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Yan Y, Li M, Cai T, Wang X, Dong Y, Hu X, Laureys S, Gosseries O, Grégoire C, Di H. Mood assessments of family caregivers of patients with severe brain injury in China. Qual Life Res 2024; 33:481-490. [PMID: 37971668 DOI: 10.1007/s11136-023-03539-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2023] [Indexed: 11/19/2023]
Abstract
OBJECTIVES Long-term care of severe brain injury patients places a significant mental burden on family caregivers, yet few studies have reported the situation in China. We aimed to describe the mood states of family caregivers of patients with severe brain injury and examine the influencing factors that affect caregivers' moods. METHODS Cross-sectional survey was used to assess the mood profiles of Chinese family caregivers between February 2019 and February 2020. Demographic data of caregivers and patients, the Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7) were used to assess the level of depressive and anxiety symptoms. The quality of life score was also assessed by a visual analog scale, and the Coma Recovery Scale-Revised was used to assess the patient's consciousness. RESULT One hundred and one patients with severe brain injury (57 unresponsive wakefulness syndrome, UWS) between the age of 14 and 70 and their main family caregivers were enrolled in the study. Most caregivers displayed depressive (n = 62) and anxiety symptoms (n = 65), with 17 and 20 of these family caregivers reporting (moderately) severe depressive symptom and severe anxiety symptom, respectively. The caregiver's depressive symptom level significantly decreased as the patient's injury lasted longer (r = - 0.208, P = 0.037). Moreover, the age of the patient negatively related to the levels of depressive (r = - 0.310, P = 0.002) and anxiety symptoms (r = - 0.289, P = 0.003) in caregivers. There was a significant positive correlation between anxiety and depressive symptoms scores in family caregivers (r = 0.838, P < 0.001). The higher the level of anxiety (r = - 0.273, P = 0.006) and depressive symptoms (r = - 0.265, P = 0.007), the worse the quality of life. CONCLUSION Many family caregivers of patients with severe brain injury experience various levels of anxiety and depressive symptoms in China. Tailor-made psychological help seems imperative. Researchers and doctors can provide information about patient's conditions to assist family members in discussing rehabilitation options for patients in different states of consciousness will help to ease anxiety of family caregivers.
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Affiliation(s)
- Yifan Yan
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- School of Public Health, Zhejiang University, Hangzhou, China
| | - Meiqi Li
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
- School of Nursing, Hangzhou Normal University, Hangzhou, China
| | - Tiantian Cai
- Department of Endocrinology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Xueying Wang
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China
| | - Yan Dong
- Department of Rehabilitation, Hospital of Zhejiang People's Armed Police, Hangzhou, China.
| | - Xiaohua Hu
- Department of Rehabilitation, Hospital of Zhejiang People's Armed Police, Hangzhou, China
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
- Joint International Research Unit on Consciousness, CERVO Brain Research Centre, Laval University, Québec, Canada
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau, University Hospital of Liège, Liège, Belgium
| | - Charlotte Grégoire
- Sensation and Perception Research Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Haibo Di
- International Vegetative State and Consciousness Science Institute, Hangzhou Normal University, Hangzhou, China.
- School of Basic Medicine, Hangzhou Normal University, Hangzhou, China.
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Tavares WM, Araujo de França S, Paiva WS, Teixeira MJ. Early tracheostomy versus late tracheostomy in severe traumatic brain injury or stroke: A systematic review and meta-analysis. Aust Crit Care 2023; 36:1110-1116. [PMID: 36775675 DOI: 10.1016/j.aucc.2022.12.012] [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: 03/19/2022] [Revised: 12/16/2022] [Accepted: 12/22/2022] [Indexed: 02/12/2023] Open
Abstract
OBJECTIVES We aim to ascertain whether the benefit of early tracheostomy can be found in patients with severe traumatic brain injury (TBI) and stroke and if the benefit will remain considering distinct pathologies. DATA SOURCES Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses protocol, a search through Lilacs, PubMed, and Cochrane databases was conducted. REVIEW METHODS Included studies were those written in English, French, Spanish, or Portuguese, with a formulated question, which compared outcomes between early and late trach (minimum of two outcomes), such as intensive care unit (ICU) length of stay (LOS), duration of mechanical ventilation (MV), hospital LOS, mortality rates, or ventilator-associated pneumonia (VAP). Likewise, patients presented exclusively with head injury or stroke had minimum hospital stay follow-up, and as for severe TBI patients, they presented Glasgow Coma Scale ≤8 at admission. Evaluated outcomes were the risk ratio (RR) of VAP, risk difference (RD) of mortality, and mean difference (MD) of the duration of MV, ICU LOS, and hospital LOS. RESULTS The early and late tracheostomy cohorts were composed of 6211 and 8140 patients, respectively. The meta-analysis demonstrated that the early tracheostomy cohort had a lower risk for VAP (RR: 0.73 [95% confidence interval {CI}, 0.66, 0.81] p < 0.00001), shorter duration of MV (MD: -4.40 days [95% CI, -8.28, -0.53] p = 0.03), and shorter ICU (MD: -6.93 days [95% CI, -8.75, -5.11] p < 0.00001) and hospital LOS (MD: -7.05 days [95% CI, -8.27, -5.84] p < 0.00001). The mortality rate did not demonstrate a statistical difference. CONCLUSION Early tracheostomy could optimise patient outcomes by patients' risk for VAP and decreasing MV durationand ICU and hospital LOS.
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Affiliation(s)
- Wagner Malago Tavares
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 215 - Al. Terracota, Room 407, Cerâmica, São Caetano do Sul, SP, 09531-190, Brazil; Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil
| | - Sabrina Araujo de França
- Department of Research of IPSPAC, Instituto Paulista de Saúde para Alta Complexidade, 215 - Al. Terracota, Room 407, Cerâmica, São Caetano do Sul, SP, 09531-190, Brazil.
| | - Wellingson Silva Paiva
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil
| | - Manoel Jacobsen Teixeira
- Institute of Neurology, University of São Paulo, 255 Dr. Enéas de Carvalho Aguiar Avenue, Cerqueira César, São Paulo, SP, 05403-900, Brazil
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Eilander HJ, van Erp WS, Driessen DMF, Overbeek BUH, Lavrijsen JCM. Post-Acute Level Of Consciousness scale revised (PALOC-sr): adaptation of a scale for classifying the level of consciousness in patients with a prolonged disorder of consciousness. BRAIN IMPAIR 2023; 24:341-346. [PMID: 38167183 DOI: 10.1017/brimp.2022.7] [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: 11/07/2022]
Abstract
OBJECTIVE To present an updated version of the 'Post-acute Level Of Consciousness scale' (PALOC-s), in accordance with the latest scientific insights. METHODS Within the context of a research project, 20 years ago, the PALOC-s was developed for the purpose of following the development of the level of consciousness of young unconscious patients participating in a rehabilitation program. Meanwhile, the understanding of the behavior related to different levels of consciousness has developed and terminology has changed, resulting in the need to revise the PALOC-s. With the preservation of the original description of the eight hierarchical levels of PALOC-s, adaptations are made in the terminology and grouping of these levels. RESULTS AND CONCLUSION This manuscript presents the revised version of PALOC-sr, which is suitable for use in clinical practice. The validation of this scale is recommended for its optimal use in future (international) research projects.
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Affiliation(s)
- Henk J Eilander
- Department of Elderly Care Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Willemijn S van Erp
- Department of Elderly Care Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Accolade Zorg, Bosch en Duin, The Netherlands
- Libra Revalidatie & Audiologie, locatie Leijpark, Tilburg, The Netherlands
| | - Daniëlle M F Driessen
- Department of Elderly Care Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Libra Revalidatie & Audiologie, locatie Leijpark, Tilburg, The Netherlands
| | - Berno U H Overbeek
- Department of Elderly Care Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
- Azora, Terborg, The Netherlands
- Kalorama, Veste Brakkestein, Nijmegen, The Netherlands
| | - Jan C M Lavrijsen
- Department of Elderly Care Medicine, Radboud Institute of Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Mélotte E, Maudoux A, Panda R, Kaux JF, Lagier A, Herr R, Belorgeot M, Laureys S, Gosseries O. Links Between Swallowing and Consciousness: A Narrative Review. Dysphagia 2023; 38:42-64. [PMID: 35773497 DOI: 10.1007/s00455-022-10452-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [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: 03/30/2021] [Accepted: 12/06/2021] [Indexed: 01/27/2023]
Abstract
This literature review explores a wide range of themes addressing the links between swallowing and consciousness. Signs of consciousness are historically based on the principle of differentiating reflexive from volitional behaviors. We show that the sequencing of the components of swallowing falls on a continuum of voluntary to reflex behaviors and we describe several types of volitional and non-volitional swallowing tasks. The frequency, speed of initiation of the swallowing reflex, efficacy of the pharyngeal phase of swallowing and coordination between respiration and swallowing are influenced by the level of consciousness during non-pathological modifications of consciousness such as sleep and general anesthesia. In patients with severe brain injury, the level of consciousness is associated with several components related to swallowing, such as the possibility of extubation, risk of pneumonia, type of feeding or components directly related to swallowing such as oral or pharyngeal abnormalities. Based on our theoretical and empirical analysis, the efficacy of the oral phase and the ability to receive exclusive oral feeding seem to be the most robust signs of consciousness related to swallowing in patients with disorders of consciousness. Components of the pharyngeal phase (in terms of abilities of saliva management) and evoked cough may be influenced by consciousness, but further studies are necessary to determine if they constitute signs of consciousness as such or only cortically mediated behaviors. This review also highlights the critical lack of tools and techniques to assess and treat dysphagia in patients with disorders of consciousness.
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Affiliation(s)
- Evelyne Mélotte
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium.
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium.
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium.
| | - Audrey Maudoux
- Sensation and Perception Research Group, GIGA, University and University Hospital of Liège, Liège, Belgium
- Otorhinolaryngology Head and Neck Surgery Department, Robert Debré University Hospital, APHP, Paris, France
| | - Rajanikant Panda
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
| | - Jean-François Kaux
- Physical and Rehabilitation Medicine Department, University and University Hospital of Liège, Avenue de l'Hopital 1, 4000, Liège, Belgium
| | - Aude Lagier
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Liège, Liège, Belgium
| | - Roxanne Herr
- Department of Speech and Language Pathology, Faculty of Medicine, University of Strasbourg, Strasbourg, France
| | - Marion Belorgeot
- Physical and Rehabilitation Medicine Department, University Hospital of Nîmes, Nîmes, France
| | - Steven Laureys
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
| | - Olivia Gosseries
- Coma Science Group, GIGA-Consciousness, University of Liège, Liège, Belgium
- Centre du Cerveau², University Hospital of Liège, Liège, Belgium
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Zhou D, Li T, Fei S, Wang C, Lv Y. The effect of positive end-expiratory pressure on intracranial pressure in obese and non-obese severe brain injury patients: a retrospective observational study. BMC Anesthesiol 2022; 22:388. [PMID: 36522657 PMCID: PMC9753360 DOI: 10.1186/s12871-022-01934-9] [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: 07/26/2022] [Accepted: 12/06/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The effect of positive end-expiratory pressure (PEEP) on intracranial pressure (ICP) had never been studied in obese patients with severe brain injury (SBI). The main aim was to evaluate the effect of PEEP on ICP in SBI patients with mechanical ventilation according to obesity status. METHODS SBI patients admitted to the ICU with mechanical ventilation between 2014 and 2015 were included. Demographic, hemodynamic, arterial blood gas, and ventilator data at the time of the paired PEEP and ICP observations were recorded and compared between obese (body mass index ≥ 30 kg/m2) and non-obese SBI patients. Generalized estimating equation (GEE) model was used to assess the relationship between PEEP and ICP in obese and non-obese SBI patients, respectively. RESULTS Six hundred twenty-seven SBI patients were included, 407 (65%) non-obese and 220 (35%) obese patients. A total of 30,415 paired PEEP and ICP observations were recorded in these patients, 19,566 (64.3%) for non-obese and 10,849 (35.7%) for obese. In the multivariable analysis, a statistically significant relationship between PEEP and ICP was found in obese SBI patients, but not in non-obese ones. For every cmH2O increase in PEEP, there was a 0.19 mmHg increase in ICP (95% CI [0.05, 0.33], P = 0.007) and a 0.15 mmHg decrease in CPP (95% CI [-0.29, -0.01], P = 0.036) in obese SBI patients after adjusting for confounders. CONCLUSIONS The results suggested that, contrary to non-obese SBI patients, the application of PEEP may produce an increase in ICP in obese SBI patients. However, the effect was modest and may be clinically inconsequential.
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Affiliation(s)
- Dawei Zhou
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Tong Li
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuyang Fei
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Chao Wang
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yi Lv
- grid.24696.3f0000 0004 0369 153XDepartment of Critical Care Medicine, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Jin D, Gu X, Jiang S, Wang Y, Yang T, Lu Y, Cao Y, Lee SK, Wu H. The Association between Evidence-Based Healthcare Practices and Outcomes among Preterm Births in China. Neonatology 2022; 119:26-32. [PMID: 34883485 DOI: 10.1159/000519846] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 09/15/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Very preterm infants are at high risk of early death or severe brain injury, with potential for impaired long-term neurodevelopmental function and physical health. There are evidence-based healthcare practices that can reduce the incidence. MATERIALS AND METHODS Infants born at 24-316 weeks gestational age and admitted within 24 h to NICUs participating in the Chinese Neonatal Network in 2019 were included. We examined the association between 4 evidence-based practices: inborn (born in a tertiary hospital in the Chinese Neonatal Network), ACS (any antenatal corticosteroid), MgSO4 (prenatal magnesium sulfate), and NT (normothermic temperature [36.0-37.5°C] at admission) and early death and/or severe brain injury in the study population. RESULTS Of 6,035 eligible infants, the incidence of early death and/or severe brain injury was 10.6%. Exposure to ACS only was associated with significant lower incidence of death and/or severe brain injury than none (aOR, 0.71; 95% CI: 0.57-0.88), but not MgSO4 only (aOR, 0.97; 95% CI: 0.81-1.17), NT only (aOR, 0.91; 95% CI: 0.76-1.08), or inborn only (aOR, 0.91; 95% CI: 0.72-1.15). The association between number of practices and incidence of early death and/or severe brain injury is as follows: none = 23% (31/138), any 1 = 14% (84/592), any 2 = 12% (185/1,538), any 3 = 9% (202/2,285), and all 4 = 9% (140/1,482). DISCUSSION/CONCLUSION More comprehensive use of evidence-based practices was associated with improved survival without severe brain injury among very preterm infants born at <32 weeks gestational age.
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Affiliation(s)
- Di Jin
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China,
| | - Xinyue Gu
- NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Siyuan Jiang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yanchen Wang
- NHC Key Laboratory of Neonatal Diseases (Fudan University), Children's Hospital of Fudan University, Shanghai, China
| | - Tongling Yang
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Yulan Lu
- Center for Molecular Medicine, Pediatrics Research Institute, Children's Hospital of Fudan University, Shanghai, China
| | - Yun Cao
- Department of Neonatology, Children's Hospital of Fudan University, Shanghai, China
| | - Shoo K Lee
- Maternal-Infant Care Research Centre, Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada.,Department of Obstetrics and Gynecology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hui Wu
- Department of Neonatology, The First Hospital of Jilin University, Changchun, China
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Li X, Tan X, Wang P, Hu X, Dong Y, Zhang X, Luo B. Chronic disorders of consciousness: a case report with longitudinal evaluation of disease progression using 7 T magnetic resonance imaging. BMC Neurol 2020; 20:396. [PMID: 33121453 PMCID: PMC7594973 DOI: 10.1186/s12883-020-01973-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 10/21/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Outcome prediction for patients with disorders of consciousness (DOC) is essential yet challenging. Evidence showed that patients with DOC lasting 1 year or longer after a brain injury were less likely to recover. However, the reasons why outcomes of DOC patients differ greatly remain unclear. With a variety of analytical methods and through quantitative behavioral assessments, we aimed to track the progression of a patient with severe brain injury, in order to advance our understanding of the underlying mechanisms of DOC. CASE PRESENTATION We performed a longitudinal study for a 52-year-old male DOC patient who has remained in the state for 1.5 years with comprehensive rehabilitative therapies. The patient underwent 3 times of assessments of Coma Recovery Scale-Revised (CRS-R) and ultra-high-field 7 T magnetic resonance imaging (MRI). Both topologic properties and brain microstructure were analyzed to track disease progression. We observed dynamic increases of fiber densities with measurements at three time points (t1:1.5 M, t2:7.5 M t3:17.5 M). Specifically, fiber densities of the superior longitudinal fasciculus and arcuate fasciculus nerve fiber bundles improved mostly in the visual, verbal, and auditory subscales, which was consistent with the CRS-R scores. Moreover, the graph-theory analyses demonstrated that network topologic properties showed an improvement although the disease duration exceeded 1 year. CONCLUSIONS DOC patients with a course longer than 1 year remain possible to improve, and including evaluation methods such as WM connectome analysis and graph theory could be potentially valuable for a more precise assessment of patients with a longer course of DOC.
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Affiliation(s)
- Xiaoxia Li
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road, Hangzhou, 310003, China
| | - Xufei Tan
- Department of Clinical Medicine, Zhejiang University City College School of Medicine, Hangzhou, China
| | - Pinyi Wang
- Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China
| | - Xiaohua Hu
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China
| | - Yan Dong
- Department of Rehabilitation, Hangzhou Hospital of Zhejiang CAPR, Hangzhou, China
| | - Xiaotong Zhang
- Interdisciplinary Institute of Neuroscience and Technology, Key Laboratory for Biomedical Engineering of Ministry of Education, Zhejiang University, Hangzhou, China. .,School of Medicine, Zhejiang University, Hangzhou, China.
| | - Benyan Luo
- Department of Neurology and Brain Medical Centre, The First Affiliated Hospital, School of Medicine, Zhejiang University, Qingchun Road, Hangzhou, 310003, China.
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Hakiki B, Pancani S, Draghi F, Portaccio E, Tofani A, Binazzi B, Anna Maria R, Scarpino M, Macchi C, Cecchi F. Decannulation and improvement of responsiveness in patients with disorders of consciousness. Neuropsychol Rehabil 2020; 32:520-536. [PMID: 33100115 DOI: 10.1080/09602011.2020.1833944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Decannulation is a rehabilitation milestone in patients with Disorders of Consciousness (DoC). investigate the relationship between decannulation and improvement of responsiveness (IR) in DoC. 236 tracheostomized patients with severe Acquired Brain Injury and DoC admitted in the Intensive Rehabilitation Unit were retrospectively included. They received personalized interdisciplinary rehabilitation. At discharge, IR was evaluated. The association between IR and demographic/clinical data was investigated using a logistic regression analysis, both in the Unresponsive Wakefulness Syndrome (UWS) and Minimal Consciousness State (MCS) group, divided according to their Coma Recovery Scale-Revised score at admission. In the UWS group (N = 107), only decannulation was associated with IR at discharge (OR: 5.94, CI: 2.08-16.91, p = .001). In the MCS group (N = 129) time post-injury (OR: 0.983, CI: 0.97-0.99, p = .012) and decannulation were associated with IR at discharge (OR: 17.9, CI: 6.39-50.13, p < .001). Decannulation and IR were found to be strongly related, independently from the initial clinical state. While the retrospective nature of the study could not exclude that decannulation may be a consequence of a spontaneous recovery, the obtained results may disclose its potential influence on the clinical history of patients with DoC.
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Affiliation(s)
- Bahia Hakiki
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy
| | | | | | - Emilio Portaccio
- SOC Neurologia, Ospedale San Giovanni di Dio, Firenze, AUSL Toscana Centro, Florence, Italy
| | | | | | | | - Maenia Scarpino
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Dipartimento Neuromuscolo-Scheletrico e degli Organi di Senso, SODc Neurofisiopatologia, AOU Careggi, Florence, Italy
| | - Claudio Macchi
- IRCCS Fondazione Don Carlo Gnocchi, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Arnts H, van Erp WS, Boon LI, Bosman CA, Admiraal MM, Schrantee A, Pennartz CMA, Schuurman R, Stam CJ, van Rootselaar AF, Hillebrand A, van den Munckhof P. Awakening after a sleeping pill: Restoring functional brain networks after severe brain injury. Cortex 2020; 132:135-146. [PMID: 32979847 DOI: 10.1016/j.cortex.2020.08.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/23/2019] [Revised: 02/09/2020] [Accepted: 08/11/2020] [Indexed: 12/11/2022]
Abstract
Some patients with severe brain injury show short-term neurological improvements, such as recovery of consciousness, motor function, or speech after administering zolpidem, a GABA receptor agonist. The working mechanism of this paradoxical phenomenon remains unknown. In this study, we used electroencephalography and magnetoencephalography to investigate a spectacular zolpidem-induced awakening, including the recovery of functional communication and the ability to walk in a patient with severe hypoxic-ischemic brain injury. We show that cognitive deficits, speech loss, and motor impairments after severe brain injury are associated with stronger beta band connectivity throughout the brain and suggest that neurological recovery after zolpidem occurs with the restoration of beta band connectivity. This exploratory work proposes an essential role for beta rhythms in goal-directed behavior and cognition. It advocates further fundamental and clinical research on the role of increased beta band connectivity in the development of neurological deficits after severe brain injury.
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Affiliation(s)
- Hisse Arnts
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands.
| | - Willemijn S van Erp
- Department of Primary and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Lennard I Boon
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Conrado A Bosman
- Cognitive and Systems Neuroscience Group, Swammerdam Institute, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Marjolein M Admiraal
- Amsterdam UMC, University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Anouk Schrantee
- Amsterdam UMC, University of Amsterdam, Department of Radiology and Nuclear Medicine, Amsterdam, the Netherlands
| | - Cyriel M A Pennartz
- Cognitive and Systems Neuroscience Group, Swammerdam Institute, Center for Neuroscience, University of Amsterdam, Amsterdam, the Netherlands
| | - Rick Schuurman
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Cornelis J Stam
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Anne-Fleur van Rootselaar
- Amsterdam UMC, University of Amsterdam, Department of Neurology and Clinical Neurophysiology, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Arjan Hillebrand
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Clinical Neurophysiology and Magnetoencephalography Center, Amsterdam Neuroscience, Amsterdam, the Netherlands
| | - Pepijn van den Munckhof
- Amsterdam UMC, University of Amsterdam, Department of Neurosurgery, Amsterdam Neuroscience, Amsterdam, the Netherlands
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Mohammad K, Dharel D, Abou Mehrem A, Esser MJ, Paul R, Zein H, Scott JN, Fiedrich E, Murthy P, Dossani S, Kopores K, Kowal D, Montpetit J, Al Awad E, Thomas S. Impact of outreach education program on outcomes of neonates with hypoxic ischemic encephalopathy. Paediatr Child Health 2020; 26:e215-e221. [PMID: 34938377 DOI: 10.1093/pch/pxaa075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 02/26/2020] [Accepted: 05/14/2020] [Indexed: 11/14/2022] Open
Abstract
Aim To evaluate the impact of outreach education targeting neuroprotection on outcomes of outborn infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Methods A retrospective cohort study of infants admitted with moderate-to-severe HIE was conducted following the implementation of outreach education in January 2016. Key interventions were early identification and referral of infants with encephalopathy utilizing telemedicine and a centralized communication system, hands-on simulation, and interactive case discussion and dissemination of clinical management guidelines and educational resources. The association between the intervention and a composite outcome of death and/or severe brain injury on brain magnetic resonance imaging (MRI) was tested controlling for the confounding factors. Results Of 165 neonates, 37 (22.4%) died and/or had a severe brain injury. This outcome decreased from 35% (27/77) to 11% (10/88) following the implementation of outreach education (P<0.001). Eligible infants not undergoing therapeutic hypothermia within 6 hours from birth decreased from 19.5% (15/77) to 4.5% (4/88). The use of inotropes decreased from 49.3% (38/77) to 19.6% (13/88). Any core temperature below 33°C was recorded for 20/53 (38%) before and 16/78 (21%) after, while those within the target range of 33°C to 34°C at admission to a tertiary care facility increased from (15/53) 28% to (51/88) 58%. Outreach education was independently associated with decreased composite outcome of death and/or severe brain injury on MRI (adjusted odds ratio 0.2; 95% confidence interval 0.07 to 0.52). Conclusion Outreach education targeting neuroprotection for infants with moderate-to-severe HIE was associated with a reduction in death and/or severe brain injury.
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Affiliation(s)
- Khorshid Mohammad
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Dinesh Dharel
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Ayman Abou Mehrem
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Michael J Esser
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Renee Paul
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Hussein Zein
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - James N Scott
- Department of Radiology, University of Calgary, Calgary, Alberta.,Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta
| | - Elsa Fiedrich
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Prashanth Murthy
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Salma Dossani
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Kaley Kopores
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Derek Kowal
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - John Montpetit
- Foothills Medical Centre, Alberta Health Services, Calgary, Alberta
| | - Essa Al Awad
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
| | - Sumesh Thomas
- Department of Pediatrics, University of Calgary, Cumming School of Medicine, Calgary, Alberta
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11
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Abstract
OBJECTIVES Prognostic value of intracranial pressure (ICP) is discussed in the recent literature. The aim of our study was to find the parameter that could be representative of ICP variations and might become a good predictor of severe traumatic brain injury (TBI) outcomes in children. MATERIALS AND METHODS The study included 81 patients with severe TBI (2004-2014). INCLUSION CRITERIA GCS ≤ 8, age > 3 years old, admission time to our clinic <24 h from the time of injury. Mean daily values of ICP were used as a predictor, Glasgow outcome scale value was used as a grouping variable. Outcomes were assessed 6 months after injury. RESULTS Total mortality was 27%. We have entered the indicator "energy ICP" (E 2), which describes the dynamics of the process and energy. E 2 value in the group of survivors was <500 mmHg2; the probability of accurate forecasting was 91%. Sensitivity, 0.9; specificity; 0.94. CONCLUSIONS The proposed method is accessible and easy to perform. This method has high specificity in the prediction of severe traumatic brain injury outcome and can be a reliable tool for ICP control.
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12
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Meshcheryakov SV, Semenova ZB, Lukianov VI, Sorokina EG, Karaseva OV. Prognosis of Severe Traumatic Brain Injury Outcomes in Children. Acta Neurochir Suppl 2018; 126:11-16. [PMID: 29492523 DOI: 10.1007/978-3-319-65798-1_3] [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] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
OBJECTIVES We aimed to determine prognostic factors that can influence the outcome of severe traumatic brain injury (TBI) in children. MATERIALS AND METHODS One hundred and sixty-nine patients with severe TBI were included. Consciousness was evaluated using the Glasgow Coma Scale (GCS). Severity of concomitant injuries was evaluated using the Injury Severity Score (ISS). Computer tomography (CT) scanning was used on admission and later. Intracranial injuries were classified using the Marshall CT scale. Intracranial pressure (ICP) monitoring took place in 80 cases. Serum samples of 65 patients were tested for S-100β protein and of 43 patients for neuron specific enolase (NSE). Outcomes were evaluated 6 months after trauma using the Glasgow Outcome Scale (GOS). Statistical and mathematical analysis was conducted. The accuracy of our prognostic model was defined in another group of patients (n = 118). RESULTS GCS, pupil size and photoreaction, ISS, hypotension and hypoxia are significant predictors of outcome of severe TBI in children. CT results complement the forecast significantly. The accuracy of surviving prognosis came to 76% (0.76) in case of S-100β protein level ≤ 0.25 μg/l and NSE level < 19 μg/l. A mathematical model of outcome prognosis was based on discriminant function analysis. The model of prognosis was tested on the control group. The accuracy of prognosis was 86%. CONCLUSIONS A personalised prognostic model makes it possible to predict the outcome of severe TBI in children on the first day after trauma.
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Affiliation(s)
- Semen V Meshcheryakov
- Children's Clinical and Research Institute of Emergency Surgery and Trauma, Moscow, Russia. .,Department of Neurosurgery, Children's Clinical and Research Institute of Emergency Surgery and Trauma, St. Bolshaya Polyanka 22, 119180, Moscow, Russia.
| | - Zhanna B Semenova
- Children's Clinical and Research Institute of Emergency Surgery and Trauma, Moscow, Russia
| | - Valery I Lukianov
- Children's Clinical and Research Institute of Emergency Surgery and Trauma, Moscow, Russia
| | - Elena G Sorokina
- Federal State Autonomous Institution "Scientific Center of Children's Health" of the Ministry of Health of the Russian Federation, Moscow, Russia
| | - Olga V Karaseva
- Children's Clinical and Research Institute of Emergency Surgery and Trauma, Moscow, Russia
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13
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Belatar B, Laidi F, Abidi AE, Eljaoudi R, Mamouch F, Kabbaj S, Maazouzi W. Serum levels of Selenium and C-reactive protein in comatose patients with severe traumatic brain injury during the first week of hospitalization: case-control study. Pan Afr Med J 2018; 29:36. [PMID: 29875918 PMCID: PMC5987113 DOI: 10.11604/pamj.2018.29.36.10945] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/09/2017] [Indexed: 12/30/2022] Open
Abstract
Introduction Mortality and morbidity related to traumatic brain injuries still remain high in patients. Many authors reported the importance of Selenium in maintaining the integrity of brain functions. This fact is supported by clinical evidence that therapy with selenium supplementation could help patients suffering from brain disorders like neurodegenerative diseases. The aim of our study was to assess the relationship between Selenium concentration in serum and evolution of comatose patients with severe traumatic brain injury, in the first week of admission, and the correlation between selenium and C-reactive protein. Methods This case-control study was conducted with 64 comatose patients with TBI, in the Department of Anesthesiology and Reanimation, IbnSina University Hospital and Hospital of specialties in Rabat-Morocco, and healthy volunteers recruited in Blood transfusion center of Rabat. Blood sampling was collected from TBI patients, in the first week (3h after admission and each 48h during one week), and from healthy volunteers one time. Concentration of Se in serum was determined by electrochemical atomic absorption spectrometry. Statistical analysis was performed using Statistical software (SPSS) and the cases and controls were compared using the Mann-Whitney U test. A P-value < 0.05 was considered to be statistically significant. Results Comparison selenium concentration in the first day (D0), third day (D2) and fifth day according to the death and survival statue in patients did not show statistical significance (p > 0.05). Selenium concentration of D0 in patients and Selenium concentration in control group also did not show statistical significance (p > 0.05). Similarly, we did not report a correlation between selenium and C-reactive protein. Conclusion According to our data selenium and CRP may not play a role in progression of coma state in patients with severe traumatic brain injury.
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Affiliation(s)
- Bahia Belatar
- Research Unit of Cerebral Monitoring in Neuro-reanimation, Faculty of Medicine and Pharmacy, University Mohammed V of Rabat, Morocco
| | - Fatna Laidi
- Oral Biomechanics and Biotechnology Research Unit, Faculty of Dental Medicine, Faculty of Medicine and Pharmacy, University Mohammed V of Rabat, Morocco
| | - Abdelah El Abidi
- Department of Toxicology, National Institute of Health, Rabat, Morocco
| | - Rachid Eljaoudi
- Pharmacology and Toxicology Department, Faculty of Medicine and Pharmacy, University Mohammed V of Rabat, Morocco
| | - Fouzia Mamouch
- Research Unit of Oncology, Faculty of Medicine and Pharmacy, University Mohammed V of Rabat, Morocco
| | - Saad Kabbaj
- Research Unit of Cerebral Monitoring in Neuro-reanimation, Faculty of Medicine and Pharmacy, University Mohammed V of Rabat, Morocco.,Service of Anesthesiology and Reanimation, Hospital of Specialties, Ibn Sina University Hospital, Morocco
| | - Wajdi Maazouzi
- Research Unit of Cerebral Monitoring in Neuro-reanimation, Faculty of Medicine and Pharmacy, University Mohammed V of Rabat, Morocco.,Service of Anesthesiology and Reanimation, Hospital of Specialties, Ibn Sina University Hospital, Morocco
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Formisano R, Contrada M, Aloisi M, Buzzi MG, Cicinelli P, Vedova CD, Laurenza L, Matteis M, Spanedda F, Vinicola V, Iosa M. Improvement rate of patients with severe brain injury during post-acute intensive rehabilitation. Neurol Sci 2017; 39:753-755. [PMID: 29214386 DOI: 10.1007/s10072-017-3203-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 08/04/2017] [Accepted: 11/19/2017] [Indexed: 10/18/2022]
Abstract
Patients with severe acquired brain injury (SABI) may evolve towards different outcomes. The primary aim was to evaluate the clinical evolution of a large population of patients with SABI admitted to post-acute rehabilitation from 2001 to 2016, diagnosed with severe brain injury (GCS ≤ 8) in the acute phase and a coma duration of at least 24 h. The possible changes between the admission time to a post-acute rehabilitation hospital and the discharge time were measured by means of Glasgow Outcome Scale (GOS), Level of Cognitive Functioning (LCF), and Disability Rating Scale (DRS). We also correlated the improvement rate with some sociodemographic and clinical features of the individuals with SABI enrolled. Data of 890 patients were analyzed (54% TBI, length of stay = 162 ± 186 days, GCS = 7.46 ± 1.28); time interval from the SABI (OR = 0.246, CI 95% = 0.181 - 0.333), scores at admission of LCF (OR = 2.243, CI 95% = 1.492 - 3.73), GOS (OR = 0.138, CI 95% = 0.071 - 0.266), DRS (OR = 0.457, CI 95% = 0.330 - 0.632), and etiology (OR = 2.273, CI 95% = 1.676 - 3.084) played a significant role (p < 0.001, explained variance 69.9%) for improving GOS score. Time interval from the SABI to admission in our post-acute rehabilitation ward (OR = 0.300, CI 95% = 0.179 - 0.501, p < 0.001), length of rehabilitation stay (OR = 2.808, CI 95% = 1.694 - 4.653, p < 0.001), and etiology (OR = 1.769, CI 95% = 1.095 - 2.857, p = 0.020) led to a statistically significant improvement in DRS (explained variance 91%). The most significant predictive factors for the outcome of patients with SABI were etiology, time interval from SABI to admission in rehabilitation, and length of rehabilitation stay.
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Affiliation(s)
- Rita Formisano
- Post-Coma Unit, IRCCS Santa Lucia Foundation, Rome, Italy.
| | - Marianna Contrada
- Post-Coma Unit, IRCCS Santa Lucia Foundation, Rome, Italy.,PhD Program in Behavioral Neuroscience, Sapienza University of Rome, Rome, Italy
| | - Marta Aloisi
- Post-Coma Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | | | | | | - Maria Matteis
- Post-Coma Unit, IRCCS Santa Lucia Foundation, Rome, Italy
| | | | | | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, IRCCS Santa Lucia Foundation, Rome, Italy
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15
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Abstract
The "brain death" standard as a criterion of death is closely associated with the need for transplantable organs from heart-beating donors. Are all of these potential donors really dead, or does the documented evidence of patients destined for organ harvesting who improve, or even recover to live normal lives, call into question the premise underlying "brain death"? The aim of this paper is to re-examine the notion of "brain death," especially its clinical test-criteria, in light of a broad framework, including medical knowledge in the field of neuro-intensive care and the traditional ethics of the medical profession. I will argue that both the empirical medical evidence and the ethics of the doctor-patient relationship point to an alternative approach toward the severely comatose patient (potential brain-dead donor). Lay Summary: Though legally accepted and widely practiced, the "brain death" standard for the determination of death has remained a controversial issue, especially in view of the occurrence of "chronic brain death" survivors. This paper critically re-evaluates the clinical test-criteria for "brain death," taking into account what is known about the neuro-critical care of severe brain injury. The medical evidence, together with the understanding of the moral role of the physician toward the patient present before him or her, indicate that an alternative approach should be offered to the deeply comatose patient.
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Affiliation(s)
- Doyen Nguyen
- Pontifical University of St. Thomas Aquinas, Rome, Italy
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16
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Falk AC, Alm A, Lindström V. Prehospital management of traumatic brain injury patients--a gender perspective. Int Emerg Nurs 2015; 23:250-3. [PMID: 25676258 DOI: 10.1016/j.ienj.2015.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2014] [Revised: 01/06/2015] [Accepted: 01/07/2015] [Indexed: 11/20/2022]
Abstract
BACKGROUND Studies show that there are differences between men and women when it comes to several aspects of health care. But the research on equal care in a prehospital setting for patients with severe traumatic brain injury (TBI) has been sparsely investigated. The aim of this study is to describe prehospital care from a gender perspective. METHOD This is a retrospective study of (n = 651) patients (>15 years) with severe TBI requiring intensive care at a University Hospital in Sweden during the years 2000-2010. Outcome was measured by survival and Glasgow Outcome Scale (GOS) scores at discharge. RESULT Our results show differences, though not significant, in the initial assessments and performed interventions between male and female TBI patients. Female patients received more assessments and performed interventions compared to men during prehospital care. Men received more interventions with I.V. fluid but significantly less airway interventions (endotracheal intubation) compared to female patients. More men were transported directly to neurosurgical specialist care as compared to females. No difference in outcome was found. CONCLUSION Our results show differences, however not significant in the assessments and performed interventions between gender, with female patients receiving more assessments and interventions compared to male patients during prehospital care. Future research should focus on gender differences in initial early signs of TBI to improve early identification.
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17
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Abstract
AIM: To analyze the prevention and treatment of stress-induced gastrointestinal bleeding after severe brain injury.
METHODS: One hundred and twenty patients with severe brain injury were randomly divided into three groups: A, B and C. Group A was treated by early enteral nutrition plus drug treatment, group B by late enteral nutrition plus drug treatment, and group C by early enteral nutrition. The incidence of stress-induced gastrointestinal bleeding, gastric juice pH and the healing time of oral ulcer were compared between the three groups. The relationship of gastric juice pH and blood glucose level with the incidence of stress-induced gastrointestinal bleeding was analyzed. The clinical effects were observed.
RESULTS: The incidence rate of stress-induced gastrointestinal bleeding (10.00%, 20.00% vs 37.50%, P < 0.05) and gastric juice pH (4.97 ± 0.73, 4.49 ± 0.35 vs 3.05 ± 1.21, P < 0.05 for both) were significantly higher in the group C than in groups A and B, but the average time of ulcer healing was significantly lower in group C (22.16 ± 3.07, 29.02 ± 2.24 vs 33.26 ± 3.61, P < 0.05 for both). The above parameters also differed significantly between groups A and B (P < 0.05 for all). The incidence rate of stress-induced gastrointestinal bleeding was significantly higher in patients with gastric juice pH ≤ 2.45 than in those with gastric juice pH > 2.45 (18.62% vs 15.69%, P < 0.05), but was significantly lower in patients with blood glucose level > 10 mmol/L than in those with blood glucose level > 15 mmol/L (16.38% vs 17.72%, P < 0.05). In total, 25 cases (92.59%) had been treated successfully, and there were 2 cases (7.41%) of failure, of whom 1 had been treated successfully by surgical treatment, and 1 (3.70%) died.
CONCLUSION: Hyperacidity, gastric mucosa damage and hyperglycemia are risk factor leading to stress-induced gastrointestinal bleeding after severe brain injury. Early enteral nutrition and drug treatment can prevent stress-induced gastrointestinal bleeding.
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