scholarly journals Appearance of isolated thrombocytopenia in a patient of acute subdural hematoma

2015 ◽  
Vol 22 (1) ◽  
pp. 101-103
Author(s):  
S. Satish Kumar ◽  
M. Srinivas ◽  
K. Raghu ◽  
P. Shashidhar ◽  
Amit Agrawal
Keyword(s):  
Critically Ill ◽  
Subdural Hematoma ◽  
Critically Ill Patients ◽  
Clinical Status ◽  
Fatal Outcome ◽  
Mass Effect ◽  
Sudden Onset ◽  
Acute Subdural Hematoma ◽  
Underlying Illness ◽  
History Of

Abstract Thrombocytopenia in critically ill patients probably reflects the severity of the underlying illness and these patients have a higher mortality due to the severity of overall clinical status. In present article we report a case of acute subdural hematoma who developed progressive thrombocytopenia resulting in fatal outcome. A 75 year gentleman presented with history of sudden onset headache and lapsed into altered sensorium. There was history of trivial fall before he developed headache. The patient was deeply comatose with pupils bilateral 2 mm and reacting to light. Computerized tomography (CT) scan brain showed large right fronto-temporo-parietal acute subdural hematoma with mass effect and midline shift. Post-operatively he was kept on elective ventilation. On following days the patient continues to develop thrombocytopenia (Day- 3 Platelet count 75,000, day-4 60,000, day-5 25,000). Thrombocytopenia is a common but a potentially life-threatening condition problem and has been considered to play a role in worsening the prognosis of critically ill patients in intensive care unit. Few studies statistically examine the strength of the association between risk factors and outcomes related to thrombocytopenia, additional research is recommended to identify putative molecular determinants.

scholarly journals Etiology, incidence, and outcomes of patient–ventilator asynchrony in critically-ill patients undergoing invasive mechanical ventilation

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Yongfang Zhou ◽  
Steven R. Holets ◽  
Man Li ◽  
Gustavo A. Cortes-Puentes ◽  
Todd J. Meyer ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mechanical Ventilation ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Invasive Mechanical Ventilation ◽  
Surgical Intensive Care ◽  
Mechanically Ventilated ◽  
History Of ◽  
Training Background ◽  
The Relationship

AbstractPatient–ventilator asynchrony (PVA) is commonly encountered during mechanical ventilation of critically ill patients. Estimates of PVA incidence vary widely. Type, risk factors, and consequences of PVA remain unclear. We aimed to measure the incidence and identify types of PVA, characterize risk factors for development, and explore the relationship between PVA and outcome among critically ill, mechanically ventilated adult patients admitted to medical, surgical, and medical-surgical intensive care units in a large academic institution staffed with varying provider training background. A single center, retrospective cohort study of all adult critically ill patients undergoing invasive mechanical ventilation for ≥ 12 h. A total of 676 patients who underwent 696 episodes of mechanical ventilation were included. Overall PVA occurred in 170 (24%) episodes. Double triggering 92(13%) was most common, followed by flow starvation 73(10%). A history of smoking, and pneumonia, sepsis, or ARDS were risk factors for overall PVA and double triggering (all P < 0.05). Compared with volume targeted ventilation, pressure targeted ventilation decreased the occurrence of events (all P < 0.01). During volume controlled synchronized intermittent mandatory ventilation and pressure targeted ventilation, ventilator settings were associated with the incidence of overall PVA. The number of overall PVA, as well as double triggering and flow starvation specifically, were associated with worse outcomes and fewer hospital-free days (all P < 0.01). Double triggering and flow starvation are the most common PVA among critically ill, mechanically ventilated patients. Overall incidence as well as double triggering and flow starvation PVA specifically, portend worse outcome.

scholarly journals Diagnostic biomarkers for adult haemophagocytic lymphohistiocytosis in critically ill patients (HEMICU): a prospective observational study protocol

BMJ Open ◽  
2019 ◽  
Vol 9 (10) ◽  
pp. e032695 ◽  
Author(s):  
Gunnar Lachmann ◽  
Cornelia Knaak ◽  
Clarissa von Haefen ◽  
Nadine Paeschke ◽  
Christian Meisel ◽  
...  
Keyword(s):  
Incidence Rate ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Fatal Outcome ◽  
Experimental Studies ◽  
Ethics Committee ◽  
Adult Patients ◽  
Haemophagocytic Lymphohistiocytosis ◽  
Diagnostic Biomarkers ◽  
Potential Biomarker

IntroductionHaemophagocytic lymphohistiocytosis (HLH) in adults is characterised by toxic immune activation and a sepsis-like syndrome, leading to high numbers of undiagnosed cases and mortality rates of up to 68%. Early diagnosis and specific immune suppressive treatment are mandatory to avoid fatal outcome, but the diagnostic criteria (HLH-2004) are adopted from paediatric HLH and have not been validated in adults. Experimental studies suggest biomarkers to sufficiently diagnose HLH. However, biomarkers for the diagnosis of adult HLH have not yet been investigated.Methods and analysisThe HEMICU (Diagnostic biomarkers for adult haemophagocytic lymphohistiocytosis in critically ill patients) study aims to estimate the incidence rate of adult HLH among suspected adult patients in intensive care units (ICUs). Screening for HLH will be performed in 16 ICUs of Charité – Universitätsmedizin Berlin. The inclusion criteria are bicytopaenia, hyperferritinaemia (≥500 µg/L), fever or when HLH is suspected by the clinician. Over a period of 2 years, we expect inclusion of about 100 patients with suspected HLH. HLH will be diagnosed if at least five of the HLH-2004 criteria are fulfilled, together with an expert review; all other included patients will serve as controls. Second, a panel of potential biomarker candidates will be explored. DNA, plasma and serum will be stored in a biobank. The primary endpoint of the study is the incidence rate of adult HLH among suspected adult patients during ICU stay. Out of a variety of measured biomarkers, this study furthermore aims to find highly potential biomarkers for the diagnosis of adult HLH in ICU. The results of this study will contribute to improved recognition and patient outcome of adult HLH in clinical routine.Ethics and disseminationThe institutional ethics committee approved this study on 1 August 2018 (Ethics Committee of Charité – Universitätsmedizin Berlin, EA4/006/18). The results of the study will be disseminated in an international peer-reviewed journal and presented at international conferences.Trial registration numberNCT03510650.

scholarly journals An Alternative Approach to Treatment of Hypophosphatemia in Nonsurgical Critically Ill Patients in Countries With Limited Resources

Dose-Response ◽  
2019 ◽  
Vol 17 (2) ◽  
pp. 155932581985042
Author(s):  
Tijana Kovačević ◽  
Peđja Kovačević ◽  
Boris Tomić ◽  
Saša Dragić ◽  
Danica Momčičević
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Phosphate Buffer ◽  
Dose Range ◽  
Clinical Status ◽  
Serum Phosphate ◽  
Serum Phosphate Level ◽  
Alternative Approach ◽  
Medical Intensive Care ◽  
A Prospective Study

Background: Hypophosphatemia can complicate and prolong the treatment of critically ill patients, and it is even thought to be related to mortality rate. Objectives: The aim of this study is to determine whether using extemporary prepared phosphate buffer in pharmacy would help correct serum phosphate in critically ill patients. Methods: A prospective study was conducted at the medical intensive care unit over a period of 1 year and included 50 patients who were diagnosed with hypophosphatemia. Phosphate buffer was prepared at the pharmacy, and the dose range was recommended by a clinical pharmacist. Results: Patients were administered phosphate buffer via the nasogastric tube, and the doses chosen by the physicians depended on serum phosphate level and the severity of the patients’ clinical status. Serum phosphate levels were successfully corrected in all treated patients. The most frequently used dose was 60 mmoL/d, and in most patients 1-day therapy was sufficient. No adverse effects were observed. Conclusion: The phosphate buffer is an adequate alternative for the treatment of hypophosphatemia of nonsurgically critically ill patients. One-day therapy with the 60 mmoL phosphate dose divided into 3 single doses resulted in normalization of serum phosphate values in most patients.

Venous thromboembolism in critically ill patients

2009 ◽  
Vol 101 (01) ◽  
pp. 139-144 ◽  
Author(s):  
Mark Williams ◽  
Andrew Shorr
Keyword(s):  
Severe Sepsis ◽  
Venous Thromboembolism ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Controlled Trial ◽  
Double Blind ◽  
Vte Prophylaxis ◽  
Drotrecogin Alfa Activated ◽  
History Of ◽  
Sepsis And Septic Shock

SummaryVenous thromboembolism (VTE) is a central concern in the intensive care unit (ICU). However, little is known about both current practices for VTE prevention in the ICU and the risk for VTE in persons with severe sepsis and septic shock. XPRESS was a randomized, double-blind, placebo-controlled trial of prophylactic heparin in patients with severe sepsis and higher disease severity who were treated with drotrecogin alfa (activated) (DAA). Subjects were randomized to unfractionated heparin, low-molecular-weight heparin, or placebo during the DAA infusion period. All patients underwent ultrasonography between days 4-6 to screen for VTE. We assessed baseline utilization of VTE prophylaxis along with application of these methods after completion of the DAA infusion. The study included 1,935 subjects and, prior to enrollment approximately half were given no form of prophylaxis. By day 6, 5% of subjects developed a VTE, and the rate of VTE did not vary based on type of heparin administered. The vast majority of VTE detected by day 6 were clinically silent. Of factors analyzed, history of VTE was the only variable independently associated with development of a VTE (odds ratio, 3.66, 95% confidence interval 1.77–7.56, p=0.005). Strikingly, patients who were initially receiving heparin prophylaxis prior to enrollment but who then had this discontinued because of randomization to placebo suffered more VTE that persons continuing on some form of heparin. Despite multiple guidelines, physicians do not uniformly prescribe VTE prophylaxis. Nonetheless, early VTE occurs even in persons given DAA. Most VTE in critically ill patients are clinically silent.

scholarly journals Natural History of Acute Subdural Hematoma

2017 ◽  
Vol 28 (2) ◽  
pp. 247-255 ◽  
Author(s):  
Rafael A. Vega ◽  
Alex B. Valadka
Keyword(s):  
Natural History ◽  
Subdural Hematoma ◽  
Acute Subdural Hematoma ◽  
History Of

Thoracolumbar spine subdural hematoma as a result of nonaccidental trauma in a 4-month-old infant

2008 ◽  
Vol 2 (2) ◽  
pp. 139-142 ◽  
Author(s):  
Thomas J. Gruber ◽  
Curtis J. Rozzelle
Keyword(s):  
Subdural Hematoma ◽  
Emergency Services ◽  
Pediatric Trauma ◽  
Thoracolumbar Spine ◽  
Male Infant ◽  
Mass Effect ◽  
Respiratory Arrest ◽  
Conus Medullaris ◽  
Nonaccidental Trauma ◽  
History Of

The authors describe the previously unreported occurrence of thoracolumbar subdural hematoma (SDH) resulting from nonaccidental trauma and emphasize the need for a complete and thorough neurological, physical, and radiological examination in all cases of suspected nonaccidental trauma. A 4-month-old male infant presented to the authors' Level 1 pediatric trauma center in respiratory arrest. According to the family, he had been previously healthy with a 1-day history of fussiness and irritability. While with one of the parents, the patient was noted to be apneic and had been shaken in 2 separate episodes in an attempt to stimulate respiration. Emergency services personnel intubated the child's trachea and transported him to the hospital. On arrival in the emergency department, the child was unresponsive and exhibited signs of myelopathy. A CT scan of his head demonstrated SDH and subarachnoid hemorrhage. Magnetic resonance imaging of the spine demonstrated an SDH dorsal to the spinal cord with some mass effect on the conus medullaris and descending nerve roots. The patient underwent emergency T-12 to L-3 laminotomies, evacuation of the hematoma, and laminoplasty. The rigid nature of the rib cage provides a point of fixation around which the thoracolumbar spine can hyperflex and hyperextend when shaken, resulting in severe injury to the bony, vascular, and neural elements of the spine.

scholarly journals Quantitative EEG Features of Level of Consciousness in Critically Ill Nonagenarians

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 122-122
Author(s):  
Shawniqua Williams Roberson ◽  
Kevin Haas
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Medical Center ◽  
Clinical Care ◽  
Quantitative Eeg ◽  
Level Of Consciousness ◽  
Anchoring Bias ◽  
History Of ◽  
Automated Processing ◽  
The Relationship

Abstract The standard for monitoring sedation levels in critically ill patients is intermittent bedside evaluation, and is prone to anchoring bias. Quantitative electroencephalography (qEEG) allows automated processing of recorded brain electrical activity and could be used to continuously monitor level of consciousness in critically ill patients. The majority of qEEG studies have included persons 80 years of age or less, and the qEEG profiles of nonagenarians have been incompletely characterized. Knowledge of the qEEG patterns of patients 90 years and older is essential for appropriate interpretation of such metrics in this population. This retrospective cohort study characterized qEEG profiles of acutely ill nonagenarians. We investigated whether the relationship between qEEG and level of consciousness differed between patients with and without a history of dementia. We included patients 90-100 years old admitted to Vanderbilt University Medical Center who underwent EEG and as part of their clinical care. We compared qEEG features to nursing-defined level of arousal as measured by the Richmond Agitation-Sedation Scale (RASS) in patients with and without history of dementia. Between January and December 2019, 26 nonagenarians underwent EEG for clinical purposes. One study was excluded due to excessive artifact. Of the remaining, 6 (24%) were male and 18 (72%) were Caucasian. Among all patients, RASS decreased with increases in EEG theta variability (coefficient -7.7, 95%CI -10.6 to -4.8). This relationship was not significantly modified by history of dementia (coefficient of interaction term -0.36, 95%CI -3.7 to 2.9). Dementia does not impact qEEG features of level of consciousness in nonagenarians.

scholarly journals Warning with chronic subdural hematomas in the elderly

2021 ◽  
Vol 11 (4) ◽  
pp. 114-117
Author(s):  
Dinh Thi Phuong Hoai ◽  
Nguyen Thi My Dung ◽  
Hoang Manh Cuong ◽  
Huynh Thi Kieu Oanh ◽  
Ngo Thuy Tram ◽  
...  
Keyword(s):  
Left Hemisphere ◽  
Subdural Hematoma ◽  
Chronic Subdural Hematoma ◽  
Mass Effect ◽  
The Elderly ◽  
Brain Parenchyma ◽  
History Of ◽  
Apparent Reason ◽  
The Right ◽  
Contrast Ct

Chronic subdural hematoma (cSDH) is a disorder in which blood collects between the dura and arachnoid mater of meninges around the brain. It's more common among the elderly and usually triggered by a head injury. We report a case of a 78-year-old male patient who had previously been diagnosed with a left hemisphere subdural hematoma for no apparent reason with a history of hypertension. Two days before hospitalizing, he had a symptom of weakness in the right extremities. Non-contrast CT of head reveals a crescent-shaped, heterodense lesion over the lateral aspect of the left hemisphere measuring 11x5x1 cm with mass effect to the adjacent brain parenchyma. Burr hole drainage was performed for the patient. His symptoms improved after the surgery.

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