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Azari Jafari A, Mirmoeeni S, Momtaz D, Kotzur T, Murtha G, Garcia C, Moran M, Martinez P, Chen K, Krishnakumar H, Seifi A. Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis. Neurocrit Care 2024; 40:551-561. [PMID: 37415023 DOI: 10.1007/s12028-023-01778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND One of the most critical issues in patients suffering from traumatic brain injury (TBI) is protecting the airway and attempting to keep a secure airway. It is evident that tracheostomy in patients with TBI after 7-14 days can have favorable outcomes if the patient cannot be extubated; however, some clinicians have recommended early tracheostomy before 7 days. METHODS A retrospective cohort of inpatient study participants was queried from the National Inpatient Sample to include patients with TBI between 2016 and 2020 undergoing tracheostomy and outcomes between the two groups of early tracheostomy (ET) (< 7 days from admission) and late tracheostomy (LT) (≥ 7 days from admission) were compared. RESULTS We reviewed 219,005 patients with TBI, out of whom 3.04% had a tracheostomy. Patients in the ET group were younger than those in the LT group (45.02 ± 19.38 years old vs. 48.68 ± 20.50 years old, respectively, p < 0.001), mainly men (76.64% vs. 73.73%, respectively, p = 0.01), and mainly White race (59.88% vs. 57.53%, respectively, p = 0.33). The patients in the ET group had a significantly shorter length of stay as compared with those in the LT group (27.78 ± 25.96 days vs. 36.32 ± 29.30 days, respectively, p < 0.001) and had a significantly lower hospital charge ($502,502.436 ± 427,060.81 vs. $642,739.302 ± 516,078.94 per patient, respectively, p < 0.001). The whole TBI cohort mortality was reported at 7.04%, which was higher within the ET group compared with the LT group (8.69% vs. 6.07%, respectively, p < 0.001). Patients in the LT had higher odds of developing any infection (odds ratio [OR] 1.43 [1.22-1.68], p < 0.001), emerging sepsis (OR 1.61 [1.39-1.87], p < 0.001), pneumonia (OR 1.52 [1.36-1.69], p < 0.001), and respiratory failure (OR 1.30 [1.09-1.55], p = 0.004). CONCLUSIONS This study shows that ET can provide notable and significant benefits for patients with TBI. Future high-quality prospective studies should be performed to investigate and shed more light on the ideal timing of tracheostomy in patients with TBI.
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Affiliation(s)
- Amirhossein Azari Jafari
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - David Momtaz
- School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - Travis Kotzur
- School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - Gregory Murtha
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Carlos Garcia
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Maggie Moran
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Paola Martinez
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Kevin Chen
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Hari Krishnakumar
- School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA.
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Krishnakumar H, Mascitelli J, Hassan A, Leary J, Son C. Treatment of cerebral aneurysms with flow diversion or stent assisted coiling in patients on concurrent oral anticoagulation. Neuroradiol J 2023; 36:464-469. [PMID: 36409963 PMCID: PMC10588601 DOI: 10.1177/19714009221114443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Flow diversion and stent assisted coiling are increasingly utilized strategies in the endovascular treatment of cerebral aneurysms. Ischemic and hemorrhagic complications play an important role in the outcome following such embolizations. Little is published regarding patients on concurrent oral anticoagulation and undergoing such embolizations and the rates of complications and patient outcomes. MATERIALS AND METHODS Retrospective data for consecutive patients on concurrent oral anticoagulation undergoing flow diversion or stent assisted coiling for cerebral aneurysms was accessed from databases at the participating sites. Patient demographics, comorbidities, antiplatelet regimens, aneurysm characteristics, complications, and radiographic results were recorded and descriptive statistics reported. RESULTS Eleven patients were identified undergoing embolization in the setting of preoperative anticoagulant use and included seven patients undergoing flow diversion and four patients undergoing stent assisted coiling. There was a wide range of antiplatelet and anticoagulant management strategies. There were four major complications in three patients (27.2%) to include two serious bleeding events in addition to ischemic strokes. Both serious bleeding events occurred in patients continued on oral anticoagulation with the addition of antiplatelets. At a mean follow-up of 9.6 months, three aneurysms had continued filling for a good radiographic outcome of 72.7%. CONCLUSIONS Anticoagulant and antiplatelet use in the setting of flow diversion or stent assisted coiling may carry increased risks as compared to historical norms and, for flow diversion, offer decreased efficacy.
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Affiliation(s)
- Hari Krishnakumar
- Long School of Medicine, University of Texas Health Science Center, San Antonio, TX, USA
| | - Justin Mascitelli
- Department of Neurosurgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Ameer Hassan
- Department of Neurology, University of Texas Rio Grande Valley Medical School, Harlingen, TX, USA
- Valley Baptist Medical Center, Harlingen, TX, USA
| | - Jonathan Leary
- Department of Neurosurgery, University of Texas Health Science Center, San Antonio, TX, USA
| | - Colin Son
- Neurosurgical Associates of San Antonio, San Antonio, TX, USA
- School of Osteopathic Medicine, University of the Incarnate Word, San Antonio, TX, USA
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Mantha Y, Ebin J, Krishnakumar H, Menon S, Pillarisetti J, Seifi A. "Forced inspiratory suction and swallow tool" a novel instrument to convert paroxysmal supraventricular tachycardia (SVT) to sinus rhythm, a case report and introduction of the device. Am J Emerg Med 2022; 62:146.e3-146.e7. [PMID: 36117016 DOI: 10.1016/j.ajem.2022.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 09/07/2022] [Indexed: 11/26/2022] Open
Abstract
Paroxysmal Supraventricular Tachycardia (SVT) is an arrhythmia with sudden onset and termination, characterized by a fast heart rate and a narrow QRS complex. There are several remedies that have been described to convert the SVT, such as the Valsalva maneuver, holding the breath for a few seconds, or putting cold water on the face. Here we are presenting a case of SVT, which we converted to sinus rhythm instantly by using a novel tool that has been designed and patented at the University of Texas. This device is named "Forced Inspiratory Suction and Swallow Tool" (FISST) and is branded as "HiccAway," which is primarily designed to stop hiccups and is available as an over-the-counter tool. It works by drinking water forcibly through a pressure valve, and it follows "Bernoulli's Principle": applications of the law of conservation energy.
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Affiliation(s)
- Yogamaya Mantha
- Division of Cardiology, Department of Medicine, University of Texas Health at San Antonio, Texas, USA
| | - Jeffrey Ebin
- Department of Emergency medicine, University of Houston, TX, USA
| | - Hari Krishnakumar
- School of Medicine, University of Texas Health at San Antonio, TX, USA
| | - Shwetha Menon
- School of Medicine, University of Texas Health at San Antonio, TX, USA
| | - Jayasree Pillarisetti
- Division of Cardiology, Department of Medicine, University of Texas Health at San Antonio, Texas, USA
| | - Ali Seifi
- Department of Neurosurgery, Neurocritical Care, University of Texas Health at San Antonio, TX, USA.
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