RESUMO
OBJECTIVE: The aim of the study is to present head injury (HI) epidemiology in a population of Buenos Aires that represents almost all socioeconomic sectors. MATERIAL AND METHOD: Prospective, population based study, approved by the Ethic, Education and Research Committees as part of a neurotrauma program. RESULTS: HI incidence was 322/100,000 inhabitants, of them mild HI accounted for 93%, moderate HI 4% and severe HI 3%. Average age was greater in women than in men (49 vs. 38 yo, p 0.01). Taking into account population under and over 40 years we found several differences: the relative risk (RR) for any kind of HI was 1.97 (CI 95% 1.77-2.19, p < 0.01, and the RR for motor vehicle (MV) related HI was 2.53 (CI 95% 2.03-3.17, p < 0.01). Male drivers had a higher RR (16.76 CI 95% 5.35-52.50, p < 0.01) regardless age. Assaults were also significantly higher in people under 40 yo (RR 2.11 IC 95% 1.46-3.03, p < 0.01) increased in young males. Self altitude falls were more frequent in population over 40 yo (RR 4.35 CI 95% 2.61-4.16, p < 0.01) and in women at any age (RR 3.15 CI 95% 2.57-3.87, p < 0.01). Pedestrian accidents were also more common in population over 40 yo (RR 1.84 CI 95% 1.41-2.41 p < 0.01). We did not find any other differences concerning the remaining trauma mechanisms. CONCLUSIONS: HI incidence in Buenos Aires is similar to other printed series, but moderate and severe HI and mortality rates are below that ones. Motor vehicle accidents are the leading HI cause, especially in the young male population, while self altitude fall and pedestrian accidents are prevalent in women and people over 40 yo.
Assuntos
Traumatismos Craniocerebrais/epidemiologia , Adolescente , Adulto , Idoso , Argentina/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , População UrbanaRESUMO
The aim of this study was to evaluate if Hyperventilation (HV) could avoid the Intracranial Pressure (ICP) peak that occurs during Fiberoptic Bronchoscopy (FB) in severely head injured patients. A Cerebral Perfusion Pressure (CPP) > 75 mmHg was maintained in 34 patients, with a subgroup randomized to receive controlled HV during FB. Measurements were done before the procedure, during maximum ICP values and 30 minutes after FB. The HV group had minor ICP values after FB, without differences in CPP and ICP peak values.
Assuntos
Broncoscopia/métodos , Traumatismos Craniocerebrais/cirurgia , Hemodinâmica/fisiologia , Hiperventilação/fisiopatologia , Pressão Intracraniana/fisiologia , Terapia Respiratória/métodos , Adulto , Pressão Sanguínea , Dióxido de Carbono/sangue , Traumatismos Craniocerebrais/complicações , Feminino , Tecnologia de Fibra Óptica , Humanos , Cuidados Intraoperatórios , Masculino , Monitorização Intraoperatória , Oxigênio/sangueRESUMO
The subarachnoid hemorrhage (SAH) by aneurysmatic rupture is responsible for 6% of the cerebral vascular accidents. The cerebral aneurysms are present in 0.2-9.9% of the population and the bleeding rate is of 10 out of 100,000 inhabitants per year. The consensus conference analyzed the different schemes of treatment and made therapeutic recommendations according to the criteria of medicine based on evidence. Levels of evidence were determined from I to V. The recommendation degrees were classified in: A, determined by evidence level I, B by evidence level II, and C suggested by evidence levels III, IV and V. These recommendations should be adapted to each patient. However, grade A recommendations are treatment standards. Seriousness of patients was evaluated on the basis of Hunt and Hess scale upon admission. Successive analyses covered: general medical treatment measures, cerebral vasospasm, diagnostic procedures and treatment of the hyponatremia and convulsion prevention.
Assuntos
Aneurisma Roto/complicações , Medicina Baseada em Evidências , Aneurisma Intracraniano/complicações , Hemorragia Subaracnóidea/tratamento farmacológico , Humanos , Hiponatremia/diagnóstico , Hiponatremia/tratamento farmacológico , Hemorragia Subaracnóidea/etiologia , Vasoespasmo Intracraniano/tratamento farmacológico , Vasoespasmo Intracraniano/prevenção & controleRESUMO
Objetivo: Evaluar la utilidad de la optimización de la PPC antes, durante y después de la realización de FB, analizando las diferentes variables hemodinámicas cerebrales. Material y método: Estudio prospectivo, del 01/07/96 al 31/07/97. Ingresaron todos los pacientes con TEC con Glasgow ó 8 a los que se les relizó FB tanto para lavado broncoalveolar (BAL) como para resolución de atelectasias. Todos los pacientes se encotraban intubados, sedados y relajados, con asistencia respiratoria mecánica (ARM) y monitorizados con: catéter de fibra óptica para la medición de Presión Intracraneana (PIC), oximetría cerebral (rSO2) y de pulso (SaO2), capnografía (ETCO2) y catéteres arterial y venoso central. Se calculó: PPC (TAM-PIC), contenido arterial y venoso de O2, diferencia arterio-venosa de O2 cerebral (Dav02C), índice de extracción de O2 cerebral (SaO2-rSO2), consumo metabólico de O2 cerebral (CMO2C) (PCO2xDavO2C). Previo a la FB se mantuvo una PPC = 70 mmHg, una SaO2 = 95 por ciento, una ETCO2 ó 35mmHg y una rSO2 > 55 por ciento. Todas las variables se midieron y calcularon antes de comenzar la FB, luego de la optimización, en el momento de mayor PIC y 30 minutos después de la FB. El análisis estadístico se realizó con el test de Student y el test de correlación de Pearson. Valores de p ó 0,05 o de r2 >0,5, fueron considerados significativos...(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Adolescente , Pessoa de Meia-Idade , Idoso , Broncoscopia/métodos , Lavagem Broncoalveolar/normas , Lesões Encefálicas Traumáticas/tratamento farmacológico , Lesões Encefálicas Traumáticas/terapia , Hipertensão Intracraniana/prevenção & controle , Estudos ProspectivosRESUMO
The subarachnoid hemorrhage (SAH) by aneurysmatic rupture is responsible for 6
of the cerebral vascular accidents. The cerebral aneurysms are present in 0.2-9.9
of the population and the bleeding rate is of 10 out of 100,000 inhabitants per year. The consensus conference analyzed the different schemes of treatment and made therapeutic recommendations according to the criteria of medicine based on evidence. Levels of evidence were determined from I to V. The recommendation degrees were classified in: A, determined by evidence level I, B by evidence level II, and C suggested by evidence levels III, IV and V. These recommendations should be adapted to each patient. However, grade A recommendations are treatment standards. Seriousness of patients was evaluated on the basis of Hunt and Hess scale upon admission. Successive analyses covered: general medical treatment measures, cerebral vasospasm, diagnostic procedures and treatment of the hyponatremia and convulsion prevention.
RESUMO
Objetivo: Evaluar la utilidad de la optimización de la PPC antes, durante y después de la realización de FB, analizando las diferentes variables hemodinámicas cerebrales. Material y método: Estudio prospectivo, del 01/07/96 al 31/07/97. Ingresaron todos los pacientes con TEC con Glasgow ó 8 a los que se les relizó FB tanto para lavado broncoalveolar (BAL) como para resolución de atelectasias. Todos los pacientes se encotraban intubados, sedados y relajados, con asistencia respiratoria mecánica (ARM) y monitorizados con: catéter de fibra óptica para la medición de Presión Intracraneana (PIC), oximetría cerebral (rSO2) y de pulso (SaO2), capnografía (ETCO2) y catéteres arterial y venoso central. Se calculó: PPC (TAM-PIC), contenido arterial y venoso de O2, diferencia arterio-venosa de O2 cerebral (Dav02C), índice de extracción de O2 cerebral (SaO2-rSO2), consumo metabólico de O2 cerebral (CMO2C) (PCO2xDavO2C). Previo a la FB se mantuvo una PPC = 70 mmHg, una SaO2 = 95 por ciento, una ETCO2 ó 35mmHg y una rSO2 > 55 por ciento. Todas las variables se midieron y calcularon antes de comenzar la FB, luego de la optimización, en el momento de mayor PIC y 30 minutos después de la FB. El análisis estadístico se realizó con el test de Student y el test de correlación de Pearson. Valores de p ó 0,05 o de r2 >0,5, fueron considerados significativos...