A Modified Translaryngeal Tracheostomy Technique in the Neurointensive Care Unit. Rationale and Single-center Experience on 199 Acute Brain-damaged Patients

This study assessed the clinical impact of this technique in brain-injured patients. Materials and Methods: This is a retrospective analysis of prospectively collected data from adult brain-injured patients who had undergone modified TLT during the period spanning from January 2010 to December 2016 at the Neurointensive care unit, San Gerardo Hospital (Monza, Italy). The incidence of intraprocedural complications, including episodes of intracranial hypertension (intracranial pressure [ICP]>20 mm Hg), was documented. Neurological, ventilatory, and hemodynamic parameters were retrieved before, during, and after the procedure. Risk factors for complications and intracranial hypertension were assessed by univariate logistic analysis. Data are presented as n (%) and median (interquartile range) for categorical and continuous variables, respectively. Results: A total of 199 consecutive brain-injured patients receiving modified TLT were included. An overall 52% male individuals who were 66 (54 to 74) years old and who had an admission Glasgow Coma Scale of 7 (6 to 10) were included in the cohort. Intracerebral hemorrhage (30%) was the most frequent diagnosis. Neurointensivists performed 130 (65%) of the procedures. Patients underwent tracheostomy 10 (7 to 13) days after intensive care unit admission. Short (ie, 20 mm Hg were observed in 11 cases. Overall, the procedure was associated with an increase in ICP from 7 (4 to 10) to 12 (7 to 18)&thinsp...
Source: Journal of Neurosurgical Anesthesiology - Category: Anesthesiology Tags: Clinical Investigations Source Type: research

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Abstract AIM OF STUDY: We investigated sex differences i n i schaemic s troke p atients t reated w ith i ntravenous a lteplase. CLINICAL RATIONALE FOR STUDY: We suggest that it is necessary to improve care for women with atrial fibrillation. Our data suggests that closer evaluation of treatment for ischaemic stroke in men and women is needed, preferably in the form of a prospective study. MATERIALS AND METHODS: This was a multicentre analysis of 1,830 ischaemic stroke patients treated with alteplase from 2004 to 2012. Data was prospectively collected in the Safe Implementation of Treatments in Stroke (SI...
Source: Neurologia i Neurochirurgia Polska - Category: Neurology Authors: Tags: Neurol Neurochir Pol Source Type: research
AbstractDiabetes is a well ‐established risk factor for both ischemic and hemorrhagic stroke. Individuals with diabetes not only have a higher risk of stroke, they also have worse clinical outcomes after stroke, including poorer neurological recovery, higher rates of stroke recurrence and mortality. In addition to optimizin g glycemia, control of cardiovascular risk factors like hypertension and dyslipidemia is crucial in stroke prevention in subjects with diabetes.
Source: Journal of Diabetes Investigation - Category: Endocrinology Authors: Tags: EDITORIAL Source Type: research
Conclusions: In the population who underwent postmortem neuropathologic evaluation, 68% of extracorporeal membrane oxygenation nonsurvivors developed acute brain injury. Hypoxic-ischemic brain injury was the most common type of injury suggesting that patients sustained acute brain injury as a consequence of cardiogenic shock and cardiac arrest. Further research with a systematic neurologic monitoring is necessary to define the timing of acute brain injury in patients with extracorporeal membrane oxygenation.
Source: Critical Care Medicine - Category: Emergency Medicine Tags: Online Brief Report Source Type: research
There is a higher incidence of stroke in both the type 2 diabetic and the non-diabetic insulin resistant patient which is accompanied by higher morbidity and mortality. The increase in the frequency of stroke is due to an increase in cerebral infarction, mainly lacunar infarcts, with the incidence of cerebral hemorrhage being less frequent. The major risk factors for stroke in the type 2 diabetic patient are age, hypertension, the number of features of the Metabolic Syndrome, the presence of diabetic nephropathy in both the type 1 and type 2 patient, the presence of peripheral and coronary artery disease and especially the...
Source: Diabetes Research and Clinical Practice - Category: Endocrinology Authors: Tags: Review Source Type: research
Stroke is becoming one of the leading causes of adult disability and death in sub-Saharan African countries. The aim of the present study is to provide an up-to-date account of the clinical and demographic characteristics of patients with stroke admitted to the University of Gondar College of Medicine and Health Science Comprehensive Specialized Hospital (CMHS). A hospital based retrospective study design was used to analyze the medical records of all patients with stroke admitted to CMHS from June 20th 2012 and April 30th 2018. Data were cleaned and entered into SPSS for analysis. Among the 448 patients with stroke admitt...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
There is a higher incidence of stroke in both the type 2 diabetic and the non-diabetic insulin resistant patient which is accompanied by higher morbidity and mortality. The increase in the frequency of stroke is due to an increase in cerebral infarction, mainly lacunar infarcts, with the incidence of cerebral hemorrhage being less frequent. The major risk factors for stroke in the type 2 diabetic patient are age, hypertension, the number of features of the Metabolic Syndrome, the presence of diabetic nephropathy in both the type 1 and type 2 patient, the presence of peripheral and coronary artery disease and especially the...
Source: Diabetes Research and Clinical Practice - Category: Endocrinology Authors: Tags: Review Source Type: research
Stroke significantly impacts public health and ranks among the leading causes of death and disabilities, resulting in enormous costs measured in both health care resources and lost productivity. It results primarily from embolus or thrombosis for ischemic stroke and hypertension for hemorrhagic stroke, respectively [1]. In 2016, there were 5.5 million deaths and 116.4 million disability-adjusted life-years (DALYs) owed to stroke [2]. As reported, the impact of stroke on the Chinese population is more severe compared to average global levels, and the prevalence of stroke continues to surpass that of ischemic heart disease [3 –4].
Source: Journal of Stroke and Cerebrovascular Diseases - Category: Neurology Authors: Source Type: research
The patient was an 88-year-old woman with a 10-year history of hypertension. She was suspected to have been hit by a car. At the time of the event, she was conscious and able to stand on her own and had no obvious injuries. She was sent home, but she lapsed into unconsciousness and was nonresponsive after 2 hours. She was sent to the hospital, and her heartbeat and breathing stopped. After half an hour of rescue attempts, her heartbeat did not recover, and she was declared dead. During the autopsy, a small subcutaneous hemorrhage was observed below the right knee joint. No obvious internal organ injuries or bone fractures ...
Source: The American Journal of Forensic Medicine and Pathology - Category: Forensic Medicine Tags: Case Reports Source Type: research
CONCLUSIONS: The study data demonstrate that hypertension, length of hospital stay, and hemorrhagic conversion were predictors of 30-day hospital readmission in stroke patients after mechanical thrombectomy. Infection was the most common cause of 30-day readmission, followed by cardiac and cerebrovascular diagnoses. These results therefore may serve to identify patients within the stroke population who require increased surveillance following discharge to reduce complications and unplanned readmissions. PMID: 32357335 [PubMed - as supplied by publisher]
Source: Journal of Neurosurgery - Category: Neurosurgery Authors: Tags: J Neurosurg Source Type: research
A 79-year-old male of African ancestry, with a history of hemorrhagic stroke, monoclonal gammopathy of unknown significance and chronic kidney disease stage 3 due to hypertension was admitted to Bichat hospital on day 1 after the first symptom of COVID-19 (fever). SARS-CoV 2 PCR was positive on nasal swab. At admission urinary dipstick was normal and plasma creatinine was 224 μmol/L. On day 4 plasma albumin was at 29 g/L and proteinuria was 11.4 g per gram of urinary creatinine (80% of albumin).
Source: Kidney International - Category: Urology & Nephrology Authors: Tags: nephrology image Source Type: research
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