Background: S-100B, a protein of astroglial cells, is described as a marker for neuronal damage. Reliable outcome prediction from severe head injury is still unresolved. Clinical scores such as the Glasgow Coma Scale score (GCS) and diagnostic scores such as the Marshall Computed Tomographic Classification are well established and investigated, but there are still some concerns about these tools. The aim of this study was to investigate the predictive value of the initial serum level of S-100B compared with the predictive value of the GCS score and the Marshall Computed Tomographic Classification to outcome after severe head injury. Methods: Forty-four patients with severe head injury (GCS score < 9) were included. Blood samples were drawn within 1 to 6 hours of injury. After a period of 11 months, their outcome was correlated by using the Glasgow Outcome Scale. Patients with an S-100B serum level above 2 μg/L, a GCS score between 3 and 5, and a computed tomographic scan in the categories 4 to 6 are predicted to have an unfavorable outcome. The predictive values of these tools were calculated according to these definitions. Results: The protein S-100B had with 17% the lowest total misclassification rate. When compared with the GCS score and Marshall Computed Tomographic Classification the S-100B serum level calculated on admission had the highest positive predictive value (87%) and negative predictive value (77%). Conclusion: The serum level of S-100B calculated within 1 to 6 hours of a severe head injury is a useful additional outcome predictor.
Background Diagnostic accuracy studies of neuromonitoring devices during carotid endarterectomy in awake patients are limited by the question of the transferability to anesthetized patients. This study was designed to compare the different neuromonitoring parameters in patients under regional and general anesthesia with stump pressure as the primary endpoint and the courses of cerebral blood flow velocity (Vmca) measured by transcranial Doppler sonography, regional cerebral oxygen saturation (rSO2) measured by near-infrared spectroscopy, and the amplitude of somatosensory evoked potentials (SEP) as the secondary endpoints. Materials and Methods Ninety-six patients undergoing carotid endarterectomy were randomized to regional (n=48) or sevoflurane/fentanyl anesthesia (n=48) group. Absolute and relative changes of Vmca and rSO2 and the SEP amplitude were recorded at baseline, during carotid artery clamping, and after declamping. Intergroup differences (ß) were calculated by generalized estimation equations and linear regression analysis. Results Mean arterial pressure (P<0.001) and heart rate (P<0.001) were significantly higher in the regional anesthesia group. SP did not differ between both the groups (ß=−1.6; P=0.71). Vmca (ß=9.2; P<0.01) and rSO2 (ß=4.1; P<0.01) values were higher in the awake patients. After adjustment for mean arterial pressure, the differences of Vmca remained consistent (ß=9.3; P<0.01) whereas these of rSO2 during clamping (ß=2.9; P=0.105) and during reperfusion (ß=2.7; P=0.095) disappeared. No significant differences were found for Vmca(%) (ß=−1.0; P=0.80), rSO2(%) (ß=−1.4; P=1.8) and SEP (ß=−2.6; P=0.29). Conclusion Carotid artery clamping leads to similar results of stump pressure and similar relative changes of transcranial Doppler sonography, near-infrared spectroscopy, and SEP monitoring in patients under regional and sevoflurane/fentanyl anesthesia.
Acute respiratory distress syndrome (ARDS) is a life-threatening condition that often requires prolonged mechanical ventilation. Tracheostomy is a common procedure with some risks, on the other hand with potential advantages over orotracheal intubation in critically ill patients. This study investigated the association of tracheostomy with health-related quality of life (HRQoL), symptoms of psychiatric disorders and return-to-work of ARDS survivors.Data were collected in the context of the prospective observational German-wide DACAPO study. Clinical and demographic patient data and treatment characteristics were obtained from the participating intensive care units (ICU). HRQoL and return-to-work were assessed using patient-reported questionnaires 3, 6 and 12 months after ICU discharge. HRQoL was measured with the Physical and Mental Component Scale of the Short-Form 12 Questionnaire (PCS-12, MCS-12). The prevalence of psychiatric symptoms (depression and post-traumatic stress disorder [PTSD]) was assessed using the Patient Health Questionnaire-9 and the Post-Traumatic Stress Syndrome-14. Physician-diagnosed anxiety and obsessive-compulsive disorder were recorded by patient self-report in the follow-up questionnaires. The associations of tracheostomy with HRQoL, psychiatric symptoms and return-to-work after 12 months were investigated by means of multivariable linear and logistic regression models.Primary 877 ARDS patients (mean ± standard deviation: 54 ± 16 years, 68% male) survived and were discharged from ICU. Out of these patients, 478 (54.5%) were tracheotomised during ICU treatment. After 12 months, patient-reported outcomes could be analysed of 388 (44.2%) respondents, 205 with tracheostomy and 183 without. One year after ICU discharge, tracheostomy showed no significant association with physical or mental health-related quality of life (PCS-12: - 0.73 [- 3.96, 2.51]; MCS-12: - 0.71 [- 4.92, 3.49]), symptoms of psychiatric disorders (depression: 0.10 [- 1.43, 1.64]; PTSD: 3.31 [- 1.81, 8.43]; anxiety: 1.26 [0.41, 3.86]; obsessive-compulsive disorder: 0.59 [0.05, 6.68]) or return-to-work (0.71 [0.31, 1.64]) in the multivariable analysis (OR [95%-CI]).Up to 1 year after ICU discharge, neither HRQoL nor symptoms of psychiatric disorders nor return-to-work was affected by tracheostomy. Trial registration NCT02637011 (ClinicalTrials.gov, Registered 15 December 2015, retrospectively registered).
