scholarly journals Biomarkers of Neurological Outcome After Aneurysmal Subarachnoid Hemorrhage as Early Predictors at Discharge from an Intensive Care Unit

2020 ◽  
Author(s):  
Jaroslaw Kedziora ◽  
Malgorzata Burzynska ◽  
Waldemar Gozdzik ◽  
Andrzej Kübler ◽  
Katarzyna Kobylinska ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Acute Treatment ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Treatment Phase ◽  
Icu Outcome ◽  
Outcome Group ◽  
Group 2 ◽  
Group 1

Abstract Background Subarachnoid bleeding is associated with brain injuries and ranges from almost negligible to acute and life threatening. The main objectives were to study changes in brain-specific biomarker levels in patients after an aneurysmal subarachnoid hemorrhage (aSAH) in relation to early clinical findings, severity scores, and intensive care unit (ICU) outcome. Analysis was done to identify specific biomarkers as predictors of a bad outcome in the acute treatment phase. Methods Analysis was performed for the proteins of neurofilament, neuron-specific enolase (NSE), microtubule-associated protein tau (MAPT), and for the proteins of glial cells, S100B, and glial fibrillary acidic protein (GFAP). Outcomes were assessed at discharge from the ICU and analyzed based on the grade in the Glasgow Outcome Scale (GOS). Patients were classified into two groups: with a good outcome (Group 1: GOS IV–V, n = 24) and with a bad outcome (Group 2: GOS I–III, n = 31). Blood samples were taken upon admission to the ICU and afterward daily for up to 6 days. Results In Group 1, the level of S100B (1.0, 0.9, 0.7, 2.0, 1.0, 0.3 ng/mL) and NSE (1.5, 2.0, 1.6, 1.2, 16.6, 2.2 ng/mL) was significantly lower than in Group 2 (S100B: 4.7, 4.8, 4.4, 4.5, 6.6, 6.8 ng/mL; NSE: 4.0, 4.1, 4.3, 3.8, 4.4, 2.5 1.1 ng/mL) on day 1–6, respectively. MAPT was significantly lower only on the first and second day (83.2 ± 25.1, 132.7 ± 88.1 pg/mL in Group 1 vs. 625.0 ± 250.7, 616.4 ± 391.6 pg/mL in Group 2). GFAP was elevated in both groups from day 1 to 6. In the ROC analysis, S100B showed the highest ability to predict bad ICU outcome of the four biomarkers measured on admission [area under the curve (AUC) 0.81; 95% CI 0.67–0.94, p < 0.001]. NSE and MAPT also had significant predictive value (AUC 0.71; 95% CI 0.54–0.87, p = 0.01; AUC 0.74; 95% CI 0.55–0.92, p = 0.01, respectively). A strong negative correlation between the GOS and S100B and the GOS and NSE was recorded on days 1–5, and between the GOS and MAPT on day 1. Conclusion Our findings provide evidence that brain biomarkers such as S100B, NSE, GFAP, and MAPT increase significantly in patients following aSAH. There is a direct relationship between the neurological outcome in the acute treatment phase and the levels of S100B, NSE, and MAPT. The detection of brain-specific biomarkers in conjunction with clinical data may constitute a valuable diagnostic and prognostic tool in the early phase of aSAH treatment.

scholarly journals Comparison of ICU Outcomes between Intravenous Immunoglobulin and Plasma Exchange in Treatment of Mechanically Ventilated Patients with GuillainBarré Syndrome in a Neuro-Intensive Care Unit in a Govt. Hospital of Bangladesh: A Observational Cohort Study

2019 ◽  
Vol 5 (2) ◽  
pp. 118-122
Author(s):  
Uzzwal Kumar Mallick ◽  
Mohammad Shah Jahirul Hoque Chowdhury ◽  
Mohammad Enayet Hussain ◽  
Mohammad Asaduzzaman ◽  
Md Sirajul Islam ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intravenous Immunoglobulin ◽  
Statistical Significance ◽  
Axonal Neuropathy ◽  
Male Predominance ◽  
Icu Stay ◽  
The Mean ◽  
Group 2 ◽  
Group 1

Background: The management of Guillain-Barré Syndrome is very crucial for the outcome of the patient. Objective: The aim of the study was to compare efficacy of IvIg(Intravenous Immunoglobulin) versus PE(Plasmaexchange) in treatment of mechanically ventilation adults with GBS in neuro-intensive care unit of Bangladesh. Methodology: Thiswas a prospective, observationalcohort study, in a Neuro-ICU from 2017 to 2018. We included all patients with GBS who required mechanical ventilation (MV). We defined two groups: group 1 (group treated by IvIg: 0.4 g/kg/day for 5 days) and group 2 (group treated by PE: 5 PE during 10days, every alternate day). We collectedclinical and therapeutic aspects and outcome. Results: A total number of 49 patients (34 in group 1 and 15 in group 2) were enrolled. The mean age was 37.4±9.2 years, with a male predominance (65.3%). on electrophysiological findings, in 4(32.7%) patients had acute inflammatory demyelinating polyradiculoneuropathy (AIDP) and acute motor axonal neuropathy (AMAN) in 26 (53.1%) patients and acute motor-sensory axonal neuropathy (AMSAN) was 3(6.1%)and NCS was not done in 4(8.2%) cases. The mean length of ICU stay was 20±19.10 days and 46.60±30.02 days in IVIG and PE group respectively. The ICU stay was significantly shorter (p = 0.001) in the IvIg group than PE group. Patients receiving IvIg were early weaned of MV (p = 0.002) compared to those receiving PE with a statistical significance. Also, duration of M/V (P=.002), Need of tracheostomy (p=.005) and over all surval rate (p=.007) was significantly in favoue of IvIg group than PE group. Out of 49 patients, total 3 patients were died and they all were AMAN variety. Conclusion: Our work reveals a meaningful difference for the MV duration, ICU stay, weaning and excellent recovery in IvIg group compared to PE group in terms of less complcations. Journal of National Institute of Neurosciences Bangladesh, 2019;5(2): 118-122

Does the subspecialty of an intensive care unit (ICU) has an impact on outcome in patients suffering from aneurysmal subarachnoid hemorrhage?

2018 ◽  
Vol 42 (1) ◽  
pp. 147-153
Author(s):  
Dorothee Mielke ◽  
Vesna Malinova ◽  
Onnen Moerer ◽  
Patricia Suntheim ◽  
Martin Voit ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Aneurysmal Subarachnoid Hemorrhage

scholarly journals Intensive care of traumatic brain injury and aneurysmal subarachnoid hemorrhage in Helsinki during the Covid-19 pandemic

2020 ◽  
Vol 162 (11) ◽  
pp. 2715-2724
Author(s):  
Teemu Luostarinen ◽  
Jyri Virta ◽  
Jarno Satopää ◽  
Minna Bäcklund ◽  
Riku Kivisaari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Traumatic Brain Injury ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Brain Injury ◽  
Retrospective Review ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Mortality Rates ◽  
Case Mix

Abstract Background To ensure adequate intensive care unit (ICU) capacity for SARS-CoV-2 patients, elective neurosurgery and neurosurgical ICU capacity were reduced. Further, the Finnish government enforced strict restrictions to reduce the spread. Our objective was to assess changes in ICU admissions and prognosis of traumatic brain injury (TBI) and aneurysmal subarachnoid hemorrhage (SAH) during the Covid-19 pandemic. Methods Retrospective review of all consecutive patients with TBI and aneurysmal SAH admitted to the neurosurgical ICU in Helsinki from January to May of 2019 and the same months of 2020. The pre-pandemic time was defined as weeks 1–11, and the pandemic time was defined as weeks 12–22. The number of admissions and standardized mortality rates (SMRs) were compared to assess the effect of the Covid-19 pandemic on these. Standardized mortality rates were adjusted for case mix. Results Two hundred twenty-four patients were included (TBI n = 123, SAH n = 101). There were no notable differences in case mix between TBI and SAH patients admitted during the Covid-19 pandemic compared with before the pandemic. No notable difference in TBI or SAH ICU admissions during the pandemic was noted in comparison with early 2020 or 2019. SMRs were no higher during the pandemic than before. Conclusion In the area of Helsinki, Finland, there were no changes in the number of ICU admissions or in prognosis of patients with TBI or SAH during the Covid-19 pandemic.

Carbapenem-Resistant Klebsiella pneumoniae Outbreak in a Neonatal Intensive Care Unit: Risk Factors for Mortality

2020 ◽  
Author(s):  
Meltem Bor ◽  
Ozkan Ilhan
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Klebsiella Pneumoniae ◽  
Congenital Anomalies ◽  
Neonatal Intensive Care ◽  
Carbapenem Resistant ◽  
Group 2 ◽  
Antifungal Use ◽  
Group 1

Abstract Aim The aim of our study was to determine the factors associated with mortality in neonates with carbapenem-resistant Klebsiella pneumoniae (CRKP). Material and methods This retrospective, single-center study was conducted in the Neonatal Intensive Care Unit of Harran University Faculty of Medicine between January 2017 and July 2018 who had CRKP growth in their blood, urine or cerebrospinal fluid cultures. The discharged group was designated as the control group (Group 1), whereas the group that faced mortality was classified as the case group (Group 2). The demographic data, clinical findings and laboratory and microbiological results of the two groups were compared to identify risk factors. Results A total of 58 patients (36 in Group 1 and 22 in Group 2) exhibited CRKP growth during the study period. Low birth weight (p = 0.039), previous antifungal (p = 0.002) or amikacin use (p = 0.040), congenital anomalies (p = 0.002), total parenteral nutrition (TPN) administration (p = 0.002), surgery (p = 0.035), thrombocytopenia (p = 0.007), low platelet mass index (p = 0.011), elevated C-reactive protein (p = 0.004), high carbapenem minimum inhibitory concentration (MIC) (p = 0.029) and high amikacin MIC (p = 0.019) were associated with mortality. In a multivariate regression analysis, previous antifungal use (p = 0.028), congenital anomalies (p = 0.032) and TPN use (p = 0.013) were independent factors in predicting mortality. Conclusion Previous antifungal use, congenital anomalies and TPN use were found to be independent risk factors for mortality in neonates with CRKP infection.

Target Serum Sodium Levels During Intensive Care Unit Management of Aneurysmal Subarachnoid Hemorrhage

Shock ◽  
2017 ◽  
Vol 48 (5) ◽  
pp. 558-563 ◽  
Author(s):  
Tomoya Okazaki ◽  
Toru Hifumi ◽  
Kenya Kawakita ◽  
Hajime Shishido ◽  
Daisuke Ogawa ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Serum Sodium ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Unit Management ◽  
Intensive Care Unit Management

scholarly journals Peculiarities of the morphology of liver biopsy samples of donors above 60 years of age

2020 ◽  
Vol 21 (4) ◽  
pp. 36-40
Author(s):  
I. M. Iljinsky ◽  
N. P. Mozheyko ◽  
D. V. Voronov ◽  
M. G. Minina ◽  
O. M. Tsirulnikova
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Biopsy ◽  
Optimal Level ◽  
Morphological Parameters ◽  
Careful Monitoring ◽  
Donor Pool ◽  
Total Pool ◽  
Group 2 ◽  
Group 1

Objective: to study the differences in the frequency of pathological processes in liver biopsy samples of donors older than 60 years (group 1) and donors currently recognized as “standard” by age – 60 years and younger (group 2). Material and methods. Of the total pool of 300 consecutive donors with brain death, there were 28 (9.3%) donors over 60 years old (61 to 73 years old; 19 men and 9 women). Results. The frequency of pathology is independent of gender in both groups (p > 0.05). In elderly donors, compared with “standard” donors, mild (p < 0.05) and significantly more often severe (p < 0.05) albuminous degeneration are significantly less frequent, and there is only a tendency (p > 0.05) to more frequent mild hepatic steatosis. Dystrophic processes are the result of more severe ischemic injury to the liver of elderly donors. Ischemic liver injury determines the risk of more frequent biliary complications, which require careful monitoring and maintenance at an optimal level of hemodynamics for donors in the intensive care unit. Based on other morphological parameters, the liver of donors above 60 years of age does not significantly differ (p > 0.05) from the liver of donors 60 years and younger. Conclusion. To expand the donor pool, age restrictions should be removed when selecting a liver for transplantation, thereby maximizing the use of donor potential.

scholarly journals Comparison of use and non-use of prophylactic antibiotics for severe acute pancreatitis

2021 ◽  
Vol 8 (8) ◽  
pp. 2281
Author(s):  
Hector Losada M. ◽  
Sonia Curitol ◽  
Andres Troncoso T. ◽  
Norberto Portillo L.
Keyword(s):  
Intensive Care Unit ◽  
Acute Pancreatitis ◽  
Intensive Care ◽  
Severe Acute Pancreatitis ◽  
Preliminary Report ◽  
Prophylactic Antibiotics ◽  
Average Hospital ◽  
Antibiotics Use ◽  
Group 2 ◽  
Group 1

Background: Acute pancreatitis is a frequent disease in Chile, with mortality rate of 10-30%. Prophylactic antibiotics administration has been part of severe acute pancreatitis treatment for theoretical prevention of infectious complications and mortality reduction. Yet the available evidence is controversial. The aim of the study was to demonstrate that prophylactic antibiotics do not reduce complications, need for intensive care unit bed or mortality in severe acute pancreatitis.Methods: Randomized clinical trial with simple randomization using a computational table (use or non-use of prophylactic antibiotics) of patients with severe acute pancreatitis. We define severe acute pancreatitis as APACHE II ≥8, C-reactive protein ≥150. In prophylactic antibiotics use group, ciprofloxacin and metronidazole were administered for 7 days. This preliminary report is presented with 50% of the calculated sample.Results: N=150, two randomized groups; group 1 (n=73), without prophylactic antibiotics use, and group 2 (n=77) with antibiotic prophylaxis use. Twenty-four patients (16%) required intensive care unit bed; twelve in group 1, and twelve in group 2 (p=0.53). Ten patients (6.66%) had some type of complication, one in group 1 and nine in group 2 (p=0.01). The average hospital stay was 15.7±9.0 days in group 1, and 16.8±17.9 days in group 2 (p=0.57). Mortality was four patients (2.66%), one in group 1 and three in group 2 (p=0.33).Conclusions: In this preliminary report, the prophylactic antibiotics use for severe acute pancreatitis was not shown to reduce complications, need for an intensive care unit bed or mortality.

Serum Cortisol as an Early Biomarker of Cardiopulmonary Parameters Within the First 24 Hours After Aneurysmal Subarachnoid Hemorrhage in Intensive Care Unit Patients

2019 ◽  
Vol 35 (11) ◽  
pp. 1173-1179
Author(s):  
Michael Bender ◽  
M. Stein ◽  
E. Uhl ◽  
M. H. T. Reinges
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Subarachnoid Hemorrhage ◽  
Troponin I ◽  
Aneurysmal Subarachnoid Hemorrhage ◽  
Elevated Serum ◽  
Serum Cortisol ◽  
Fisher Grade ◽  
Gcs Score ◽  
Icu Treatment

Objective: Cardiopulmonary complications/stress are well-known phenomena in patients after aneurysmal subarachnoid hemorrhage (aSAH) and might be associated with an elevated serum troponin I (TNI) level. Since the glucocorticoid hormone cortisol is released during stress situations, the present study was conducted to investigate the influence of serum cortisol (SC) on cardiac and pulmonary parameters in patients after aSAH within the first 24 hours of intensive care unit (ICU) treatment. Patients and Methods: We retrospectively analyzed a cohort of 104 patients with aSAH admitted to our emergency department between January 2008 and April 2017. Blood samples were taken to determine SC and TNI. Demographics, initial Glasgow Coma Scale (GCS) score, World Federation of Neurosurgical Societies (WFNS) score, and Fisher grade were evaluated retrospectively. Mean norepinephrine application rate (NAR) in µg/kg/min and mean inspiratory oxygen fraction (OF) within the first 24 hours were defined as cardiopulmonary parameters. Results: An elevated SC value was found in 44 (42%) patients, and 27 (26%) patients showed an increased TNI value. In patients with initially increased SC value, a significant higher NAR ( P = .04) was needed. Furthermore, patients with initially elevated TNI value had a lower GCS score ( P = .0013) and a higher WFNS score ( P = .003) on admission and required a higher NAR ( P = .02) as well as OF ( P = .0008) within the first 24 hours of ICU treatment. Conclusions: In the current study, initially elevated SC values were associated with a higher need of NAR within the first 24 hours of ICU treatment after aSAH. Moreover, patients with initially elevated TNI values required an increased NAR and a higher OF so that these biomarkers could be useful to improve ICU treatment.

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