Objective Patients with traumatic brain injury are particularly susceptible to sepsis, which may exacerbate the systemic inflammatory response and lead to organ dysfunction. The influence of clinical variables on the mortality of intensive care unit patients with traumatic brain injury and sepsis was investigated.Methods The present investigation was a retrospective study involving 175 patients with traumatic brain injury who were treated in a period of 1 year at a reference hospital for trauma and who had sepsis, severe sepsis, or septic shock. Demographic and clinical data were obtained, and the SOFA score was calculated at the time sepsis was found and after 72 hours.Results There was a predominance of young men with severe traumatic brain injury, multiple head injuries, sepsis with a pulmonary focus, prolonged hospital stay, and high mortality (37.7%). Circulatory and respiratory failure had a high incidence, but renal and coagulation failure were less frequent, and liver failure was not observed. After logistic regression, the presence of septic shock and respiratory failure 72 hours after the sepsis diagnosis was associated with higher mortality, with an odds ratio of 7.56 (95%CI=2.04-27.31, p=0.0024) and 6.62 (95%CI=1.93-22.78, p=0.0027), respectively. In addition, there was a higher mortality among patients who had no organ failure on D1 but who developed the condition after 72 hours of sepsis and in those patients who already had organ failure at the time sepsis was diagnosed and remained in this condition after 72 hours.Conclusion Septic shock and progressive organ (particularly respiratory) dysfunction increases the mortality of patients with traumatic brain injury and sepsis.

No abstract

Objective To characterize the pressures, resistances, oxygenation, and decarboxylation efficacy of two oxygenators associated in series or in parallel during venous-venous extracorporeal membrane oxygenation support. Methods Using the results of a swine severe respiratory failure associated with multiple organ dysfunction venous-venous extracorporeal membrane oxygenation support model and mathematical modeling, we explored the effects on oxygenation, decarboxylation and circuit pressures of in-parallel and in-series associations of oxygenators. Results Five animals with a median weight of 80kg were tested. Both configurations increased the oxygen partial pressure after the oxygenators. The return cannula oxygen content was also slightly higher, but the impact on systemic oxygenation was minimal using oxygenators with a high rated flow (~ 7L/minute). Both configurations significantly reduced the systemic carbon dioxide partial pressure. As the extracorporeal membrane oxygenation blood flow increased, the oxygenator resistance decreased initially with a further increase with higher blood flows but with a small clinical impact. Conclusion Association of oxygenators in parallel or in series during venous-venous extracorporeal membrane oxygenation support provides a modest increase in carbon dioxide partial pressure removal with a slight improvement in oxygenation. The effect of oxygenator associations on extracorporeal circuit pressures is minimal.

Original J Bras Neurocirurg 22 (3): 95-99, 2011Júnior LCMC, Barros BP, Holanda MFC -Fatores de risco em pacientes com aneurismas intracranianos atendidos em um hospital de referência de Belém -PA. 95Fatores de risco em pacientes com aneurismas intracranianos atendidos em um hospital de referência de Belém -PA. Risk factors in patients presenting with intracranial aneurysmsassisted in a reference hospital in Belém -PA. SUMÁRIO Objetivo: Este estudo visa averiguar a influência de fatores de risco sobre a mortalidade no tratamento de aneurismas.Método: estudo retrospectivo, transversal e quantitativo com pacientes atendidos entre Janeiro de 2001 a Dezembro de 2010 em virtude de aneurismas cerebrais no Hospital Ophir Loyola. Prontuários foram utilizados como fonte para coleta de dados sócio-demográficos, sobre fatores de risco e sobre o aneurisma. Foi realizada análise descritiva seguida pelo cálculo do risco relativo de cada variável em relação ao tipo de alta.Resultados: Dentre 123 pacientes com 158 aneurismas, 72,36% eram mulheres, a idade média foi 46,5 ± 12,7, 38,21% eram hipertensos, 5,69% diabéticos, 21,95% tinha múltiplos aneurismas, 87,80% foram tratados de forma intervencionista, a taxa de letalidade foi de 12,20% e 90,24% dos aneurismas tinha sítio na circulação anterior. O risco relativo de morte foi de 5,14 para o tratamento conservador em relação ao intervencionista e 4,02 para os com 60 anos ou mais em relação aos que tinham menos de 60 anos. Conclusão:Considerando as características dos pacientes deste estudo sugere-se a necessidade de pesquisas que avaliem a eficácia da triagem em pacientes com risco, detectando os aneurismas antes de sua ruptura e modificando a história natural desta doença. ABSTRACTObjective: This study aimed to investigate the influence of several risk factors over mortality in aneurysms treatment. Methods:A retrospective, quantitative transversal study with patients treated was undertaken in the period of January of 2001 to December of 2010 with cerebral aneurysm diagnosis in the Hospital Ophir Loyola. Medical papers were used for the data extraction, including socio-demographic data, information about risk factors and about the aneurysm. A descriptive analysis was performed, followed by relative risk of each variable to risk of death. Results: One hundred and twenty three patients with 158 aneurysms were collected , with a female predominance of 72,36% ; mean age was 46,5 ± 12,7, 38,21% had arterial hypertension, 5,69% diabetes; 21,95% had multiple aneurysms, 87,80% were surgically treated with a mortality rate of 12,20%: 90,24% of aneurysms were in the anterior circulation. The relative risk for death was 5,14 for conservative treatment versus interventional treatment and 4,02 for age of 60 or greater against less than 60 years old. Conclusion:Considering the patients characteristics of this study, we suggest new prospective studies in order to assess the efficacy of screening in risky patients to detect the aneurysms before their rupture , in order to modify the natural his...

Background Whether fasting early in critical illness course is acceptable is not clear and high‐quality data on this topic are lacking. To generate equipoise for future clinical trials and bring additional data to current literature, we compared outcomes of patients fasted during the first 72 h of intensive care unit (ICU) stay to patients receiving any nutrition support during this period. Methods Retrospective cohort study of a medical ICU from a tertiary academic center in Brazil. Adult patients treated between November 2017 and February 2022 with an ICU length of stay of ≥5 days were included. Baseline and daily data were retrieved from the prospectively collected administrative database. We did 1:1 propensity score matching to compare patients fasting for at least 72 h with controls. Primary outcome was hospital mortality and secondary outcomes were other resources' use. Results During the study period, 1591 patients were cared for in this ICU, of which 998 stayed ≥5 days. After excluding readmissions and propensity score matching, 93 patients in the fasting group were matched to 93 controls. Hospital mortality was similar between fasting and matched control groups (odds ratio = 1.04; 95% CI = 0.56–1.94; P > 0.99). Secondary outcomes were not different between groups, including length of stay, days on mechanical ventilation, and incidence of new infections. Conclusion Withholding nutrition support in the first 72 h of ICU stay was not associated with worse outcomes in this cohort of severe critically ill patients.

No abstract

No abstract

No abstract