This single site retrospective observational study assessed the evolution of sedation therapy for severe alcohol withdrawal syndrome in the intensive care unit. Patient records for 2 intervals were reviewed: Interval 1, which included 87 intensive care unit patients admitted January 2005 through September 2007, for whom benzodiazedpine monotherapy was utilized; and Interval 2, January 2010 through December 2010, for whom 54 of 84 (64.3%) intensive care unit patients, including all those intubated, received adjunctive agents, including dexmedetomidine or propofol. Clinical management was similar for both intervals, as well as prevalence of alcohol withdrawal syndrome versus total adult hospital admissions and comorbid conditions. Overall, respiratory failure (53 versus 39%), seizures (36 versus 18%), and pneumonia (51 versus 38%) were less frequent during Interval 2 (all p < .05), with lower benzodiazedpine basal dose requirements for those given adjunctive therapy. However, if instances of pneumonia or respiratory failure related to seizures prior to intensive care unit admission are excluded, the prevalence of these complications was similar (p = ns) for Interval 1 and Interval 2. Intensive care unit and hospital length of stay were not altered by adjunctive therapy, which was typically employed for more severely affected patients. High intensity sedation with adjunctive drugs led to few cardiovascular adverse events and may have facilitated management, but did not alter intensive care unit course of severe alcohol withdrawal syndrome.
Learning Objectives: Introduction: Arterial air emboli as a result of venous air emboli (VAE) are a rare complication following centrally or peripherally inserted central catheters (PICC). Case Description: A 79yo female with history of CAD was admitted for a post-operative hip infection, and was undergoing PICC placement for long-term antibiotic use. Post-procedure the patient was unresponsive, hypoxic, and rigid, with clenched fists and left lateral conjugate gaze. Despite assisted respirations with bag ventilation mask, the patient required intubation. Once stabilized, a head CT was performed and demonstrated gas bubbles in both cerebral hemispheres. The patient remained poorly responsive and a STAT EEG was performed which demonstrated epileptiform activity. A head CT the next morning demonstrated resolution of gas bubbles. An echocardiogram, to evaluate for stroke symptoms, displayed a significant right to left shunt within the atria. An MRI demonstrated ischemic changes within the right frontal, parietal, and left temporal regions, which correlate directly with areas of prior gas visualization. The patient failed to recover neurologically and the family withdrew care. Discussion: The patient's clinical scenario and imaging support cerebral air emboli (CAE) resulting from venous air entering circulation during PICC insterion, and into aterial circulation via an atrial defect. The incidence of CAE is estimated to be 0.13% during insterion/removal of central venous catheters. CAE causes ischemia and inflammation, resulting in decreased cerebral perfusion and neurologic impairment. Morbidity and mortality of air emboli depend on the rate and volume of gas entering venous circulation and the organ affected. Catheterassociated VAE carry a mortality rate between 23-30%. As little as 20mL of cerebral air has been reported to cause clinical harm, but traditionally 5 mL/kg is required to cause mortality. Treatment of CAE is supportive, with maintenance of adequate oxygenation and hemodynamic stability. High-flow and hyperbaric oxygen are reported to improve resorption of air.
Crit Care Med 2014 • Volume 42 • 12 (Suppl.) was available for analysis.10 patients had a combination of traumatic subdural hematoma, intraparenchymal and subarachnoid hemorrhage.1 patient had nonconvulsive status epilepticus and 3 had malignant MCA stroke.Left sided oximetry values had a spearman correlation co-efficient of 0.201(p< 0.001),0.146(p< 0.001) and -0.369(p< 0.001) with pulse pressure,MAP and ICP respectively. Right sided oximetry values had a spearman correlation co-efficient of 0.209(p< 0.001),0.346(p< 0.001) and -0.142(p=0.004) with MAP,pulse pressure and ICP respectively. Conclusions: Brain oximetry showed a weak but positive correlation with MAP and pulse pressure indicating some preservation of cerebral autoregulation.ICP had weak but negative correlation with Cerebral oxygenation suggesting minor changes in ICP may be important in optimizing cerebral oxygenation in acute brain injuries.Further studies using longer monitoring and more patients are needed to confirm these findings.Learning Objectives: Cerebral edema and consequent intracranial hypertension (ICH) may result from traumatic brain injuries, intracranial malignancies, ischemic stroke, cerebral venous thrombosis, intracranial hemorrhage. Hypertonic saline (HTS) is frequently used in neurosurgical patients to mitigate cerebral ischemia by reducing intracranial pressure (ICP) and improving cerebral blood flow. There are limited, contradictory findings of the effects of continuous HTS (3%) infusions in this setting. Methods: The purpose of this study was to determine the effect of sodium exposure on serum sodium levels in patients with intracranial hypertension. The hypothesis was that sodium exposure correlated with serum sodium levels. This was a single-center, retrospective, observational study conducted at a tertiary academic medical center. Patients with ICH received a 3% HTS via intravenous continuous infusion at a fixed rate of 50 milliliters/hour. A sample size of 95 subjects was identified using 80% power to detect a correlation of 0.3 or greater (alpha 0.05) between sodium exposure and serum sodium levels. Hierarchical linear and mixed models were used to analyze daily measurements over multiple days for both the response and explanatory variables and control for inter-subject effects. Results: 95 subjects were included in data analysis. Common diagnoses included subarachnoid hemorrhage, subdural hematoma, intracranial hemorrhage and traumatic brain injury. There was a 0.5 mEq/liter increase in the serum sodium for every liter of 3% HTS given (p=0.013), assuming 0.9% NS was held constant. For every liter of 0.9% NS, there was a 0.1898 mEq/liter increase in serum sodium (p=0.0047), assuming 3% HTS was held constant. There were no correlations between net or cumulative fluid exposure and serum sodium concentrations (p=0.88; p=0.23, respectively). The effect of chloride exposure on serum creatinine was not statistically significant (p=0.42). Conclusions: Continuous infusion of hypertonic saline results in a relatively small, increm...
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.