Non- Neurological Complications after Traumatic Brain Injury: A Prospective Observational Study

Abstract

Introduction and Aims:Recognizing and treating nonneurological complications occurring in traumatic brain injury (TBI) patients during intensive care unit (ICU) stay are challenging. The aim is to estimate various nonneurological complications in TBI patients. The secondary aim is to see the effect of these complications on ICU stay, disability, and mortality.Materials and Methods:This was a prospective observational study at the neuro-ICU of a Level-I trauma center. A total of 154 TBI patients were enrolled. The period of the study was from admission to discharge from ICU or demise. Inclusion criteria were patients aged >16 years and patients with severe TBI (Glasgow coma score [GCS] ≤8). Nonneurological complications were frequent in TBI patients.Results:We observed respiratory complications to be the most common (61%). Other complications, in the decreasing order, included dyselectrolytemia (46.1%), cardiovascular (34.4%), coagulopathy (33.1%), sepsis (26%), abdominal complications (17.5%), and acute kidney injury (AKI, 3.9%). The presence of systemic complications except AKI was found to be significantly associated with increased ICU stay. Most of the patients of AKI died early in ICU. Respiratory dysfunction was found to be independently associated with 3.05 times higher risk of worsening clinical condition (disability) (P < 0.018). The presence of cardiovascular complications during ICU stay (4.2 times, P < 0.005), AKI (24.7 times, P < 0.02), coagulopathy (3.13 times, P < 0.047), and GCS <6 (4.2 times, P < 0.006) of TBI was independently associated with significantly increased risk of ICU mortality.Conclusion:TBI patients tend to have poor outcome due to concomitant nonneurological complications. These have significant bearing on ICU stay, disability, and mortality.

Air-Evacuation-Relevant Hypobaria Following Traumatic Brain Injury Plus Hemorrhagic Shock in Rats Increases Mortality and Injury to the Gut, Lungs, and Kidneys

“…Patients with severe TBI often become septic and succumb to multiple organ dysfunction syndrome (16). Organs most frequently affected include the lung (17), kidneys (18), and the gut (15,19). The role of the gut in post-hemorrhagic shock multiple organ failure was identified over two decades ago (20).…”

Incidence and Outcomes of Acute Lung Injury in Patients With Isolated Traumatic Brain Injury

“…The severity of TBI was stratified by grouping the research patients according to GCS score [3][4][5][6][7][8][11][12][13][14][15][16][17], mean AIS head score, the number of pack cell units transfused in the first 24 hours of hospitalization, the type of treatment (surgery or conservative treatment), the type of airway management (intubation or nonintubation), the duration of hospitalization, and GCS at the time of discharge, as well as the patient outcome as improvement or in-hospital death was assessed and recorded. The diagnosis of ALI was based on the International Consensus Criteria per PaO2/FiO2 ratio on the first and third days.…”

“…Moreover, this complication being an independent predictor factor for poor prognosis. This data discrepancy was caused by differences in the inclusion criteria; regardless of these differences, all of these studies reported that the presence of ALI/ARDS was associated with increased mortality and morbidity in patients with severe brain injury [11][12][13][14][15][16][17][18]. It was also associated…”

Neurogenic Pulmonary Edema : A Rare Presentation of Traumatic Brain Injury

“…However, the clinical presentation of NPE is thought to range from subclinical to fulminant pulmonary edema. Meningeal haemorrhage is thought to be one of the most common causes of neurogenic pulmonary edema [2]. We present a case of a 23-year-old female who presented with traumatic brain injury (TBI) and within hours developed neurogenic pulmonary edema.…”