BackgroundMaintaining brain oxygenation status is the main goal of treatment in severe traumatic brain injury (TBI). Jugular venous oxygen saturation (SjvO2) monitoring is a technique to estimate global balance between cerebral oxygen supply and its metabolic requirement. Full Outline of Responsiveness (FOUR) score, a new consciousness measurement scoring, is expected to become an alternative for Glasgow Coma Scale (GCS) in evaluating neurologic status of patients with severe traumatic head injury, especially for those under mechanical ventilation.MethodsA total of 63 patients with severe TBI admitted to emergency department (ED) were included in this study. SjvO2 sampling was taken every 24 hours, until 72 hours after arrival. The assessment of FOUR score was conducted directly after each blood sample for SjvO2 was taken. Spearman’s rank correlation was used to determine the correlation between SjvO2 and FOUR score. Regression analysis was used to determine mortality predictors.ResultsFrom the 63 patients, a weak positive correlation between SjvO2 and FOUR score (r=0.246, p=0.052) was found upon admission. Meanwhile, strong and moderate negative correlation values were found in 48 hours (r=−0.751, p<0.001) and 72 hours (r=−0.49, p=0.002) after admission. Both FOUR score (p<0.001) and SjvO2 (p=0.04) were found to be independent mortality predictors in severe TBI.ConclusionThere was a negative correlation between the value of SjvO2 and FOUR score at 48 and 72 hours after admission. Both SjvO2 and FOUR score are independent mortality predictors in severe TBI.
Background: Fasting, anesthesia and surgery lead to metabolic stress response. Increase of cortisol level lead to insulin resistance and hyperglicemic state has significant effect to the wound healing and increase morbidity and mortality to the patient undergoing surgery. The aim of this research is to prove that preoperative oral glucose loading can decrease metabolic stress response and also the difference effect on preoperative oral glucose that given twice and once time to decrease metabolic stress response in patient undergoing major oncology surgery.
Objectives: The purpose of this study was to assess that qSOFA validity is equal with SOFA as the predictor of mortality, both in sepsis and nonsepsis patients.Design: Diagnostic test with a retrospective design.
Setting:Intensive Care Unit in Sanglah General Hospital, Bali. Indonesia.
Subjects:Patients admitted to the ICU Sanglah General Hospital, from July 2015 to December 2016 (n=192), that have complete data and able to be evaluated with SOFA score.
Interventions: None
Measurement and Main Results:With the total population sampling techniques, 192 patients have met the criteria as the samples. The descriptive statistical analysis were performed, and the area under the ROC curve (AuROC) were used. The cutoff points will also be determined and will conclude the sensitivity and specificity of each score. From the 192 patients, the cutoff point for the SOFA and qSOFA are 11 and 2. While the AuROC from SOFA and qSOFA are 0.9307 and 0.9241, with p=0.7037 (95% confidence interval).
Conclusion:In this study, we conclude that the validity of qSOFA is equal to SOFA, both in sepsis and nonsepsis. So, for the reasons of efficiency and effectiveness, qSOFA can be used to replace SOFA score in predicting mortality in ICU.
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