scholarly journals Acute brain trauma, lung injury, and pneumonia: more than just altered mental status and decreased airway protection

2017 ◽  
Vol 313 (1) ◽  
pp. L1-L15 ◽  
Author(s):  
Parker J. Hu ◽  
Jean-Francois Pittet ◽  
Jeffrey D. Kerby ◽  
Patrick L. Bosarge ◽  
Brant M. Wagener
Keyword(s):  
Brain Injury ◽  
Lung Injury ◽  
Pulmonary Edema ◽  
Mental Status ◽  
Nosocomial Pneumonia ◽  
Altered Mental Status ◽  
Pulmonary Complications ◽  
Cellular Mechanisms ◽  
Mortality And Morbidity ◽  
Lung Immunity

Traumatic brain injury (TBI) is a major cause of mortality and morbidity worldwide. Even when patients survive the initial insult, there is significant morbidity and mortality secondary to subsequent pulmonary edema, acute lung injury (ALI), and nosocomial pneumonia. Whereas the relationship between TBI and secondary pulmonary complications is recognized, little is known about the mechanistic interplay of the two phenomena. Changes in mental status secondary to acute brain injury certainly impair airway- and lung-protective mechanisms. However, clinical and translational evidence suggests that more specific neuronal and cellular mechanisms contribute to impaired systemic and lung immunity that increases the risk of TBI-mediated lung injury and infection. To better understand the cellular mechanisms of that immune impairment, we review here the current clinical data that support TBI-induced impairment of systemic and lung immunity. Furthermore, we also review the animal models that attempt to reproduce human TBI. Additionally, we examine the possible role of damage-associated molecular patterns, the chlolinergic anti-inflammatory pathway, and sex dimorphism in post-TBI ALI. In the last part of the review, we discuss current treatments and future pharmacological therapies, including fever control, tracheostomy, and corticosteroids, aimed to prevent and treat pulmonary edema, ALI, and nosocomial pneumonia after TBI.

scholarly journals Evaluation of Mortality and Morbidity According to Initial Symptoms in COVID-19 Patients Using Clinical Epidemiologic Data from the Korea Centers for Disease Control & Prevention

Medicina ◽  
2021 ◽  
Vol 57 (7) ◽  
pp. 688
Author(s):  
So Young Kim ◽  
Dae Myoung Yoo ◽  
Chanyang Min ◽  
Joo-Hee Kim ◽  
Hyo Geun Choi
Keyword(s):  
Disease Control ◽  
Mental Status ◽  
Respiratory Symptoms ◽  
Clinical Symptoms ◽  
Altered Mental Status ◽  
High Morbidity ◽  
Shortness Of Breath ◽  
Mortality And Morbidity ◽  
Initial Symptoms ◽  
Centers For Disease Control

Background and Objectives: This study aimed to investigate whether initial symptoms of COVID-19 are associated with mortality and morbidity. Materials and Methods: The data of 5628 laboratory-confirmed COVID-19 patients were collected by the Korea Centers for Disease Control and Prevention. The maximum level of morbidity during hospital admission was classified as mild or severe, and patient mortality was recorded. Clinical symptoms were categorized as respiratory, gastrointestinal, general, and neurologic symptoms. The hazard ratios (HRs) for clinical symptoms associated with mortality were analyzed using the Cox proportional hazards model. The odds ratios (ORs) for clinical symptoms associated with morbidity were analyzed using the logistic regression model. Results: Of the included COVID-19 patients, 15.4% (808/5253) were classified as having severe morbidity. Morbidity was related to the clinical symptoms of cough, sputum, shortness of breath, vomiting/nausea, diarrhea, fever, and altered mental status or confusion. According to the symptom categories, respiratory and general symptoms were related to high morbidity (OR = 1.41, 95% CI = 1.30–1.53, p < 0.001 for respiratory symptom and OR = 1.37, 95% CI = 1.18–1.59, p < 0.001 for general symptom). Mortality was associated with the clinical symptoms of shortness of breath, fever, and altered mental status or confusion. Among the symptom categories, respiratory symptoms were associated with a 1.17-fold increased HR for mortality (95% CI = 1.04–1.32, p = 0.008). Conclusions: Initial respiratory symptoms were related to high morbidity and mortality in COVID-19 patients.

scholarly journals Operative Hysteroscopy Intravascular Absorption Syndrome Causing Hyponatremia with Associated Cerebral and Pulmonary Edema

2019 ◽  
Vol 3 (3) ◽  
pp. 252-255 ◽  
Author(s):  
Marco Elegante ◽  
Joseph Hamera ◽  
Jane Xiao ◽  
David Berger
Keyword(s):  
Computed Tomography ◽  
Emergency Department ◽  
Pulmonary Edema ◽  
Mental Status ◽  
Cerebral Edema ◽  
Altered Mental Status ◽  
Supplemental Oxygen ◽  
Hysteroscopic Myomectomy ◽  
Operative Hysteroscopy ◽  
Intravenous Saline

Operative hysteroscopy intravascular absorption syndrome is an iatrogenic syndrome caused by absorption of hypo-osmolar distension medium during hysteroscopy, which can lead to rapid hyponatremia with resulting cerebral and pulmonary edema. We present a case of a 47-year-old female who underwent hysteroscopic myomectomy at an outpatient ambulatory surgical center who was brought to the emergency department with dyspnea, hypoxia, and altered mental status. Workup showed hyponatremia with cerebral edema on computed tomography of the head and pulmonary edema on chest radiograph. The patient improved after resuscitation with intravenous saline and supplemental oxygen, and she was discharged home the next day.

Altered Mental Status in Children After Traumatic Brain Injury

2019 ◽  
Vol 48 (5) ◽  
pp. e192-e196 ◽  
Author(s):  
Vivek Dubey ◽  
Eric Nau ◽  
Marc Sycip
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Mental Status ◽  
Altered Mental Status

Emergency Department Hypertension Predicts Traumatic Brain Injury In Patients With Altered Mental Status

2014 ◽  
Vol 186 (2) ◽  
pp. 690
Author(s):  
G. Barmparas ◽  
D. Liou ◽  
J. Lu ◽  
A. Gangi ◽  
E.J. Ley ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Emergency Department ◽  
Brain Injury ◽  
Mental Status ◽  
Altered Mental Status

Pulmonary Complications following Tricyclic Antidepressant Overdose in an Adolescent

1993 ◽  
Vol 27 (5) ◽  
pp. 572-574 ◽  
Author(s):  
Gary B. Zuckerman ◽  
Edward E. Conway
Keyword(s):  
Tracheal Intubation ◽  
Lung Injury ◽  
Pulmonary Edema ◽  
Clinical Picture ◽  
Suicide Attempts ◽  
Case Reports ◽  
Tricyclic Antidepressant ◽  
Pulmonary Complications ◽  
Fluid Restriction ◽  
Gastric Aspiration

OBJECTIVE: To report a case of pulmonary edema following a tricyclic antidepressant (TCA) overdose in an adolescent. CASE SUMMARY: A 14-year-old girl with a history of prior suicide attempts ingested 54 50-mg desipramine hydrochloride tablets (45 mg/kg ingestion). The patient developed a cardiac dysrhythmia and hypotension, which were successfully treated. She subsequently developed pulmonary edema and a clinical picture suggestive of adult respiratory distress syndrome (ARDS). She was successfully managed with fluid restriction, tracheal intubation, application of positive end-expiratory pressure (PEEP), and vasopressors. The patient was discharged without any clinical sequelae. DISCUSSION: Pulmonary complications secondary to TCA overdose have rarely been reported in children. We reviewed literature pertaining to the etiology, epidemiology, pathophysiology, and management of TCA-induced lung injury, as well as other case reports. We discuss the potential relationship between sequelae resulting from TCA ingestion (e.g., cardiac disturbances, hypotension, acidosis, gastric aspiration, pneumonia) and the development of ARDS and pulmonary edema, and relate this association to our patient. CONCLUSIONS: Pulmonary edema and a clinical picture suggestive of ARDS was noted in an adolescent girl who ingested a large quantity of desipramine. Her lung injury may have been the result of a variety of factors including hypotension, metabolic acidosis, possible aspiration, or a direct action on the lung parenchyma by desipramine. We attribute her favorable clinical outcome to early intervention consisting of tracheal intubation, PEEP, fluid restriction, and vasopressor therapy.

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