Your email was sent successfully. Check your inbox.

An error occurred while sending the email. Please try again.

Proceed reservation?

Export
  • 1
    ISSN: 0942-0940
    Keywords: Head injury ; cerebral perfusion pressure ; arterial hypotension ; raised intracranial pressure ; outcome
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary A group of 74 patients with head injury (54 severe, 17 moderate and 3 minor) had continuous monitoring of both arterial and intracranial pressure with computer-based registration of these pressures, cerebral perfusion pressure and other vairables. In 60 patients cerebral perfusion pressure CPP fell below 60 mm Hg for periods of 5 minutes or longer. The distribution over time of these reductions in CPP during up to 12 days of monitoring was studied, and each episode of reduced CPP was attributed to a fall in arterial pressure, an increase in intracranial pressure, or both. Two clusters of reduced CPP were found, one during the first 24 hours of monitoring, when reduced CPP was mainly caused by a reduction in arterial pressure, and the other at 5 or 6 days after injury, when reduced CPP was due mainly to an increase in intracranial pressure. There was a significant correlation between low CPP due to reduced arterial pressure and the Injury Severity Score (p〈0.001), suggesting that resuscitative measures may have been less than optimal in these cases. There was also significant correlation between the duration of low CPP and low arterial pressure and an adverse outcome from injury as assessed at 6, 12 and 24 months after injury (p〈0.001). It is recommended that in patients with severe and significant head injury who require monitoring, this should include both arterial and intracranial pressure, be continued for at least 6 days, that cerebral perfusion pressure should be displayed and recorded, and that particular attention is paid to detecting and correcting even small reductions in arterial pressure, especially those that reduce CPP below 60 mm Hg.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
  • 2
    ISSN: 1435-1420
    Keywords: Key words MOF – epidemiology – Goris score – Moore score – SOFA score ; Schlüsselwörter MOV – Epidemiologie – Goris-Score – Moore-Score – SOFA-Score
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Fragestellung: Interdisziplinäre Erfassung des Auftretens eines Multiorganversagens bei Patienten auf operativen und nicht-operativen Intensivstationen.¶   Methode: Prospektive, offene klinische Studie auf operativen und nichtoperativen Intensivstationen. Einschluss aller Patienten mit einer Behandlungsdauer über 48 Stunden auf einer Intensivstation in einem 3-Monatszeitraum. Tägliche Erhebung epidemiologischer Basisdaten und physiologischer Parameter zur Berechnung des SOFA-, Moore- und Goris-Scores. Analyse von Differenzwerten zwischen den Behandlungstagen und Korrelation mit dem Überleben hinsichtlich Aufnahmediagnosen und Fachgebieten.¶   Ergebnisse: 443 Patienten wurden eingeschlossen und 4880 Beobachtungstage dokumentiert. Es bestand ein Übergewicht an operativ behandelten Patienten (allgemeinchirurgisch (119 Pat.), unfallchirurgisch (163 Pat.), neurochirurgisch (82 Pat.)) gegenüber konservativ behandelten Patienten (Innere Medizin (49 Pat.), Neurologie (19 Pat.)). Überlebende wurden durchschnittlich 8 Tage und Verstorbene 6 Tage intensivmedizinisch behandelt. Die Gesamtmortalität betrug 17,3%. Fachspezifisch wiesen die nicht-operativen Fächer eine höhere Letalität auf mit einem höheren MOV-Score bei Aufnahme nach Goris als die operativ behandelten Patienten. Bei der Auswertung der Differenzwerte differenzierte der SOFA-Score am besten bezüglich Überleben und Versterben. Die Wertigkeit des Goris-Scores unterschied mit und ohne Verwendung der Parameter für ZNS und Gastrointestinaltrakt signifikant unterschiedlich zwischen überlebenden und verstorbenen Patienten.¶   Schlussfolgerung: Mit der vorliegenden Studie wurde ein erster interdisziplinärer intensivmedizinischer Basisdatensatz für Patienten 6 verschiedener Fachgebiete erhoben und verglichen. Es konnten fachgebietsspezifische Unterschiede bezüglich Struktur der Patientenkollektive und der Mortalität gezeigt werden. Diese haben Auswirkungen auf die Stratifizierung von Patientengruppen im Rahmen weiterer fachgebietsübergreifender Studien. Die klinische Einschätzung der Häufigkeit eines MOV als Todesursache und die der täglichen Zustandsänderung des Patienten im Rahmen seiner Erkrankung wurde von allen Scores nicht ausreichend widergespiegelt. Obgleich der SOFA-Score am zuverlässigsten über alle Fachbereiche zur Beurteilung des klinischen Verlaufs geeignet erscheint, ist die interdisziplinäre Weiterentwicklung eines fachübergreifenden Scores zur Beurteilung eines Multiorganversagens erforderlich.
    Notes: Summary Objective The aim of this prospective study was to describe a collective of patients with respect to the manifestation of multiple organ failure in operative and non-operative intensive care units.¶   Methods: Included were all patients treated longer than 48 hours in a participating intensive care unit. Basic epidemiologic data and physiological parameters were recorded and three different score values (SOFA, Moore and Goris scores) were calculated for each day in the intensive care unit and presented according to the particular specialty. A delta score value for each patient was calculated from the first and last recorded value and was compared to the outcome of the patient (survivor/non-survivor). With the Kohen-Kappa coefficient the daily change of the score value relating to an improvement or deterioration was referred to the clinical assessment. Further statistical analysis was performed with Mann-Whitney U test and by means of ANOVA.¶   Results: 443 patients were included and 4880 observation days were recorded. There was an over-representation of operative patients (general surgery (119 pat.), trauma surgery (163 pat.), neurosurgery (82 pat.)) compared to non-operative patients (medicine (49 pat.), neurology (19 pat.)). Survivors stayed 8 and non-survivors 6 days in the intensive care unit. Overall mortality was 17.3%.¶   Non-operative specialties had a higher mortality with a significantly higher Goris multiple organ failure score on admission for neurologic patients and a higher Goris multiple organ failure score for medical patients (not significant) compared to operative patients.¶   The delta SOFA score value is the most powerful to indicate survival or death compared to the other two delta scores. The Goris score on admission produces statistically significant differences concerning survivors and non-survivors even without the gastrointestinal and central nervous system, but is unreliable considering the delta score.¶   Conclusion: In the present investigation, a basic data set for patients from six different medical specialties were collected and compared. Faculty-specific differences between sets of patients and mortality were shown. This will have consequences for stratifying groups of patients for further interdisciplinary investigation. Clinical assessment of the incidence of multiple organ failure and clinical assessment of changes in daily multiple organ failure status were poorly mirrored by all scores under surveillance. Considering delta score values, the SOFA score is the most reliable score for interdisciplinary description of survival or non-survival. Although the SOFA score seems most reliable for describing a patient‘s clinical course, there is a need for the development of a comprehensive, interdisciplinary score for assessment of multiple organ failure.
    Type of Medium: Electronic Resource
    Signatur Availability
    BibTip Others were also interested in ...
Close ⊗
This website uses cookies and the analysis tool Matomo. More information can be found here...