In recent decades, there is increasing evidence suggesting that hyperoxia and hypocapnia are associated with poor outcomes in critically ill patients with cardiac arrest or traumatic brain injury. Yet, the impact of hyperoxia and hypocapnia on neurological outcome in patients with subarachnoid hemorrhage (SAH) has not been well studied. In the present study, we evaluated the impact of hyperoxia and hypocapnia on neurological outcomes in patients with aneurysmal SAH (aSAH). Patients with aSAH who were admitted to the intensive care unit (ICU) of a tertiary hospital in Hong Kong between January 2011 and December 2016 were retrospectively recruited. Patients' demographics, comorbidities, radiological findings, clinical grades of SAH, PO2, and PCO2 within 24 hours of ICU admission, and Glasgow Outcome Scale (GOS) at 3 months after admission were recorded. Patients with a GOS score of 3 or less were considered having poor neurological outcomes. Among the 244 patients with aSAH, 122 of them (50%) had poor neurological outcomes at 3 months. Early hyperoxia (PO2 > 200 mmHg) and hypercapnia (PCO2 > 45 mmHg) were more common among patients with poor neurological outcomes. Logistic regression analysis indicated that hyperoxia independently predicted poor neurological outcomes (OR 3.788, 95% CI 1.131–12.690, P=0.031). Classification tree analysis revealed that hypocapnia was associated with poor neurological outcomes in patients who were less critically ill (APACHE < 50) and without concomitant intracranial hemorrhage (ICH) or intraventricular hemorrhage (IVH) (adjusted P=0.006, χ2 = 7.452). These findings suggested that hyperoxia and hypocapnia may be associated with poor neurological outcomes in patients with aSAH.
Our results suggest that the PK of labetalol are significantly affected by the common CYP2C19 polymorphisms in individuals of Chinese ethnicity. Future larger studies are needed to evaluate the effect of CYP2C19 and UGT1A1 polymorphisms on the PK of labetalol stereoisomers and the pharmacodynamic effects.
Pseudoaneurysm of the iliac arteries are rarely reported in the literature. Failure to identify the pathology may delay the necessary treatment, and potentially lead to high mortality. We report a case of ruptured mycotic iliac artery aneurysm in a 46-year-old man with newly diagnosed diabetes mellitus. Initial CT appearance mimicked psoas abscess. However, further CT showed features more suggestive of a psoas haematoma with heterogeneous hyperdensities within the lesion. A ruptured mycotic iliac artery aneurysm was diagnosed. Patient was urgently referred to the vascular team for endovascular stenting. Blood-stained purulent material was noted in the left psoas muscle intra-operatively. It was drained and sent for culture, which later yielded Salmonella Enteritidis sensitive to cefotaxime. We present this case to highlight the importance of reviewing any pre-contrast intramuscular hyperdensities which may suggest acute blood content, and raise suspicion of adjacent vascular pathologies.
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