Jean Reignier
- Medical Intensive Care Unit, Nantes University Hospital, Nantes, France
| | | | - Romain Sonneville
- APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris, France.,Université de Paris, UMR 1148, LVTS, Paris, France
| | - Jean-François Timsit
- Université de Paris, UMR 1137, IAME, Paris, France.,APHP, Medical and Infectious Diseases Intensive Care Unit, Bichat-Claude Bernard Hospital, 46 Rue Henri Huchard, 75018, Paris, France
| | | |
Collapse
|
22
|
González-Cordero G, Garduño-Chávez BI, Palacios-Ríos D, Estrada-Solís YN, Rodríguez-Sánchez IP, Martínez-Ponce-de-León ÁR. Fast-track extubation in patients after intracranial hematoma surgery. Exp Ther Med 2020; 19:2563-2569. [PMID: 32256735 PMCID: PMC7098210 DOI: 10.3892/etm.2020.8507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/07/2019] [Indexed: 12/18/2022] Open
Abstract
Early extubation, also known as fast track, is desirable after intracranial hematoma surgery to avoid ventilator-associated complications associated with admission to an intensive care unit (ICU). The objective of the present study was to determine whether ICU stay and ventilator-associated complications are reduced in patients who received surgery for intracranial hematoma if they are extubated early. A total of 17 patients were randomly assigned to two groups: In Group 1, patients were extubated early or using the fast track method, while those in Group 2 were conventionally extubated at a later stage and were managed at the ICU. Patients from both groups were assessed on admission to the operating room per the established standards and after the selection criteria had been confirmed, general anesthesia was applied. Extubation time and hemodynamic stability (number of anesthetic adjustments required to maintain hemodynamic parameters within 20% of the predicted values) were assessed post-operatively. Patients in the conventional group (n=10) were transferred to the ICU and extubated at 8 h post-operatively; hemodynamic stability and the presence of complications were evaluated. The fast track group had no complications associated with ventilation or any other parameter. All patients extubated in a conventional manner and who were transferred to the ICU presented with complications, including seizures, aspiration, atelectasis or failed extubation. In the future, fast track should be regarded as a routine technique in patients who meet the required criteria, so that they may be discharged quickly and with fewer complications. The present study was authorized by the ethics committee of the hospital and the research sub-directorate with the number AN14-003; it was submitted to and approved by the ISRCTN registry for clinical trials (ID, ISRCTN16924441).
Collapse
Affiliation(s)
- Gustavo González-Cordero
- Servicio de Anestesiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario 'Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León 64460, Mexico
| | - Belia Inés Garduño-Chávez
- Servicio de Anestesiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario 'Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León 64460, Mexico
| | - Dionisio Palacios-Ríos
- Servicio de Anestesiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario 'Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León 64460, Mexico
| | - Yesenia Nohemí Estrada-Solís
- Servicio de Anestesiología, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario 'Dr Jose Eleuterio Gonzalez, Monterrey, Nuevo León 64460, Mexico
| | - Iram Pablo Rodríguez-Sánchez
- Laboratorio de Fisiología Molecular y Estructural, Universidad Autónoma de Nuevo León, Facultad de Ciencias Biológicas, San Nicolás de los Garza, Nuevo León 66450, Mexico
| | - Ángel Raymundo Martínez-Ponce-de-León
- Servicio de Neurocirugía, Universidad Autónoma de Nuevo León, Facultad de Medicina y Hospital Universitario 'Dr Jose Eleuterio Gonzalez', Monterrey, Nuevo León 64460, Mexico
| |
Collapse
|
23
|
Huang GQ, Lin YT, Wu YM, Cheng QQ, Cheng HR, Wang Z. Individualized Prediction Of Stroke-Associated Pneumonia For Patients With Acute Ischemic Stroke. Clin Interv Aging 2019; 14:1951-1962. [PMID: 31806951 PMCID: PMC6844226 DOI: 10.2147/cia.s225039] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Accepted: 10/15/2019] [Indexed: 12/21/2022] Open
Abstract
Background Stroke-associated pneumonia (SAP) is a serious and common complication in stroke patients. Purpose We aimed to develop and validate an easy-to-use model for predicting the risk of SAP in acute ischemic stroke (AIS) patients. Patients and methods The nomogram was established by univariate and multivariate binary logistic analyses in a training cohort of 643 AIS patients. The prediction performance was determined based on the receiver operating characteristic curve (ROC) and calibration plots in a validation cohort (N=340). Individualized clinical decision-making was conducted by weighing the net benefit in each AIS patient by decision curve analysis (DCA). Results Seven predictors, including age, NIHSS score on admission, atrial fibrillation, nasogastric tube intervention, mechanical ventilation, fibrinogen, and leukocyte count were incorporated to construct the nomogram model. The nomogram showed good predictive performance in ROC analysis [AUROC of 0.845 (95% CI: 0.814-0.872) in training cohort, and 0.897 (95% CI: 0.860-0.927) in validation cohort], and was superior to the A2DS2, ISAN, and PANTHERIS scores. Furthermore, the calibration plots showed good agreement between actual and nomogram-predicted SAP probabilities, in both training and validation cohorts. The DCA confirmed that the SAP nomogram was clinically useful. Conclusion Our nomogram may provide clinicians with a simple and reliable tool for predicting SAP based on routinely available data. It may also assist clinicians with respect to individualized treatment decision-making for patients differing in risk level.
Collapse
Affiliation(s)
- Gui-Qian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, People's Republic of China
| | - Yu-Ting Lin
- Department of Pulmonary Medicine, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, People's Republic of China
| | - Yue-Min Wu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, People's Republic of China
| | - Qian-Qian Cheng
- School of Mental Health, Wenzhou Medical University, Wenzhou 325000, Zhejiang, People's Republic of China
| | - Hao-Ran Cheng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, People's Republic of China
| | - Zhen Wang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou 325000, Zhejiang, People's Republic of China
| |
Collapse
|
24
|
Mullaguri N, Khan Z, Nattanmai P, Newey CR. Extubating the Neurocritical Care Patient: A Spontaneous Breathing Trial Algorithmic Approach. Neurocrit Care 2019; 28:93-96. [PMID: 28948503 DOI: 10.1007/s12028-017-0398-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Delaying extubation in neurologically impaired patients otherwise ready for extubation is a source for significant morbidity, mortality, and costs. There is no consensus to suggest one spontaneous breathing trial (SBT) over another in predicting extubation success. We studied an algorithm using zero pressure support and zero positive end-expiratory pressure (ZEEP) SBT followed by 5-cm H2O pressure support and 5-cm H2O positive end-expiratory pressure (i.e., 5/5) SBT in those who failed ZEEP SBT. METHODS This is a retrospective analysis of intubated patients in a neurosciences intensive care unit. All eligible patients were initially challenged with ZEEP SBT. If failed, a 5/5 SBT was immediately performed. If passed either the ZEEP SBT or the subsequent 5/5 SBT, patients were liberated from mechanical ventilation. RESULTS In total, 108 adult patients were included. The majority of patients were successfully liberated from mechanical ventilation using ZEEP SBT alone (82.4%; p = 0.0007). Fifteen (13.8%) patients failed ZEEP SBT but immediately passed 5/5 SBT (p = 0.0005). One patient (0.93%) required reintubation. We found high sensitivity of this extubation algorithm (100; 95% CI 95.94-100%) but poor specificity (6.67; 95% CI 0.17-31.95%). CONCLUSION This study showed that the majority of patients could be successfully liberated from mechanical ventilation after a ZEEP SBT. In those who failed, a 5/5 SBT increased the successful liberation from mechanical ventilation.
Collapse
Affiliation(s)
- Naresh Mullaguri
- Department of Neurology, University of Missouri, 5 Hospital Drive CE 540, Columbia, MO, 65211, USA
| | - Zalan Khan
- Department of Neurology, University of Missouri, 5 Hospital Drive CE 540, Columbia, MO, 65211, USA
| | - Premkumar Nattanmai
- Department of Neurology, University of Missouri, 5 Hospital Drive CE 540, Columbia, MO, 65211, USA
| | - Christopher R Newey
- Department of Neurology, University of Missouri, 5 Hospital Drive CE 540, Columbia, MO, 65211, USA.
| |
Collapse
|
25
|
Intracerebral Hemorrhage in the Neurocritical Care Unit. Neurocrit Care 2019. [DOI: 10.1017/9781107587908.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
26
|
Hostettler IC, Seiffge DJ, Werring DJ. Intracerebral hemorrhage: an update on diagnosis and treatment. Expert Rev Neurother 2019; 19:679-694. [PMID: 31188036 DOI: 10.1080/14737175.2019.1623671] [Citation(s) in RCA: 149] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Spontaneous non-traumatic intracerebral hemorrhage (ICH) is most often caused by small vessel diseases: deep perforator arteriopathy (hypertensive arteriopathy) or cerebral amyloid angiopathy (CAA). Although ICH accounts for only 10-15% of all strokes it causes a high proportion of stroke mortality and morbidity, with few proven effective acute or preventive treatments. Areas covered: We conducted a literature search on etiology, diagnosis, treatment, management and current clinical trials in ICH. In this review, We describe the causes, diagnosis (including new brain imaging biomarkers), classification, pathophysiological understanding, treatment (medical and surgical), and secondary prevention of ICH. Expert opinion: In recent years, significant advances have been made in deciphering causes, understanding pathophysiology, and improving acute treatment and prevention of ICH. However, the clinical outcome remains poor and many challenges remain. Acute interventions delivered rapidly (including medical therapies - targeting hematoma expansion, hemoglobin toxicity, inflammation, edema, anticoagulant reversal - and minimally invasive surgery) are likely to improve acute outcomes. Improved classification of the underlying arteriopathies (from neuroimaging and genetic studies) and prognosis should allow tailored prevention strategies (including sustained blood pressure control and optimized antithrombotic therapy) to further improve longer-term outcome in this devastating disease.
Collapse
Affiliation(s)
- Isabel C Hostettler
- a UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation , UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery , London , UK
| | - David J Seiffge
- a UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation , UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery , London , UK.,b Stroke Center, Department of Neurology and Department of Clinical Research , University of Basel and University Hospital Basel , Basel , Switzerland
| | - David J Werring
- a UCL Stroke Research Centre, Department of Brain Repair and Rehabilitation , UCL Institute of Neurology and the National Hospital for Neurology and Neurosurgery , London , UK
| |
Collapse
|
27
|
Reyes R, Viswanathan M, Aiyagari V. An update on neurocritical care for intracerebral hemorrhage. Expert Rev Neurother 2019; 19:557-578. [PMID: 31092052 DOI: 10.1080/14737175.2019.1618709] [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] [Indexed: 02/06/2023]
Abstract
Introduction: Intracerebral hemorrhage remains one of the leading causes of death and disability worldwide with few established interventions that improve neurologic outcome. Research dedicated to better understanding and treating hemorrhagic strokes has multiplied in the past decade. Areas Covered: This review aims to discuss the current landscape of management of intracerebral hemorrhage in a critical care setting and provide updates regarding developments in therapeutic interventions and targets. PubMed was utilized to review recent literature, with a focus on large trials and meta-analyses, which have shaped current practice. Published committee guidelines were also included. A focus was placed on research published after 2015 in an effort to supplement previous reviews included in this publication. Expert Opinion: Literature pertaining to ICH management has allowed for a greater understanding of ineffective strategies as opposed to those of benefit. Despite this, mortality has improved worldwide, which may be the result of growing research efforts. Areas of future research that will impact mortality and improve neurologic outcomes include prevention of hematoma expansion, optimization of blood pressure targets, effective coagulopathy reversal, and minimally invasive surgical techniques to reduce hematoma burden.
Collapse
Affiliation(s)
- Ranier Reyes
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Meera Viswanathan
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| | - Venkatesh Aiyagari
- a Neurological Surgery & Neurology and Neurotherapeutics , The University of Texas Southwestern Medical Center , Dallas , TX , USA
| |
Collapse
|
28
|
Tanwar G, Singh U, Kundra S, Chaudhary AK, Kaytal S, Grewal A. Evaluation of airway care score as a criterion for extubation in patients admitted in neurosurgery intensive care unit. J Anaesthesiol Clin Pharmacol 2019; 35:85-91. [PMID: 31057247 PMCID: PMC6495608 DOI: 10.4103/joacp.joacp_362_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background and Aims: Early extubation in neurocritical patients has several potential benefits. Glasgow Coma Scale (GCS) is a crude measure of neurologic function in these patients and a low GCS score does not necessarily mean contraindication for extubation. Data on patients with neurosurgical or neurological pathology undergoing early extubation utilizing the airway score criteria is limited. Hence, this study was conceived to assess the usefulness of modified airway care score (ACS) as a criterion for successful extubation of neurocritical patients whilst comparing various outcomes. Material and Methods: One hundred and twenty four patient who underwent endotracheal intubation in the neurocritical care unit were enrolled in this prospective observational study over a period of 12 months. Patients were randomly enrolled into either the study group patients (S), who were extubated immediately after a successful spontaneous breathing trial (SBT) and an ACS ≤7 or into the control group (N), wherein patients were extubated/tracheostomized at discretion of the attending neurointensivist. Both groups were observed for comparison of preset outcomes and analyzed statistically. Results: Patients of study group experienced a statistically significant shorter extubation delay (3.28 h vs 25.41 h) compared to the control group. Successful extubation rate was significantly higher and reintubation rate was significantly lower in study group (6.6% vs 29.3%). Incidence of nosocomial pneumonia, duration of ICU stay and overall duration of mechanical ventilation were significantly lower in the study group. ACS and GCS had a negative correlation at the time of extubation. Conclusion: ACS can be used as a criterion for successful early extubation of neurocritical patients.
Collapse
Affiliation(s)
- Gayatri Tanwar
- Department of Anaesthesiology, Dr. S.N. Medical College, Jodhpur, Rajasthan, India
| | - Udeyana Singh
- Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sandeep Kundra
- Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Ashwani K Chaudhary
- Department of Neurosurgery, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Sunil Kaytal
- Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - Anju Grewal
- Department of Anaesthesiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| |
Collapse
|
29
|
Ventilatory Strategies in the Brain-injured Patient. Int Anesthesiol Clin 2019; 56:131-146. [PMID: 29227316 DOI: 10.1097/aia.0000000000000169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
30
|
Li J, Zhang P, Tao W, Yi X, Zhang J, Wang C. Age-specific clinical characteristics and outcome in patients over 60 years old with large hemispheric infarction. Brain Behav 2018; 8:e01158. [PMID: 30566281 PMCID: PMC6305916 DOI: 10.1002/brb3.1158] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 09/24/2018] [Accepted: 10/14/2018] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE We aimed to investigate age-specific clinical characteristics in patients aged >60 years with large hemispheric infarction (LHI). METHODS We prospectively enrolled consecutive patients with LHI. Patients were divided into two groups: ≤60 vs. >60 years, and demographics, vascular risk factors, clinical feature, in-hospital treatment, 3-month mortality, and unfavorable outcome (defined as a mRS score of 4-6) rate were compared. RESULTS Of the 256 cases included, 140 (54.7%) were older than 60 years. Compared with the younger, the older patients had higher rates of hypertension (66.4% vs. 31.0%), coronary heart disease (19.3% vs. 2.6%), atrial fibrillation (53.6% vs. 31.0%; all p < 0.001), more history of stroke (21.4% vs. 5.2%, p < 0.001), less history of rheumatic heart disease (16.4% vs. 30.1%, p = 0.009), and alcohol consumption (12.1% vs. 21.6%, p = 0.043). Cardio-embolism is the most common stroke etiology regardless of age (55.7% and 38.8%, respectively). Furthermore, the elderly less frequently received decompressive hemicraniectomy (4.3% vs. 15.5%, p = 0.005) and mechanical ventilation (7.9% vs. 16.4%, p = 0.035) and had a higher frequency of stroke-related complication (83.6% vs. 66.4%, p = 0.001). A total of 26 (18.6%) older patients and 15 (12.9%) younger patients died during hospitalization (p = 0.221), and 59 (42.1%) older patients and 35 (30.2%) younger patients died at 3 months (p = 0.061). Patient aged >60 years had significantly higher unfavorable outcome rate at 3 months (adjusted odds ratio, OR 4.30, 95% confidence interval [CI] 2.08-8.88; p < 0.05]. However, older age is not independently associated with 3-month mortality (42.1% vs. 30.2%, p = 0.095 [log-rank test]). CONCLUSIONS Large hemispheric infarction patients over 60 years old were a little more than those aged ≤60 years and constitute more than half of those suffered from malignant brain edema and two thirds of in-hospital death and 3-month mortality. The elderly had more cardio-origin risk factors, received less aggressive hospital treatment, and showed higher risk of unfavorable outcome than the younger.
Collapse
Affiliation(s)
- Jie Li
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Ping Zhang
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Wendan Tao
- Stroke Clinical Research Unit, Department of Neurology, West China Hospital, Sichuan University, Chengdu, China
| | - Xingyang Yi
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| | - Jing Zhang
- Department of Neurology, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chun Wang
- Department of Neurology, People's Hospital of Deyang City, Deyang, China
| |
Collapse
|
31
|
Inoue S, Saito M, Kotani J. Immunosenescence in neurocritical care. J Intensive Care 2018; 6:65. [PMID: 30349725 PMCID: PMC6186132 DOI: 10.1186/s40560-018-0333-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 09/20/2018] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Several advanced and developing countries are now entering a superaged society, in which the percentage of elderly people exceeds 20% of the total population. In such an aging society, the number of age-related diseases such as malignant tumors, diabetes, and severe infections including sepsis is increasing, and patients with such disorders often find themselves in the ICU. MAIN BODY Age-related diseases are closely related to age-induced immune dysfunction, by which reductions in the efficiency and specificity of the immune system are collectively termed "immunosenescence." The most noticeable is a decline in the antigen-specific acquired immune response. The exhaustion of T cells in elderly sepsis is related to an increase in nosocomial infections after septicemia, and even death over subacute periods. Another characteristic is that senescent cells that accumulate in body tissues over time cause chronic inflammation through the secretion of proinflammatory cytokines, termed senescence-associated secretory phenotype. Chronic inflammation associated with aging has been called "inflammaging," and similar age-related diseases are becoming an urgent social problem. CONCLUSION In neuro ICUs, several neuro-related diseases including stroke and sepsis-associated encephalopathy are related to immunosenescence and neuroinflammation in the elderly. Several advanced countries with superaged societies face the new challenge of improving the long-term prognosis of neurocritical patients.
Collapse
Affiliation(s)
- Shigeaki Inoue
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ward, Kobe, 650-0017 Japan
| | - Masafumi Saito
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ward, Kobe, 650-0017 Japan
| | - Joji Kotani
- Department of Disaster and Emergency Medicine, Kobe University Graduate School of Medicine, Kusunoki-cho 7-5-2, Chuo-ward, Kobe, 650-0017 Japan
| |
Collapse
|
32
|
Chatterjee A, Chen M, Gialdini G, Reznik ME, Murthy S, Kamel H, Merkler AE. Trends in Tracheostomy After Stroke: Analysis of the 1994 to 2013 National Inpatient Sample. Neurohospitalist 2018; 8:171-176. [PMID: 30245766 PMCID: PMC6146345 DOI: 10.1177/1941874418764815] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Real-world data on long-term trends in the use of tracheostomy after stroke are limited. METHODS Patients who underwent tracheostomy for acute ischemic stroke (AIS), intracerebral hemorrhage (ICH), or subarachnoid hemorrhage (SAH) were identified from the 1994 through 2013 releases of the National Inpatient Sample using previously validated International Classification of Diseases, Ninth Revision, Clinical Modification codes. Survey weights were used to report nationally representative estimates. Our primary outcome was the trend in tracheostomy use during the index stroke hospitalization over the last 20 years. Additionally, we evaluated trends in in-hospital mortality, timing of placement, and discharge disposition among patients who received a tracheostomy. RESULTS We identified 9.9 million patients with AIS, ICH, or SAH in the United States from 1994 to 2013, of which 170 255 (1.7%; 95% confidence interval [CI]: 1.6%-1.8%) underwent tracheostomy. Among all patients with stroke, tracheostomy use increased from 1.2% (95% CI: 1.1%-1.4%) in 1994 to 1.9% (95% CI: 1.8%-2.1%) in 2013, with similar trends across stroke types. From 1994 to 2013, the timing of tracheostomy decreased from 16.5 days (95% CI: 14.9-18.1 days) to 10.3 days (95% CI: 9.9-10.8 days) after mechanical ventilation. In-hospital mortality decreased from 32.6% (95% CI: 29.1%-36.1%) to 13.8% (95% CI: 12.3%-15.3%) among tracheostomy patients; however, discharge to a nonacute care facility increased from 42.9% (95% CI: 38.0%-47.8%) to 83.3% (95% CI: 81.6%-85.0%) and home discharge declined from 9.3% (95% CI: 7.3%-11.3%) to 2.9% (95% CI: 2.1%-3.7%). CONCLUSION Over the past 2 decades, tracheostomy use has increased among patients with stroke. This increase was associated with earlier placement, reduced in-hospital mortality, and lower rates of home discharge.
Collapse
Affiliation(s)
- Abhinaba Chatterjee
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Monica Chen
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Gino Gialdini
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | | | - Santosh Murthy
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Hooman Kamel
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| | - Alexander E. Merkler
- Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
- Department of Neurology, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
33
|
Chapman C, Morgan P, Cadilhac DA, Purvis T, Andrew NE. Risk factors for the development of chest infections in acute stroke: a systematic review. Top Stroke Rehabil 2018; 25:445-458. [PMID: 30028658 DOI: 10.1080/10749357.2018.1481567] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Chest infections occur in approximately one-third of patients following acute stroke, and are associated with poor outcomes. Limitations in previous reviews restricted the accuracy of results. OBJECTIVES To perform a systematic review to reliably identify modifiable risk factors for chest infections following acute stroke. METHODS Ovid Medline, CINAHL, Cochrane, EMBASE and AMED were searched from 1946 to April 2017 for observational studies where risk factors for chest infections in patients hospitalized with acute stroke were reported. Key words used to identify included chest infection or pneumonia. Included studies were evaluated based on methodological criteria and scientific quality. Results were collated and separate meta-analyses were performed for risk factors examined in three or more studies where quality and homogeneity criteria were met. RESULTS 3172 studies were identified, 15 were eligible for inclusion. Data collection methods included primary data collection, medical record audit and registry data. Chest infections were diagnosed 2-30 days following acute stroke in ten studies. Of the 39 risk factors identified, four were included in the meta-analysis. These were mechanical ventilation: 4 studies, OR: 3.83, 95%CI: 3.21, 4.57; diabetes: 4 studies, OR: 1.06, 95%CI: 1.04, 1.08; pre-existing respiratory conditions: 3 studies, OR: 1.48, 95%CI 1.21, 1.81 and atrial fibrillation: 3 studies, OR: 1.21, 95%CI: 1.17, 1.24. Common risk factors not eligible for meta-analysis were dysphagia and cardiac comorbidities. CONCLUSION Evidence has been comprehensively synthesized to provide reliable estimates of the association between important risk factors and chest infection. Monitoring patients meeting these criteria may promote early identification and treatment to improve long-term outcomes.
Collapse
Affiliation(s)
- Chantelle Chapman
- a Department of Physiotherapy , Monash University , Melbourne , Australia
| | - Prue Morgan
- a Department of Physiotherapy , Monash University , Melbourne , Australia
| | - Dominique A Cadilhac
- b Stroke & Ageing Research, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- c Florey Institute of Neurosciences and Mental Health , Heidelberg , Australia
| | - Tara Purvis
- b Stroke & Ageing Research, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
| | - Nadine E Andrew
- b Stroke & Ageing Research, School of Clinical Sciences at Monash Health , Monash University , Clayton , Australia
- d Peninsula Clinical School , Monash University , Clayton , Australia
| |
Collapse
|
34
|
Lioutas VA, Marchina S, Caplan LR, Selim M, Tarsia J, Catanese L, Edlow J, Kumar S. Endotracheal Intubation and In-Hospital Mortality after Intracerebral Hemorrhage. Cerebrovasc Dis 2018; 45:270-278. [PMID: 29898436 DOI: 10.1159/000489273] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Accepted: 04/15/2018] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Many patients with acute intracerebral hemorrhages (ICHs) undergo endotracheal intubation with subsequent mechanical ventilation (MV) for "airway protection" with the intent to prevent aspiration, pneumonias, and its related mortality. Conversely, these procedures may independently promote pneumonia, laryngeal trauma, dysphagia, and adversely affect patient outcomes. The net benefit of intubation and MV in this patient cohort has not been systematically investigated. METHODS We conducted a large single-center observational cohort study to examine the independent association between endotracheal intubation and MV, hospital-acquired pneumonia (HAP), and in-hospital mortality (HM) in patients with ICH. All consecutive patients admitted with a primary diagnosis of a spontaneous ICH to a tertiary care hospital in Boston, Massachusetts, from June 2000 through January 2014, who were ≥18 years of age and hospitalized for ≥2 days were eligible for inclusion. Patients with pneumonia on admission, or those having brain or lung neoplasms were excluded. Our exposure of interest was endotracheal intubation and MV during hospitalization; our primary outcomes were incidence of HAP and HM, ascertained using International Classification of Diseases-9 and administrative discharge disposition codes, respectively, in patients who underwent endotracheal intubation and MV versus those who did not. Multivariable logistic regression was used to control for confounders. RESULTS Of the 2,386 hospital admissions screened, 1,384 patients fulfilled study criteria and were included in the final analysis. A total of 507 (36.6%) patients were intubated. Overall 133 (26.23%) patients in the intubated group developed HAP versus 41 (4.67%) patients in the non-intubated group (p < 0.0001); 195 (38.5%) intubated patients died during hospitalization compared to 48 (5.5%) non-intubated patients (p < 0.0001). After confounder adjustments, OR for HAP and HM, were 4.23 (95% CI 2.48-7.22; p < 0.0001) and 4.32 (95% CI 2.5-7.49; p < 0.0001) with c-statistics of 0.79 and 0.89, in the intubated versus non-intubated patients, respectively. CONCLUSION In this large hospital-based cohort of patients presenting with an acute spontaneous ICH, endotracheal intubation and MV were associated with increased odds of HAP and HM. These findings urge further examination of the practice of intubation in prospective studies.
Collapse
Affiliation(s)
- Vasileios-Arsenios Lioutas
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Sarah Marchina
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Louis R Caplan
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Magdy Selim
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Joseph Tarsia
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Luciana Catanese
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| | - Jonathan Edlow
- Harvard Medical School, Boston, Massachusetts, USA.,Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Sandeep Kumar
- Department of Neurology, Stroke Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.,Harvard Medical School, Boston, Massachusetts, USA
| |
Collapse
|
35
|
Schneider H, Hertel F, Kuhn M, Ragaller M, Gottschlich B, Trabitzsch A, Dengl M, Neudert M, Reichmann H, Wöpking S. Decannulation and Functional Outcome After Tracheostomy in Patients with Severe Stroke (DECAST): A Prospective Observational Study. Neurocrit Care 2018; 27:26-34. [PMID: 28324263 DOI: 10.1007/s12028-017-0390-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Tracheostomy is performed in ventilated stroke patients affected by persisting severe dysphagia, reduced level of consciousness, or prolonged mechanical ventilation. The study aim was to determine the frequency and predictors of successful decannulation and long-term functional outcome in tracheotomized stroke patients. METHODS A prospective single-center observational study recruited ventilated patients with ischemic stroke, intracerebral hemorrhage, and subarachnoid hemorrhage. Follow-up visits were performed at hospital discharge, 3, and 12 months. Competing risk analyses were performed to identify predictors of decannulation. RESULTS We included 53 ventilated stroke patients who had tracheostomy. One year after tracheostomy, 19 patients were decannulated (median [IQR] time to decannulation 74 [58-117] days), 13 patients were permanently cannulated, and 21 patients died without prior removal of the cannula. Independent predictors for decannulation in our cohort were patient age (HR 0.95 [95% CI: 0.92-0.99] per one year increase, p = 0.003) and absence of sepsis (HR 4.44 [95% CI: 1.33-14.80], p = 0.008). Compared to surviving patients without cannula removal, decannulated patients had an improved functional outcome after one year (median modified Rankin Scale score 4 vs. 5 [p < 0.001]; median Barthel index 35 vs. 5 [p < 0.001]). CONCLUSIONS Decannulation was achieved in 59.4% of stroke patients surviving the first 12 months after tracheostomy and was associated with better functional outcome compared to patients without decannulation. Further prospective studies with larger sample sizes are needed to confirm our results.
Collapse
Affiliation(s)
- Hauke Schneider
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany.
| | - Franziska Hertel
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Matthias Kuhn
- Institute for Medical Informatics and Biometry, Technische Universität Dresden, Dresden, Germany
| | - Maximilian Ragaller
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Birgit Gottschlich
- Department of Anesthesiology and Intensive Care Medicine, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Anne Trabitzsch
- Surgery Center, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Markus Dengl
- Department of Neurosurgery, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Marcus Neudert
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Technische Universität Dresden, Dresden, Germany
| | - Heinz Reichmann
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| | - Sigrid Wöpking
- Department of Neurology and Dresden University Stroke Center, University Hospital, Technische Universität Dresden, Fetscherstr. 74, 01307, Dresden, Germany
| |
Collapse
|
36
|
Popat C, Ruthirago D, Shehabeldin M, Yang S, Nugent K. Outcomes in Patients With Acute Stroke Requiring Mechanical Ventilation: Predictors of Mortality and Successful Extubation. Am J Med Sci 2018; 356:3-9. [PMID: 30049327 DOI: 10.1016/j.amjms.2018.03.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 03/15/2018] [Accepted: 03/19/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The majority of patients with acute stroke requiring mechanical ventilation have a poor prognosis and often present difficult decisions regarding extubation. The best criteria for planned extubation in these patients are uncertain. METHODS We reviewed the electronic medical records of patients hospitalized between 1/1/2010 and 12/15/2015 with acute stroke requiring mechanical ventilation to determine the mortality rate, the respiratory parameters recorded before planned extubation, and the reintubation rate. RESULTS This study included 226 patients. The mean age was 60.3 ± 14.3 years. The mean duration of mechanical ventilation was 6.5 ± 5.9 days. The overall in-hospital mortality rate was 56.6%. The best predictors of mortality were age and stroke volume calculated from radiographic images. One hundred and one patients had planned extubations; 9 patients (8.9%) required reintubation. There was no difference in respiratory parameters or Glasgow coma scale scores between those patients with successful extubation and those patients with failed extubation. CONCLUSIONS The in-hospital mortality rate of patients with acute stroke who require mechanical ventilation is quite high. The success rate with planned extubation is relatively good and comparable to rates in previous studies which largely involved patients with respiratory failure. There is no single weaning parameter or Glasgow coma scale score which identifies patients with high success rates.
Collapse
Affiliation(s)
- Chirag Popat
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Doungporn Ruthirago
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Mohamed Shehabeldin
- Department of Neurology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Shengping Yang
- Department of Pathology, Texas Tech University Health Sciences Center, Lubbock, Texas
| | - Kenneth Nugent
- Department of Internal Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas.
| |
Collapse
|
37
|
Gerhardson T, Sukovich JR, Pandey AS, Hall TL, Cain CA, Xu Z. Catheter Hydrophone Aberration Correction for Transcranial Histotripsy Treatment of Intracerebral Hemorrhage: Proof-of-Concept. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:1684-1697. [PMID: 28880166 PMCID: PMC5681355 DOI: 10.1109/tuffc.2017.2748050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
Histotripsy is a minimally invasive ultrasound therapy that has shown rapid liquefaction of blood clots through human skullcaps in an in vitro intracerebral hemorrhage model. However, the efficiency of these treatments can be compromised if the skull-induced aberrations are uncorrected. We have developed a catheter hydrophone which can perform aberration correction (AC) and drain the liquefied clot following histotripsy treatment. Histotripsy pulses were delivered through an excised human skullcap using a 256-element, 500-kHz hemisphere array transducer with a 15-cm focal distance. A custom hydrophone was fabricated using a mm PZT-5h crystal interfaced to a coaxial cable and integrated into a drainage catheter. An AC algorithm was developed to correct the aberrations introduced between histotripsy pulses from each array element. An increase in focal pressure of up to 60% was achieved at the geometric focus and 27%-62% across a range of electronic steering locations. The sagittal and axial -6-dB beam widths decreased from 4.6 to 2.2 mm in the sagittal direction and 8 to 4.4 mm in the axial direction, compared to 1.5 and 3 mm in the absence of aberration. After performing AC, lesions with diameters ranging from 0.24 to 1.35 mm were generated using electronic steering over a mm grid in a tissue-mimicking phantom. An average volume of 4.07 ± 0.91 mL was liquefied and drained after using electronic steering to treat a 4.2-mL spherical volume in in vitro bovine clots through the skullcap.
Collapse
|
38
|
Improvement in Quality Metrics Outcomes and Patient and Family Satisfaction in a Neurosciences Intensive Care Unit after Creation of a Dedicated Neurocritical Care Team. Crit Care Res Pract 2017; 2017:6394105. [PMID: 29119023 PMCID: PMC5651093 DOI: 10.1155/2017/6394105] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 05/19/2017] [Accepted: 09/05/2017] [Indexed: 11/18/2022] Open
Abstract
Introduction Dedicated neurointensivists have been shown to improve outcome measurements in the neurosciences intensive care unit (NSICU). Quality outcome data in relation to patient and family satisfaction is lacking. This study evaluated the impact of newly appointed neurointensivists and creation of a neurocritical care team on quality outcome measures including patient satisfaction in a NSICU. Methods This is a retrospective study of data over 36 months from a 14-bed NSICU evaluating quality outcome measures and anonymous patient satisfaction questionnaires before and after neurointensivists appointment. Results After appointment of neurointensivists, patient acuity of the NSICU increased by 33.4% while LOS decreased by 3.5%. There was a decrease in neurosciences mortality (35.8%), catheter-associated urinary tract infection (50%), central line associated bloodstream infection (100%), and ventilator-associated pneumonia (50%). During the same time, patient satisfaction increased by 28.3% on physicians/nurses consistency (p = 0.025), by 69.5% in confidence/trust in physicians (p < 0.0001), by 78.3% on physicians treated me with courtesy/respect (p < 0.0001), and by 46.4% on physicians' attentiveness (p < 0.0001). Ultimately, patients recommending the hospital to others increased by 67.5% (p < 0.0001). Conclusion Dedicated neurointensivists and the subsequent development of a neurocritical care team positively impacted quality outcome metrics, particularly significantly improving patient satisfaction.
Collapse
|
39
|
Abstract
The incidence of spontaneous intracerebral hematoma (SICH) is even now high worldwide, especially higher in Japan than in Western countries, despite the development of advances in blood pressure (BP) management and food/alcohol intake education. Although mortality and morbidity for SICH are high, some controversies remain regarding the appropriate acute phase of treatment. Recent studies have revealed that BP lowering treatment than 140 mmHg resulted in better outcomes. However the efficacy of surgical treatment for SICH has not been well established, with the exception of that for cerebellar SICH over 3 cm in diameter and life-saving procedures, although many randomized control studies and systematic reviews focused on surgical treatment have been reported. In this review, we summarize some issues and discuss strategies in development for the treatment of SICH.
Collapse
Affiliation(s)
- Motohiro Morioka
- Department of Neurosurgery, Kurume University, School of Medicine
| | - Kimihiko Orito
- Department of Neurosurgery, Kurume University, School of Medicine
| |
Collapse
|
40
|
Otite FO, Khandelwal P, Malik AM, Chaturvedi S, Sacco RL, Romano JG. Ten-Year Temporal Trends in Medical Complications After Acute Intracerebral Hemorrhage in the United States. Stroke 2017; 48:596-603. [DOI: 10.1161/strokeaha.116.015746] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 01/22/2017] [Accepted: 01/23/2017] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Data on medical complications after intracerebral hemorrhage (ICH) are sparse. We assessed trends in the prevalence of urinary tract infection, pneumonia, sepsis, deep venous thrombosis (DVT), pulmonary embolism, acute renal failure (ARF), and acute myocardial infarction after ICH in the United States.
Methods—
A total of 575 211 adult ICH cases were identified from the 2004 to 2013 Nationwide Inpatient Sample. Weighted complication risks were computed by sex and mechanical ventilation status. Multivariate models were used to evaluate trends in complications and assess their association with in-hospital mortality, cost, and length of stay.
Results—
Overall risks of urinary tract infection, pneumonia, sepsis, DVT, pulmonary embolism, ARF, and acute myocardial infarction after ICH were 14.8%, 7.8%, 4.1%, 2.7%, 0.7%, 8.2%, and 2.0%, respectively, but risk differed by sex and mechanical ventilation status. From 2004 to 2013, odds of DVT and ARF increased, whereas odds of pneumonia, sepsis, and mortality declined over time. All complications were associated with >2.5-day increase in length of stay and >$8000 increase in cost. ARF and acute myocardial infarction were associated with increased mortality in all patients; sepsis and pneumonia were associated with increased mortality only in nonmechanical ventilation patients, whereas urinary tract infection and DVT were associated with reduced mortality in all patients.
Conclusions—
Despite significant mortality reduction, ARF and DVT risk after ICH have increased, whereas odds of sepsis and pneumonia have declined over the last decade. All complications were associated with increased cost and length of stay, but their associations with mortality were variable, likely due in part to survival bias. Innovative strategies are needed to prevent ICH-associated medical complications.
Collapse
Affiliation(s)
- Fadar Oliver Otite
- From the Department of Neurology, University of Miami Miller School of Medicine, FL
| | - Priyank Khandelwal
- From the Department of Neurology, University of Miami Miller School of Medicine, FL
| | - Amer M. Malik
- From the Department of Neurology, University of Miami Miller School of Medicine, FL
| | - Seemant Chaturvedi
- From the Department of Neurology, University of Miami Miller School of Medicine, FL
| | - Ralph L. Sacco
- From the Department of Neurology, University of Miami Miller School of Medicine, FL
| | - Jose G. Romano
- From the Department of Neurology, University of Miami Miller School of Medicine, FL
| |
Collapse
|
41
|
Seder DB, Bösel J. Airway management and mechanical ventilation in acute brain injury. HANDBOOK OF CLINICAL NEUROLOGY 2017; 140:15-32. [PMID: 28187797 DOI: 10.1016/b978-0-444-63600-3.00002-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Patients with acute neurologic disease often develop respiratory failure, the management of which profoundly affects brain physiology and long-term functional outcomes. This chapter reviews airway management and mechanical ventilation of patients with acute brain injury, offering practical strategies to optimize treatment of respiratory failure and minimize secondary brain injury. Specific concerns that are addressed include physiologic changes during intubation and ventilation such as the effects on intracranial pressure and brain perfusion; cervical spine management during endotracheal intubation; the role of tracheostomy; and how ventilation and oxygenation are utilized to minimize ischemia-reperfusion injury and cerebral metabolic distress.
Collapse
Affiliation(s)
- D B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA; Tufts University School of Medicine, Boston, MA, USA.
| | - J Bösel
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| |
Collapse
|
42
|
Barras CD, Asadi H, Phal PM, Tress BM, Davis SM, Desmond PM. Audit of CT reporting standards in cases of intracerebral haemorrhage at a comprehensive stroke centre in Australia. J Med Imaging Radiat Oncol 2016; 60:720-727. [DOI: 10.1111/1754-9485.12491] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Accepted: 06/04/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Christen D Barras
- Lysholm Department of Neuroradiology; The National Hospital for Neurology and Neurosurgery; Queen Square; London UK
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| | - Hamed Asadi
- Interventional Neuroradiology Service; Department of Radiology; Beaumont Hospital; Dublin Ireland
- School of Medicine; Faculty of Health; Deakin University; Victoria Australia
| | - Pramit M Phal
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
- Epworth Medical Imaging; Richmond Victoria Australia
| | - Brian M Tress
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| | - Stephen M Davis
- Department of Neurosciences; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| | - Patricia M Desmond
- Department of Radiology; Royal Melbourne Hospital; The University of Melbourne; Melbourne Victoria Australia
| |
Collapse
|
43
|
Carcel C, Sato S, Zheng D, Heeley E, Arima H, Yang J, Wu G, Chen G, Zhang S, Delcourt C, Lavados P, Robinson T, Lindley RI, Wang X, Chalmers J, Anderson CS. Prognostic Significance of Hyponatremia in Acute Intracerebral Hemorrhage. Crit Care Med 2016; 44:1388-94. [DOI: 10.1097/ccm.0000000000001628] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
|
44
|
Abstract
Many neurologic diseases can cause acute respiratory decompensation, therefore a familiarity with these diseases is critical for any clinician managing patients with respiratory dysfunction. In this article, we review the anatomy of the respiratory system, focusing on the neurologic control of respiration. We discuss general mechanisms by which diseases of the peripheral and central nervous systems can cause acute respiratory dysfunction, and review the neurologic diseases which can adversely affect respiration. Lastly, we discuss the diagnosis and general management of acute respiratory impairment due to neurologic disease.
Collapse
Affiliation(s)
- Rachel A. Nardin
- From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - Frank W. Drislane
- From the Department of Neurology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| |
Collapse
|
45
|
The SETscore to Predict Tracheostomy Need in Cerebrovascular Neurocritical Care Patients. Neurocrit Care 2016; 25:94-104. [DOI: 10.1007/s12028-015-0235-5] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
|
46
|
Schönenberger S, Niesen WD, Fuhrer H, Bauza C, Klose C, Kieser M, Suarez JI, Seder DB, Bösel J. Early tracheostomy in ventilated stroke patients: Study protocol of the international multicentre randomized trial SETPOINT2 (Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2). Int J Stroke 2016; 11:368-79. [PMID: 26763913 DOI: 10.1177/1747493015616638] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/03/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Tracheostomy is a common procedure in long-term ventilated critical care patients and frequently necessary in those with severe stroke. The optimal timing for tracheostomy is still unknown, and it is controversial whether early tracheostomy impacts upon functional outcome. METHOD The Stroke-related Early Tracheostomy vs. Prolonged Orotracheal Intubation in Neurocritical care Trial 2 (SETPOINT2) is a multicentre, prospective, randomized, open-blinded endpoint (PROBE-design) trial. Patients with acute ischemic stroke, intracerebral hemorrhage or subarachnoid hemorrhage who are so severely affected that two weeks of ventilation are presumed necessary based on a prediction score are eligible. It is intended to enroll 190 patients per group (n = 380). Patients are randomized to either percutaneous tracheostomy within the first five days after intubation or to ongoing orotracheal intubation with consecutive weaning and extubation and, if the latter failed, to percutaneous tracheostomy from day 10 after intubation. The primary endpoint is functional outcome defined by the modified Rankin Scale (mRS, 0-4 (favorable) vs. 5 + 6 (unfavorable)) after six months; secondary endpoints are mortality and cause of mortality during intensive care unit-stay and within six months from admission, intensive care unit-length of stay, duration of sedation, duration of ventilation and weaning, timing and reasons for withdrawal of life support measures, relevant intracranial pressure rises before and after tracheostomy. CONCLUSION The necessity and optimal timing of tracheostomy in ventilated stroke patients need to be identified. SETPOINT2 should clarify whether benefits in functional outcome can be achieved by early tracheostomy in these patients.
Collapse
Affiliation(s)
| | - Wolf-Dirk Niesen
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Hannah Fuhrer
- Department of Neurology, University of Freiburg, Freiburg im Breisgau, Germany
| | - Colleen Bauza
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Christina Klose
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Meinhard Kieser
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - José I Suarez
- Division of Vascular Neurology and Neurocritical Care, Department of Neurology, Baylor College of Medicine, Houston, Texas, USA
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, Maine, USA
| | - Julian Bösel
- Department of Neurology, University of Heidelberg, Heidelberg, Germany
| | | | | |
Collapse
|
47
|
|
48
|
Godoy DA, Piñero GR, Koller P, Masotti L, Napoli MD. Steps to consider in the approach and management of critically ill patient with spontaneous intracerebral hemorrhage. World J Crit Care Med 2015; 4:213-229. [PMID: 26261773 PMCID: PMC4524818 DOI: 10.5492/wjccm.v4.i3.213] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2014] [Revised: 03/03/2015] [Accepted: 06/08/2015] [Indexed: 02/06/2023] Open
Abstract
Spontaneous intracerebral hemorrhage is a type of stroke associated with poor outcomes. Mortality is elevated, especially in the acute phase. From a pathophysiological point of view the bleeding must traverse different stages dominated by the possibility of re-bleeding, edema, intracranial hypertension, inflammation and neurotoxicity due to blood degradation products, mainly hemoglobin and thrombin. Neurological deterioration and death are common in early hours, so it is a true neurological-neurosurgical emergency. Time is brain so that action should be taken fast and accurately. The most significant prognostic factors are level of consciousness, location, volume and ventricular extension of the bleeding. Nihilism and early withdrawal of active therapy undoubtedly influence the final result. Although there are no proven therapeutic measures, treatment should be individualized and guided preferably by pathophysiology. The multidisciplinary teamwork is essential. Results of recently completed studies have birth to promising new strategies. For correct management it’s important to establish an orderly and systematic strategy based on clinical stabilization, evaluation and establishment of prognosis, avoiding secondary insults and adoption of specific individualized therapies, including hemostatic therapy and intensive control of elevated blood pressure. Uncertainty continues regarding the role of surgery.
Collapse
|
49
|
Lahiri S, Mayer SA, Fink ME, Lord AS, Rosengart A, Mangat HS, Segal AZ, Claassen J, Kamel H. Mechanical Ventilation for Acute Stroke: A Multi-state Population-Based Study. Neurocrit Care 2014; 23:28-32. [DOI: 10.1007/s12028-014-0082-9] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
|
50
|
Poli S, Purrucker J, Priglinger M, Ebner M, Sykora M, Diedler J, Bulut C, Popp E, Rupp A, Hametner C. Rapid Induction of COOLing in Stroke Patients (iCOOL1): a randomised pilot study comparing cold infusions with nasopharyngeal cooling. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2014; 18:582. [PMID: 25346332 PMCID: PMC4234831 DOI: 10.1186/s13054-014-0582-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2014] [Accepted: 10/08/2014] [Indexed: 01/01/2023]
Abstract
Introduction Induction methods for therapeutic cooling are under investigated. We compared the effectiveness and safety of cold infusions (CI) and nasopharyngeal cooling (NPC) for cooling induction in stroke patients. Methods A prospective, open-label, randomised (1:1), single-centre pilot trial with partially blinded safety endpoint assessment was conducted at the neurointensive care unit of Heidelberg University. Intubated stroke patients with an indication for therapeutic cooling and an intracranial pressure (ICP)/temperature brain probe were randomly assigned to CI (4°C, 2L at 4L/h) or NPC (60L/min for 1 h). Previous data suggested a maximum decrease of tympanic temperature for CI (2.1L within 35 min) after 52 min. Therefore the study period was 1 hour (15 min subperiods I-IV). The brain temperature course was the primary endpoint. Secondary measures included continuous monitoring of neurovital parameters and extracerebral temperatures. Statistical analysis based on repeated-measures analysis of variance. Results Of 221 patients screened, 20 were randomized within 5 months. Infusion time of 2L CI was 33 ± 4 min in 10 patients and 10 patients received NPC for 60 min. During active treatment (first 30 min), brain temperature decreased faster with CI than during NPC (I: −0.31 ± 0.2 versus −0.12 ± 0.1°C, P = 0.008; II: −1.0 ± 0.3 versus −0.49 ± 0.3°C, P = 0.001). In the CI-group, after the infusion was finished, the intervention no longer decreased brain temperature, which increased after 3.5 ± 3.3 min. Oesophageal temperature correlated best with brain temperature during CI and NPC. Tympanic temperature reacted similarly to relative changes of brain temperature during CI, but absolute values slightly differed. CI provoked three severe adverse events during subperiods II-IV (two systolic arterial pressure (SAP), one shivering) compared with four in the NPC-group, all during subperiod I (three SAP, one ICP). Classified as possibly intervention-related, two cases of ventilator failure occurred during NPC. Conclusions In intubated stroke patients, brain cooling is faster during CI than during NPC. Importantly, contrary to previous expectations, brain cooling stopped soon after CI cessation. Oesophageal but neither bladder nor rectal temperature is suited as surrogate for brain temperature during CI and NPC. Several severe adverse events in CI and in NPC demand further studying of safety. Trial registration ClinicalTrials.gov NCT01573117. Registered 31 March 2012 Electronic supplementary material The online version of this article (doi:10.1186/s13054-014-0582-1) contains supplementary material, which is available to authorized users.
Collapse
|