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Signa Vitae

Journal of Intensive Care and Emergency Medicine

Impact of pre-hospital oxygenation and ventilation status on outcome in patients with isolated severe traumatic brain injury

Abstract

Introduction. Hypoxia is one of the secondary insults and it worsens the outcome in patients with severe traumatic brain injury (TBI). On the other hand, there is some controversy about the impact of hyperoxia on the outcome in these patients. The aim of the study was to determine the impact of pre-hospital hypoxia, hyperoxia and pre-hospital ventilation status on outcome after isolated TBI.

Methods. We retrospectively reviewed charts from patients with isolated severe TBI who underwent pre-hospital endotracheal intubation. The population was sorted into groups based on PaO2 (hypoxic, PaO2 <100 mmHg; normoxic, PaO2 100-200 mmHg; hyperoxic, PaO2 > 200 mmHg) and initial Glasgow Coma Scale (GCS) level (3-5 and ≥ 6). Ventilation status was defined as: hypocarbic (PaCO2 < 35 mmHg), normocarbic (PaCO2 35-45 mmHg) and hypercarbic (PaCO2 > 45 mmHg).

Results. Oxygenation status had no significant impact on 24- and 48-hour survival, on the length of hospital stay or on neurological outcome (measured by the Glasgow Outcome Scale (GOS), Glasgow Pittsburgh Cerebral Performance Categories Scale (CPC), and GCS score at discharge) when all six groups were compared together. We were unable to prove a deleterious effect of hypoxia or hyperoxia compared to normoxia on rate of survival to hospital discharge (STHD) (0.38 (0.52) vs 0.50 (0.51) vs 0.65 (0.49), where 0 – no and 1 – yes; f = 1.246, p = 0.298). Ventilation status also failed to significantly affect survival and functional outcome in patients with isolated severe TBI.

Conclusion. Pre-hospital oxygenation and ventilation status have no significant impact on outcome in patients with isolated severe TBI.

Key words: hypoxia, pre-hospital, intubation, hyperventilation, traumatic brain injury

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Internal carotid artery dissection at the supraclinoid portion after severe traumatic head injury in a child

Abstract

A 14-year-old boy with severe traumatic brain injury (TBI) and cranial fractures was admitted to our emergency department after a motor vehicle accident. An emergency craniotomy was performed, and traumatic carotid artery (CA) dissection (tCAD) was revealed by cerebral angiography. The patient then underwent close observation in the intensive care unit. Traumatic CADs are difficult to diagnose in the early period after injury, and are associated with serious problems and a high mortality rate. There is still a lack of knowledge surrounding its natural history and treatment options, especially in children. Moreover, it commonly occurs at the cervical internal CA, and tCAD at the supraclinoid portion is quite rare. To the best of our knowledge, this is the first report accompanied by radiological images of the clinical course of tCAD at the supraclinoid portion following severe TBI in a child.

Key words: traumatic brain injury, craniotomy, neurosurgery, computed tomography, angiography.

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Induced mild hypothermia in children

Abstract

The objective of this study was to measure outcomes and to determine the safety and effectiveness of mild induced hypothermia in children after traumatic and posthypoxic brain injury.
Methods. Forty patients, following traumatic or posthypoxic brain injury, were involved in the study. Mean age was 10.7 ± 0.8 years. Median GCS (Glasgow Coma Scale) was  6.0 (4-7) and mean PIM2 (Pediatric Index of Mortality) 14.6 ± 3.8 %.
Results. GOS (Glasgow Outcome Scale) of 5 was assigned for 15 (37.5%) patients, GOS 4 for 14 (35.0%), GOS 3 for 7 (17.5%) and GOS 2 for 4 (10%) patients. The average GOS in patients after severe head trauma was 3.6 ± 0.9 points and in patients with posthypoxic brain injury 5 points, (p < 0.05). No life threatening complications occurred.
Conclusion. Mild induced hypothermia can be safely used in pediatric patents after severe traumatic or posthypoxic brain injury. This method may be of benefit while improving outcomes in children.

 

Key words: traumatic brain injury, posthypoxic brain injury, children, hypothermia, outcome, Pediatric Index of Mortality

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