Acute spontaneous intracerebral hemorrhage and traumatic brain injury are the most common causes of critical illness in the ICU and have high early mortality

Abstract

BackgroundCritical care covers multiple disciplines. However, the causes of critical illness in the ICU, particularly the most common causes, remain unclear. We aimed to investigate the incidence and the most common causes of critical illness and the corresponding early mortality rates in ICU patients.MethodsA retrospective cohort study was performed to examine critically ill patients (aged over 15 years) in the general ICU in Shuyang County in northern China (1/2014–12/2015). The incidences and causes of critical illnesses and their corresponding early mortality rates in the ICU were determined by an expert panel.ResultsDuring the 2-year study period, 1,211,138 person-years (PY) and 1645 critically ill patients (mean age, 61.8 years) were documented. The median Glasgow Coma Scale (GCS) score was 6 (range, 3–15). The mean acute physiology and chronic health evaluation II (APACHE II) score was 21.2 ± 6.8. The median length of the ICU stay was 4 days (range, 1–29 days). The most common causes of critical illness in the ICU were spontaneous intracerebral hemorrhage (SICH) (26%, 17.6/100,000 PY) and traumatic brain injury (TBI) (16.8%, 11.4/100,000 PY). During the first 7 days in the ICU, SICH was the most common cause of death (42.2%, 7.4/10,000 PY), followed by TBI (36.6%, 4.2/100,000 PY). Based on a logistic analysis, older patients had a significantly higher risk of death from TBI (risk ratio [RR], 1.7; 95% CI, 1.034–2.635), heart failure/cardiovascular crisis (RR, 0.2; 95% CI, 0.083–0.484), cerebral infarction (RR, 0.15; 95% CI, 0.050–0.486), or respiratory failure (RR, 0.35; 95% CI, 0.185–0.784) than younger patients. However, the risk of death from SICH in the two groups was similar.ConclusionsThe most common causes of critical illness in the ICU were SICH and TBI, and both critical illnesses showed a higher risk of death during the first 7 days in the ICU.

A Comprehensive Review on the Applications of Exosomes and Liposomes in Regenerative Medicine and Tissue Engineering

“…TBI, which would be induced by a hit or shake on the head, has become a life-threatening disorder that is the leading risk factor for death and principally lengthy disabilities globally [ 170 ]. The primary causes of mortality in TBI instances are increasing in number including car crashes and violence, armed conflicts, or terrorist acts accounting for the majority of cases.…”

“…Hence, it may help move stem cells to the damaged sites by combining biomaterials with altered exosomes, thus still growing their viability and facilitating successful care. [ 169 , 170 ] Neuroinflammation is also a crucial therapy aim for TBI due to its ability to contribute to secondary harm. Even to avoid TBI damage, exosomes are presumed to modify immunity activity [ 169 ].…”

Unplanned ICU transfer from post-anesthesia care unit following cerebral surgery: A retrospective study

“…The risk of complications in cerebral surgery is high, and patients are prone to unpredictable changes after surgery [11, 12] . In previous clinical practice, patients were usually admitted to the ICU for 12–24 hours of observation and treatment after cerebral surgery; most of them were transferred to the general ward the next day [13-15] .…”

Ketamine for critically ill patients with severe acute brain injury: Protocol for a systematic review with meta-analysis and Trial Sequential Analysis of randomised clinical trials

“…Encompassing traumatic brain injury, subarachnoid haemorrhage, intracerebral haemorrhage, acute ischaemic stroke, hypoxic brain injury after cardiac arrest [ 11 – 20 ], as well as complications from neurosurgery [ 21 ], severe acute brain injury is a common cause of critical illness requiring admission to intensive or neurointensive care units [ 11 , 22 – 24 ].…”