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Background and Purpose: The treatment of patients with intracerebral hemorrhage along with moderate hematoma and without cerebral hernia is controversial. This study aimed to explore risk factors and establish prediction models for early deterioration and poor prognosis. Methods: We screened patients from the prospective intracerebral hemorrhage (ICH) registration database (RIS-MIS-ICH, ClinicalTrials.gov Identifier: NCT03862729). The enrolled patients had no brain hernia at admission, with a hematoma volume of more than 20 ml. All patients were initially treated by conservative methods and followed up ≥ 1 year. A decline of Glasgow Coma Scale (GCS) more than 2 or conversion to surgery within 72 h after admission was defined as early deterioration. Modified Rankin Scale (mRS) ≥ 4 at 1 year after stroke was defined as poor prognosis. The independent risk factors of early deterioration and poor prognosis were determined by univariate and multivariate regression analysis. The prediction models were established based on the weight of the independent risk factors. The accuracy and value of models were tested by the receiver operating characteristic (ROC) curve. Results: After screening 632 patients with ICH, a total of 123 legal patients were included. According to statistical analysis, admission GCS (OR, 1.43; 95% CI, 1.18-1.74; P < 0.001) and hematoma volume (OR, 0.9; 95% CI, 0.84-0.97; P = 0.003) were the independent risk factors for early deterioration. Hematoma location (OR, 0.027; 95% CI, 0.004-0.17; P < 0.001) and hematoma volume (OR, 1.09; 95% CI, 1.03-1.15; P < 0.001) were the independent risk factors for poor prognosis, and island sign had a trend toward significance (OR, 0.5; 95% CI, 0.16-1.57; P = 0.051). The admission GCS and hematoma volume score were combined for an early deterioration prediction model with a score from 2 to 5. ROC curve showed an area under the curve (AUC) was 0.778 and cut-off point was 3.5. Combining the score of hematoma volume, island sign, and hematoma location, a long-term prognosis prediction model was established with a score from 2 to 6. ROC curve showed AUC was 0.792 and cutoff point was 4.5. Conclusions: The novel early deterioration and long-term prognosis prediction models are simple, objective, and accurate for patients with ICH along with a hematoma volume of more than 20 ml.

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OBJECTIVE: To examine the effect of a newly-developed tracheal detecting-bulb (TDB) in preventing the spray of contaminants in patients' exhalent during emergency endotracheal intubation procedure. METHODS: 62 emergency patients (male or female, age 21-73 years, weight 47-83 kg, with different levels of consciousness and spontaneous breathing) were randomly divided into two groups (n =31 each) to receive endotracheal intubation by an anesthesiologist with more than 17 years of experience, with (TDB group) or without (control group) a TDB connected to the tracheal tubing. Records were taken regarding the patient's coughing, expansion / contraction of the TDB, the operator's feeling of the patient's exhalent on his face / neck and the contamination of these areas by blood / secretions from the patients in the due course. RESULTS: In TDB group, expansion / contraction of TDB occurred in all cases, but the operator felt no exhalent in any of them. In 9 cases the patients coughed but the operator was contaminated only in 2 cases. While in control group, the patients' exhalent was felt in 16 cases. Coughing were recorded in 7 cases, and the operator was contaminated in 11 cases. In comparison with the control group, TDB group had significantly lower(both P < 0.05), incidence in feeling the exhalent (0 vs. 16), and contamination by blood or secretions (2 vs. 11) although the two groups had no significant difference in the incidence of coughing (9 vs. 7, P > 0.05). CONCLUSION: TDB can play an important role in blocking the spray of contaminants in patients' exhalent during endotracheal intubation.

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BACKGROUND: The tracheal detecting-bulb (TDB) is a diagnostic tool for confirmation of tracheal intubation. Capnography is also accepted as a standard way for such confirmation. The purpose of this investigation was to determine whether the results by TDB agreed with those by capnography. METHODS: Four hundred patients were allocated to three separate studies. In 200 consecutive patients of study 1, tracheal intubation was first confirmed with the TDB followed by capnography. In study 2, 100 patients had the esophagus intentionally intubated, and confirmation was performed likewise as in study 1. The tube was then removed, the trachea was intubated, and confirmation tests followed. Study 3 involved 100 patients and was carried out in a double-blind, randomized manner. The tube was intentionally inserted into either the esophagus (n = 42) or trachea (n = 58), and confirmation tests immediately followed. RESULTS: In study 1, the rhythmic expansion-contraction of TDB was evident in 173 patients, and always agreed with capnographic reading; In 27 instances, the latex bulb of TDB remained collapsed or was scantily filled without the turning-up of capnographic reading as counterchecked, indicating esophageal intubation. In study 2, regardless of esophageal or tracheal intubation, agreement between TDB and capnogram was 100%. In study 3, the agreement between the two detecting instruments was 100% too. In the 400 patients studied, the results from the TDB were in complete accord with those of capnogram. The sensitivity, specificity, and predictive value of the TDB in all of these studies were 100%. CONCLUSIONS: The TDB is a valuable diagnostic technique for confirming tracheal intubation as it could correctly detect esophageal or tracheal intubation of the tracheal tube in all our 400 patients. The results of using TDB agree with the results of using capnography.

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