scholarly journals Association of Flow Rate of Prehospital Oxygen Administration and Clinical Outcomes in Severe Traumatic Brain Injury

2021 ◽  
Vol 10 (18) ◽  
pp. 4097
Author(s):  
Won Pyo Hong ◽  
Ki Jeong Hong ◽  
Sang Do Shin ◽  
Kyoung Jun Song ◽  
Tae Han Kim ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Flow Rate ◽  
Severe Traumatic Brain Injury ◽  
High Flow ◽  
Low Flow ◽  
Oxygen Administration ◽  
High Flow Oxygen ◽  
Oxygen Group

The goal of this study was to investigate the association of prehospital oxygen administration flow with clinical outcome in severe traumatic brain injury (TBI) patients. This was a cross-sectional observational study using an emergency medical services-assessed severe trauma database in South Korea. The sample included adult patients with severe blunt TBI without hypoxia who were treated by EMS providers in 2013 and 2015. Main exposure was prehospital oxygen administration flow rate (no oxygen, low-flow 1~5, mid-flow 6~14, high-flow 15 L/min). Primary outcome was in-hospital mortality. A total of 1842 patients with severe TBI were included. The number of patients with no oxygen, low-flow oxygen, mid-flow oxygen, high-flow oxygen was 244, 573, 607, and 418, respectively. Mortality of each group was 34.8%, 32.3%, 39.9%, and 41.1%, respectively. Compared with the no-oxygen group, adjusted odds (95% CI) for mortality in the low-, mid-, and high-flow oxygen groups were 0.86 (0.62–1.20), 1.15 (0.83–1.60), and 1.21 (0.83–1.73), respectively. In the interaction analysis, low-flow oxygen showed lower mortality when prehospital saturation was 94–98% (adjusted odds ratio (AOR): 0.80 (0.67–0.95)) and ≥99% (AOR: 0.69 (0.53–0.91)). High-flow oxygen showed higher mortality when prehospital oxygen saturation was ≥99% (AOR: 1.33 (1.01~1.74)). Prehospital low-flow oxygen administration was associated with lower in-hospital mortality compared with the no-oxygen group. High-flow administration showed higher mortality.

scholarly journals Association of flow rate of prehospital oxygen administration and clinical outcomes in severe traumatic brain injury

2021 ◽  
Author(s):  
Won Pyo Hong ◽  
Ki Jeong Hong ◽  
Sang Do Shin ◽  
Kyoung Jun Song ◽  
Tae Han Kim ◽  
...  
Keyword(s):  
Flow Rate ◽  
Oxygen Supply ◽  
Severe Trauma ◽  
High Flow ◽  
Low Flow ◽  
Optimal Flow ◽  
Oxygen Administration ◽  
High Flow Oxygen ◽  
Severe Tbi ◽  
Oxygen Group

Abstract Background To prevent hypoxia during prehospital phase is important in severe traumatic brain injury (TBI) but optimal flow rate of prehospital oxygen supply is controversial. The goal of this study is to investigate the association of prehospital oxygen administration flow on clinical outcome in severe TBI patients. Methods This is a cross-sectional observational study using emergency medical services assessed severe trauma database in South Korea. In 2013 and 2015, adult patients with severe blunt TBI (abbreviated injury scale ≥3 in head lesion) without hypoxia (< 94% of oxygen saturation in prehospital pulse oximetry) were included. Main exposure was prehospital oxygen administration flow rate (no oxygen, 1~5 L/min, 6~14 L/min, 15 L/min). Primary outcome was in-hospital mortality. A multivariate logistic regression model was used to association of prehospital oxygen supply and outcomes. Results 1,842 patients with severe TBI were included. The number of patients with no oxygen, low-flow oxygen (1~5 L/min), mid-flow oxygen (6~14 L/min), high-flow oxygen (15 L/min) was 244, 573, 607 and 418. Mortality of each group was 34.8%, 32.3%, 39.9% and 41.1%. Compared with no-oxygen group, adjusted odds (95% CI) for mortality in the low, mid, high-flow oxygen groups were 0.86 (0.62–1.20), 1.15 (0.83–1.60) and 1.21 (0.83–1.73). In the interaction analysis, low-flow oxygen showed lower mortality when prehospital saturation was 94-98% (adjusted odds ratio(AOR): 0.80 [0.67–0.95]) and ≥99% (AOR: 0.69 [0.53–0.91]). High-flow oxygen (15 L/min) showed higher mortality when prehospital saturation was ≥99% in pulse oximetry (AOR: 1.33[1.01~1.74]). Conclusions Prehospital low-flow oxygen administration was associated with lower in-hospital mortality compared with the no-oxygen group in severe TBI patients. High-flow oxygen administration showed higher mortality. Optimal flow of prehospital oxygenation according prehospital saturation could reduce mortality in severe TBI. Trial registration This study used cases retrospectively registered in the emergency medical services assessed severe trauma database.

scholarly journals Early diagnosis of mortality using admission CT perfusion in severe traumatic brain injury patients (ACT-TBI): protocol for a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. e047305
Author(s):  
Susan Alcock ◽  
Divjeet Batoo ◽  
Sudharsana Rao Ande ◽  
Rob Grierson ◽  
Marco Essig ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cohort Study ◽  
Brain Injury ◽  
Early Diagnosis ◽  
Hospital Mortality ◽  
Brain Death ◽  
Severe Traumatic Brain Injury ◽  
Health Research ◽  
Ct Perfusion ◽  
Severe Tbi

IntroductionSevere traumatic brain injury (TBI) is a catastrophic neurological condition with significant economic burden. Early in-hospital mortality (<48 hours) with severe TBI is estimated at 50%. Several clinical examinations exist to determine brain death; however, most are difficult to elicit in the acute setting in patients with severe TBI. Having a definitive assessment tool would help predict early in-hospital mortality in this population. CT perfusion (CTP) has shown promise diagnosing early in-hospital mortality in patients with severe TBI and other populations. The purpose of this study is to validate admission CTP features of brain death relative to the clinical examination outcome for characterizing early in-hospital mortality in patients with severe TBI.Methods and analysisThe Early Diagnosis of Mortality using Admission CT Perfusion in Severe Traumatic Brain Injury Patients study, is a prospective cohort study in patients with severe TBI funded by a grant from the Canadian Institute of Health Research. Adults aged 18 or older, with evidence of a severe TBI (Glasgow Coma Scale score ≤8 before initial resuscitation) and, on mechanical ventilation at the time of imaging are eligible. Patients will undergo CTP at the time of first imaging on their hospital admission. Admission CTP compares with the reference standard of an accepted bedside clinical assessment for brainstem function. Deferred consent will be used. The primary outcome is a binary outcome of mortality (dead) or survival (not dead) in the first 48 hours of admission. The planned sample size for achieving a sensitivity of 75% and a specificity of 95% with a CI of ±5% is 200 patients.Ethics and disseminationThis study has been approved by the University of Manitoba Health Research Ethics Board. The findings from our study will be disseminated through peer-reviewed journals and presentations at local rounds, national and international conferences. The public will be informed through forums at the end of the study.Trial registration numberNCT04318665

Effect of high flow oxygen on exertional dyspnea in cancer patients: A double-blind randomized clinical trial.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. 11600-11600
Author(s):  
David Hui ◽  
Liliana Larsson ◽  
Sajan Thomas ◽  
Carol Harrison ◽  
Jimin Wu ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Cancer Patients ◽  
Flow Rate ◽  
Mixed Effects ◽  
High Flow ◽  
Low Flow ◽  
Double Blind ◽  
Exertional Dyspnea ◽  
Exercise Time ◽  
High Flow Oxygen

11600 Background: High flow oxygen therapy is effective for hypoxemic respiratory failure. However, its effect on dyspnea in non-hypoxemic patients is unknown. In this 2x2 factorial, double-blind randomized clinical trial, we assessed the effect of flow rate (high vs. low) and gas (oxygen vs. air) on exertional dyspnea in cancer patients. Methods: Non-hypoxemic patients with cancer completed two structured cycle ergometer exercise tests with Low Flow Air [LFAir] at 2 L/min. They were then randomized to receive High Flow Oxygen [HFOx] with up to 60 L/min, High Flow Air [HFAir], Low Flow Oxygen [LFOx] or LFAir during a constant work rate exercise test at 80% maximum. Dyspnea intensity was assessed with the modified 0-10 Borg scale. The primary outcome was difference in the slope of dyspnea intensity vs. time during the third test. Secondary outcomes included difference in exercise time, vital signs, and adverse events. We estimated that 10 patients per arm will provide 86% power to detect a 1-standard deviation main effect and 86% power to detect a 2-SD interaction effect with an alpha of 5%. A linear mixed effects model was used to assess the impact of flow rate and gas on study outcomes. Results: 45 patients were randomized and 44 completed the study (10, 11, 12, 11 patients on HFOx, HFAir, LFOx, LFAir, respectively). The mean age was 63 (range 47-77); 18 (41%) were female; 34 (44%) had lung cancer; and 20 (46%) had metastatic disease. In mixed effects model, the association between the change in dyspnea intensity over time with flow rate differed significantly between oxygen and air (P = 0.04). Specifically, HFOx (slope difference -0.20, P < 0.001) and LFOx (-0.14, P = 0.01) were significantly better than LFAir, but not HFAir (+0.09, P = 0.09). Exercise time also significantly increased with HFOx (difference +2.5 min, P = 0.009) compared to LFAir, but not HFAir (+0.63 min, P = 0.48) or LFOx (+0.39 min, P = 0.65). HFOx was well tolerated without significant adverse effects. Conclusions: The combination of high flow rate and oxygen improved dyspnea and exercise duration during constant work exercise test in non-hypoxemic cancer patients. Larger trials are needed to confirm the benefits of HFOx during exercises. Clinical trial information: NCT02357134.

scholarly journals Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index

2021 ◽  
Author(s):  
Maximilian Peter Forssten ◽  
Gary Alan Bass ◽  
Kai-Michael Scheufler ◽  
Ahmad Mohammad Ismail ◽  
Yang Cao ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Risk Stratification ◽  
Hospital Mortality ◽  
Severe Traumatic Brain Injury ◽  
Mortality Risk ◽  
Risk Index ◽  
Cardiac Risk ◽  
Increased Risk ◽  
Severe Tbi

Abstract Purpose Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. Methods All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. Results 259,399 patients met the study’s inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01–1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05–1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11–1.90), p = 0.006], compared to RCRI 0. Conclusion An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.

scholarly journals Early enteral nutrition in patients with severe traumatic brain injury: a propensity score–matched analysis using a nationwide inpatient database in Japan

2019 ◽  
Vol 111 (2) ◽  
pp. 378-384 ◽  
Author(s):  
Hiroyuki Ohbe ◽  
Taisuke Jo ◽  
Hiroki Matsui ◽  
Kiyohide Fushimi ◽  
Hideo Yasunaga
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Propensity Score ◽  
Enteral Nutrition ◽  
Hospital Mortality ◽  
Nosocomial Pneumonia ◽  
Severe Traumatic Brain Injury ◽  
Scale Scores ◽  
Severe Tbi ◽  
Inpatient Database

ABSTRACT Background Whether enteral nutrition (EN) should be administered early in severe traumatic brain injury (TBI) patients has not been fully addressed. Objective The present study aimed to evaluate whether early EN can reduce mortality or nosocomial pneumonia among severe TBI patients. Methods Using the Japanese Diagnosis Procedure Combination inpatient database from April 2014 to March 2017 linked with the Survey for Medical Institutions, we identified patients admitted for intracranial injury with Japan Coma Scale scores ≥30 (corresponding to Glasgow Coma Scale scores ≤8) at admission. We designated patients who started EN within 2 d of admission as the early EN group, and those who started EN at 3–5 d after admission as the delayed EN group. The primary outcome was in-hospital mortality. The secondary outcome was nosocomial pneumonia. Propensity score–matched analyses were performed to compare the outcomes between the 2 groups. Results We identified 3080 eligible patients during the 36-mo study period, comprising 1100 (36%) in the early EN group and 1980 (64%) in the delayed EN group. After propensity score matching, there was no significant difference in in-hospital mortality (difference: −0.3%; 95% CI: −3.7%, 3.1%) between the 2 groups. The proportion of nosocomial pneumonia was significantly lower in the early EN group than in the delayed EN group (difference: −3.2%; 95% CI: −5.9%, −0.4%). Conclusions Early EN may not reduce mortality, but may reduce nosocomial pneumonia in patients with severe TBI.

1512: TRANSPORTATION TIME AND HOSPITAL MORTALITY IN ICU PATIENTS WITH SEVERE TRAUMATIC BRAIN INJURY

2016 ◽  
Vol 44 (12) ◽  
pp. 453-453
Author(s):  
Eric Sy ◽  
Ofer Amram ◽  
Heather Baer ◽  
Morad Hameed ◽  
Donald Griesdale
Keyword(s):  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Hospital Mortality ◽  
Severe Traumatic Brain Injury ◽  
Icu Patients ◽  
Transportation Time
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