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Signa Vitae

Journal of Intensive Care and Emergency Medicine

The effects of post-intubation hypertension in severe traumatic brain injury

Abstract

Introduction. The effect of post-intubation hypertension in severe traumatic brain injury (TBI) patients remains uncertain. We aimed to determine the relationship between post-intubation hypertension (mean arterial pressure (MAP) > 110mmHg) and outcomes in severe TBI.

Methods. In this retrospective cohort study, adults who presented with isolated TBI and a MAP ≥ 70mmHg were assessed. Data were retrieved from our institutional trauma registry and the admission list of our neurosurgical intensive care unit (ICU).

Results. We enrolled 126 patients, 81 of whom had a MAP ≤ 110 mmHg after intubation and were assigned to group 1; 45 patients who had a MAP > 110 mmHg were assigned to group 2. Only age (P = 0.008), heart rate (HR; P = 0.036), and MAP before intubation (P < 0.001) were significantly different between groups. We found no significant intergroup differences in mortality (35.8 vs. 35.6%, P = 1.000) or in the motor function of survivors at discharge (P = 0.333). The length of ventilator-dependent (median: 2.0 vs. 5.0 days; P = 0.003) and ICU stays (median: 4.5 vs. 10.0 days; P = 0.005) were significantly longer in group 2. Post-intubation hypertension remained significantly associated with longer ICU stay (≥ 7 days) and poor neurologic outcome (motor < 4 at discharge) after adjusting for other variables (post-intubation MAP >110 mmHg, P < 0.034, OR 3.119, 95% CI 1.087-8.953).

Conclusion. Post-intubation hypertension was associated with longer ventilator-dependent and ICU stays in patients with severe TBI.

Key words: endotracheal intubation, hemodynamics, blood pressure, mean arterial pressure, intracranial hemorrhage.

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Bilateral Intracerebral hemorrhage following CPR

Abstract

Intracranial hemorrhage is an extremely rare complication following cardiopulmonary resuscitation (CPR). Only a few cases of subarachnoid hemorrhage during the post-resuscitation period have been reported in the literature.
A 55 year-old man, who was resuscitated following a cardiac arrest, sustained an intracranial hemorrhage during the post cardiac arrest period. His brain computerized tomography (CT), performed 4 hours after return of spontaneous circulation, showed no signs of intracranial hemorrhage. However, a brain CT performed 7 days after cardiac arrest revealed a massive intracerebral hemorrhage in both basal ganglia and thalami with an associated subarachnoid hemorrhage.
This paper reports the first case of intracerebral hemorrhages in bilateral basal ganglia and thalami that developed following cardiac arrest and resuscitation.

 

Key words: cardiopulmonary resuscitation (CPR), intracranial hemorrhage, basal ganglia hemorrhage, cardiac arrest

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