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1.
Michael Darmon Eric Diconne Bertrand Souweine Stéphane Ruckly Christophe Adrie Elie Azoulay Christophe Clec'h Ma?té Garrouste-Orgeas Carole Schwebel Dany Goldgran-Toledano Hatem Khallel Anne-Sylvie Dumenil Samir Jamali Christine Cheval Bernard Allaouchiche Fabrice Zeni Jean-Fran?ois Timsit 《Critical care (London, England)》2013,17(1):R12
Introduction
To assess the prevalence of dysnatremia, including borderline changes in serum sodium concentration, and to estimate the impact of these dysnatremia on mortality after adjustment for confounders.Methods
Observational study on a prospective database fed by 13 intensive care units (ICUs). Unselected patients with ICU stay longer than 48 h were enrolled over a 14-year period were included in this study. Mild to severe hyponatremia were defined as serum sodium concentration < 135, < 130, and < 125 mmol/L respectively. Mild to severe hypernatremia were defined as serum sodium concentration > 145, > 150, and > 155 mmol/L respectively. Borderline hyponatremia and hypernatremia were defined as serum sodium concentration between 135 and 137 mmol/L or 143 and 145 respectively.Results
A total of 11,125 patients were included in this study. Among these patients, 3,047 (27.4%) had mild to severe hyponatremia at ICU admission, 2,258 (20.3%) had borderline hyponatremia at ICU admission, 1,078 (9.7%) had borderline hypernatremia and 877 (7.9%) had mild to severe hypernatremia. After adjustment for confounder, both moderate and severe hyponatremia (subdistribution hazard ratio (sHR) 1.82, 95% CI 1.002 to 1.395 and 1.27, 95% CI 1.01 to 1.60 respectively) were associated with day-30 mortality. Similarly, mild, moderate and severe hypernatremia (sHR 1.34, 95% CI 1.14 to 1.57; 1.51, 95% CI 1.15 to 1.99; and 2.64, 95% CI 2.00 to 3.81 respectively) were independently associated with day-30 mortality.Conclusions
One-third of critically ill patients had a mild to moderate dysnatremia at ICU admission. Dysnatremia, including mild changes in serum sodium concentration, is an independent risk factor for hospital mortality and should not be neglected. 相似文献2.
3.
Jae Yun Jung Eun Mi Ham Hyuksool Kwon Young Ho Kwak Do Kyun Kim Jin Hee Lee Jin Hee Jung 《The American journal of emergency medicine》2019,37(3):468-471
Background
Coronary artery dilatation (CAD) is a great concern with Kawasaki disease (KD). This study aimed to investigate the relationship between serum N-terminal pro-brain natriuretic peptide (NT-proBNP) levels and CAD in patients with the hyperacute phase (≤4?days of fever) of KD.Methods
Serum NT-proBNP levels were compared between patients with and those without CAD, who underwent transthoracic echocardiography (TTE) within 24?h of the hyperacute phase of KD in the pediatric emergency department (PED). Electronic medical records of patients aged 1?month to 15?years who visited the PED were retrospectively assessed from January 2010 to December 31, 2014.Results
One hundred nine patients were enrolled in the study. Twenty-three of those patients had CAD within 24?h of TTE. Median serum NT-proBNP levels were significantly higher in patients with CAD (824.1?pg/ml; interquartile range [IQR], 515.4–1570.0184.8–767.8?pg/ml) than in patients without CAD (396.4?pg/ml; IQR, 184.8–767.8?pg/ml) (p?≤?0.001). The cutoff value of serum NT-proBNP, which predicted CAD during the hyperacute phase of KD, was 515.4?pg/ml, which yielded sensitivity of 78.26% and specificity of 61.63%. The area under the curve for NT-proBNP for predicting CAD during hyperacute KD was 0.749 (95% CI, 0.642–0.856).Conclusion
Serum NT-proBNP might be an additional laboratory marker for detecting early CAD during the hyperacute phase of KD in the PED. 相似文献4.
R. Jouffroy A. Saade P. Alexandre P. Philippe P. Carli B. Vivien 《The American journal of emergency medicine》2019,37(3):387-390
Background
Epinephrine is recommended for the treatment of non-shockable out of hospital cardiac arrest (OHCA) to obtain return of spontaneous circulation (ROSC). Epinephrine efficiency and safety remain under debate.Objective
We propose to describe the association between the cumulative dose of epinephrine and the failure of ROSC during the first 30?min of advanced life support (ALS).Methodology
A retrospective observational cohort study using the Paris SAMU 75 registry including all non-traumatic OHCA. All OHCA receiving epinephrine during the first 30?min of ALS were enrolled. Cumulative epinephrine dose given during ALS to ROSC was retrieved from medical reports.Results
Among 1532 patients with OHCA, 776 (51%) had initial non-shockable rhythm. Fifty-four patients were excluded for missing data.The mean value of cumulative dose of epinephrine was 10?±?4?mg in patients who failed to achieve ROSC (ROSC?) and 4?±?3?mg (p?=?0.04) for those who achieved ROSC.ROC curve analysis indicated a cut-off point of 7?mg total cumulative epinephrine associated with ROSC? (AUC?=?0.89 [0.86–0.92]).Using propensity score analysis including age, sex and no-flow duration, association with ROSC? only remained significant for epinephrine?>?7?mg (p?≤10–3, OR [CI95]?=?1.53 [1.42–1.65]).Conclusion
An association between total cumulative epinephrine dose administered during OHCA resuscitation and ROSC? was reported with a threshold of 7?mg, best identifying patients with refractory OHCA. We suggest using this threshold in this context to guide the termination of ALS and early decide on the implementation of extracorporeal life support or organ harvesting in the first 30?min of ALS. 相似文献5.
Atakan Yilmaz Ramazan Sabirli Mert Ozen Ibrahim Turkcuer Bulent Erdur Cuneyt Arikan Ezgi Demirozogul Ahmet Sarohan Murat Seyit Nusret Ok 《The American journal of emergency medicine》2019,37(5):902-908
Introduction
Musculoskeletal system traumas are among the most common presentations in the emergency departments. In the treatment of traumatic musculoskeletal pain, paracetamol and non-steroidal anti-inflammatory analgesics (NSAID) are frequently used. Our aim in this study is to compare the efficacy of intravenous dexketoprofen and paracetamol in the treatment of traumatic musculoskeletal pain.Methods
This prospective, randomised, double blind, controlled study was conducted in a tertiary care emergency unit. The participating patients were randomised into two groups to receive either 50?mg of dexketoprofen or 1000?mg of paracetamol intravenously by rapid infusion in 150?mL of normal saline. Visual analogue scale (VAS), Numeric Rating Scala (NRS) and Verbal Rating Scale (VRS) was employed for pain measurement at baseline, after 15, after 30 and after 60?mins.Results
200 patients were included in the final analysis. The median age of the paracetamol group was 34 (24–48), while that of the dexketoprofen group was 35 (23–50), and 63% (n?=?126) of them consisted of men. Paracetamol and dexketoprofen administration reduced VAS pain scores over time (p?=?0.0001). Median reduction in VAS score at 60?min was 55 (IQR 30–65) for the paracetamol group and 50(IQR 30.25–60) for the dexketoprofen group. There was no statistically significant difference between the paracetamol and dexketoprofen groups in terms of VAS reductions (p?=?0.613).Conclusion
Intravenous paracetamol and dexketoprofen seem to produce equivalent pain relief for acute musculoskeletal trauma in the emergency department.CLINICALTRIALS.GOV NO: NCT03428503 相似文献6.
Eileen Shu Leyla Farshidpour Megann Young Michael Darracq Crystal Ives Tallman 《The American journal of emergency medicine》2019,37(3):502-505
Background
Synovial lactate is a promising biomarker to distinguish septic from aseptic arthritis. If available as a point-of care test, synovial lactate would be rapidly available to aid the emergency provider in clinical decision making. This study assesses the test characteristics of synovial lactate obtained using an EPOC© point-of-care (POC) analyzer to rapidly distinguish septic from aseptic arthritis in the emergency department.Methods
We enrolled a convenience sample of patients with possible septic arthritis presenting to the emergency department at a large urban academic center between October 2016 and April 2018. Enrolled patients underwent arthrocentesis based on the clinical judgment of the treating provider. We obtained synovial lactate levels (SLL) from the POC device. Standard laboratory analysis, synovial fluid culture, emergency and hospital course, operative procedures, antibiotics, and discharge diagnosis were abstracted from the electronic medical record.Results
Thirty-nine patients undergoing forty separate arthrocentesis procedures were enrolled in this study over the two-year period. The sensitivity and specificity of SLL?≥?5?mmol/L was 0.55 and 0.76 respectively, with +LR 2.3 and ?LR 0.6. The sensitivity and specificity of SLL?≥?10?mmol/L was 0.27 and 0.97 respectively, with +LR 7.9 and ?LR 0.8; SLL?≥?10?mmol/L performed similarly to overall synovial WBC?≥?50,000/μL by conventional laboratory testing.Conclusion
It is feasible to obtain a synovial lactate level using the EPOC© POC device. In our study, POC SLL performs similarly to other markers used to diagnose septic arthritis. Further study with larger sample sizes is warranted. 相似文献7.
Manisha Jhamb Khaled Abdel-Kader Jonathan Yabes Yisi Wang Steven D. Weisbord Mark Unruh Jennifer L. Steel 《Journal of pain and symptom management》2019,57(3):566-575.e3
Context
Although symptom clusters have been studied in the context of cancer, few data exist in chronic and end-stage kidney disease (CKD/ESKD) patients.Objectives
The objectives of this study were to 1) characterize and compare symptom cluster phenotypes in patients with advanced CKD, ESKD, and cancer and 2) explore predictors of symptom clusters.Methods
We conducted secondary data analysis of three prospective studies in which pain, depression, and fatigue were assessed in patients with Stage 4–5 CKD, ESKD, and gastrointestinal cancer. Tetrachoric correlations between these symptoms were quantified, and partitioning around medoids algorithm was used for symptom cluster analysis.Results
In the 82 CKD, 149 ESKD, and 606 cancer patients, no differences in the average fatigue (P = 0.17) or pain levels (P = 0.21) were observed. Over 80% of patients in each group had at least one symptom. Moderate or severe depressive symptoms were more common in patients with cancer (31% vs. 19% in ESKD vs. 9% in CKD; P < 0.001). Mild-moderate correlations were observed between the three symptoms in ESKD and cancer patients. Three distinct clusters were observed in each group. In ESKD, the HIGH cluster (with high probability of pain, depression, and fatigue) had higher body mass index (P < 0.001) and antidepressant use (P = 0.01). In cancer patients, the HIGH cluster patients were more likely to be female (P = 0.04), use antidepressants (P = 0.04), and have lower serum albumin (P < 0.001) and hemoglobin (P = 0.03) compared to the other two clusters.Conclusion
Although the burden of fatigue, pain, and depressive symptoms for CKD and ESKD patients is similar to patients with gastrointestinal cancer, symptom cluster phenotypes differed between the groups as did the predictors of symptom clusters. 相似文献8.
Amy Hammerich Julie Whitman Paul Mintken Thomas Denninger Venu Akuthota Eric E. Sawyer Melissa Hofmann John D. Childs Joshua Cleland 《Archives of physical medicine and rehabilitation》2019,100(5):797-810
Objective
To examine the effectiveness of epidural steroid injection (ESI) and back education with and without physical therapy (PT) in individuals with lumbar spinal stenosis (LSS).Design
Randomized clinical trial.Setting
Orthopedic spine clinics.Participants
A total of 390 individuals were screened with 60 eligible and randomly selected to receive ESI and education with or without PT (N=54).Interventions
A total of 54 individuals received 1-3 injections and education in a 10-week intervention period, with 31 receiving injections and education only (ESI) and 23 additionally receiving 8-10 sessions of multimodal PT (ESI+PT).Main Outcome Measures
Disability, pain, quality of life, and global rating of change were collected at 10 weeks, 6 months, and 1 year and analyzed using linear mixed model analysis.Results
No significant difference was found between ESI and ESI+PT in the Oswestry Disability Index at any time point, although the sample had significant improvements at 10 weeks (P<.001; 95% confidence interval [CI], ?18.01 to ?5.51) and 1 year (P=.01; 95% CI, ?14.57 to ?2.03) above minimal clinically important difference. Significant differences in the RAND 36-Item Short Form Health Survey 1.0 were found for ESI+PT at 10 weeks with higher emotional role function (P=.03; 95% CI, ?49.05 to ?8.01), emotional well-being (P=.02; 95% CI, ?19.52 to -2.99), and general health perception (P=.05; 95% CI, ?17.20 to ?.78).Conclusions
Epidural steroid injection plus PT was not superior to ESI alone for reducing disability in individuals with LSS. Significant benefit was found for the addition of PT related to quality of life factors of emotional function, emotional well-being, and perception of general health. 相似文献9.
Mauro Giordano Tiziana Ciarambino Pietro Castellino Lorenzo Malatino Alessandro Cataliotti Luca Rinaldi Giuseppe Paolisso Luigi Elio Adinolfi 《The American journal of emergency medicine》2017,35(5):749-752
Study objective
We investigated seasonal prevalence of hyponatremia in the emergency department (ED).Design
A cross-sectional study using clinical chart review.Setting
University Hospital ED, with approximately 28 000 patient visits a year.Type of participants
We reviewed 15 049 patients, subdivided in 2 groups: the adult group consisting of 9822 patients aged between 18 and 64 years old and the elderly group consisting of 5227 patients aged over 65 years presenting to the ED between January 1st, 2014 and December 31st, 2015.Intervention
Emergency patients were evaluated for the presence of hyponatremia by clinical chart review.Measurements and main results
Hyponatremia was defined as a serum sodium level < 135 mmol/l. Mean monthly prevalence of hyponatremia was of 3.74 ± 0.5% in the adult group and it was significantly increased to 10.3 ± 0.7% in the elderly group (p < 0.05 vs adults). During the summer, hyponatremia prevalence was of 4.14 ± 0.2% in adult and markedly increased to 12.52 ± 0.7% (zenith) in elderly patients (p < 0.01 vs adult group; p < 0.05 vs other seasons in elderly group). In the elderly group, we reported a significant correlation between weather temperature and hyponatremia prevalence (r: 0.491; p < 0.05).Conclusion
We observed a major influence of climate on the prevalence of hyponatremia in the elderly in the ED. Decline in renal function, salt loss, reduced salt intake and increased water ingestion could all contribute to developing hyponatremia in elderly patients during the summer. These data could be useful for emergency physicians to prevent hot weather-induced hyponatremia in the elderly. 相似文献10.
Anna Marie Chang Judd E. Hollander Erica Su Robert E. Weiss Annick N. Yagapen Susan E. Malveau David H. Adler Aveh Bastani Christopher W. Baugh Jeffrey M. Caterino Carol L. Clark Deborah B. Diercks Bret A. Nicks Daniel K. Nishijima Manish N. Shah Kirk A. Stiffler Alan B. Storrow Scott T. Wilber Benjamin C. Sun 《The American journal of emergency medicine》2019,37(5):869-872
Almost 20% of patients with syncope will experience another event. It is unknown whether recurrent syncope is a marker for a higher or lower risk etiology of syncope. The goal of this study is to determine whether older adults with recurrent syncope have a higher likelihood of 30-day serious clinical events than patients experiencing their first episode.
Methods
This study is a pre-specified secondary analysis of a multicenter prospective, observational study conducted at 11 emergency departments in the US. Adults 60?years or older who presented with syncope or near syncope were enrolled. The primary outcome was occurrence of 30-day serious outcome. The secondary outcome was 30-day serious cardiac arrhythmia. In multivariate analysis, we assessed whether prior syncope was an independent predictor of 30-day serious events.Results
The study cohort included 3580 patients: 1281 (35.8%) had prior syncope and 2299 (64.2%) were presenting with first episode of syncope. 498 (13.9%) patients had 1 prior episode while 771 (21.5%) had >1 prior episode. Those with recurrent syncope were more likely to have congestive heart failure, coronary artery disease, previous diagnosis of arrhythmia, and an abnormal ECG. Overall, 657 (18.4%) of the cohort had a serious outcome by 30?days after index ED visit. In multivariate analysis, we found no significant difference in risk of events (adjusted odds ratio 1.09; 95% confidence interval 0.90–1.31; p?=?0.387).Conclusion
In older adults with syncope, a prior history of syncope within the year does not increase the risk for serious 30-day events. 相似文献11.
12.
Objective
The purpose of this study was to examine the relationship between spirituality and health status outcome in nursing home (PSTW Khusnul Khotimah) in Pekanbaru, Riau-Indonesia.Method
This study methods was a cross-sectional study with 36 elderly people as samples and it was taken by total sampling technique. JAREL Spiritual Well-Being Scale was used to assess elderly people spirituality level. Univariate and bivariate use non-parametric analysis were performed to determine the relationship between elderly people spirituality and self-reported health status.Results
Majority marital status of respondent (85.8%) were divorce with their couple. Seventy two point two percent elderly health status was not good and 52.8% (the results spiritual statement of indicates: When I was sick, I reduced spiritual welfare 33.3%, I cannot accept changes in my life 27.8%) of them have less spirituality. This study also found that the elderly people who has low spirituality level more likely have health problems. There was significant correlation between spirituality and elderly health status in nursing home (p = 0.035).Conclusion
It was important to increase the elderly people spirituality to prevent health status degradation in elderly people in nursing home. 相似文献13.
Michelle Ng Jerrold Perrott Sarah Burgess 《The American journal of emergency medicine》2019,37(3):444-449
Introduction
Tranexamic acid (TXA) has been shown to decrease mortality in adult trauma patients with or at significant risk of hemorrhage when administered within 3?h of injury. The use and appropriateness of TXA in adult trauma patients presenting to Royal Columbian Hospital (RCH) was investigated.Methods
This retrospective chart review utilized the British Columbia Trauma Registry to identify 100 consecutive trauma patients that presented to the emergency department at RCH between April 2012 to June 2015 and met the following indications for TXA: systolic blood pressure <90?mm?Hg and/or heart rate >110?bpm and presentation within 8?h of injury. Primary outcomes included: percentage that met indications for TXA, received TXA according to the CRASH-2 protocol, received a pre-hospital dose, and received TXA ≤1, >1 to ≤3, or >3?h from injury.Results
During the given time period, 117 subjects (2.7%) met indications for TXA. 67 patients (57%) received TXA in any dose, with 10 subjects (8.5%) receiving TXA according to the CRASH-2 protocol. Of the 67 patients who received any TXA, 76% did so ≤3?h. 22 patients (19%) received TXA as a pre-hospital dose.Conclusions
<10% of adult trauma patients that met the indication for TXA received it according to the CRASH-2 protocol. Of those patients that received TXA, 76% did so within 3?h. Further inquiry to identify reasons trauma patients are not receiving TXA as well as quality improvement initiatives in trauma care are required.Level of evidence
IIIStudy type
Therapeutic 相似文献14.
Background
Despite the evidence and available guidelines about endotracheal suction (ETS), a discrepancy between published guidelines and clinical practice persists. To date, ETS practice in the adult intensive care unit (ICU) population across New Zealand and Australia has not been described.Objective
To describe ICU nurses' ETS practice in New Zealand and Australia including the triggers for performing endotracheal suction.Methods
A single day, prospective observational, binational, multicentre point prevalence study in New Zealand and Australian ICUs. All adult patients admitted at 10:00 on the study day were included.Main outcome measures
In addition to patient demographic data, we assessed triggers for ETS, suction canister pressures, use of preoxygenation, measures of oxygenation, and ETS at extubation.Results
There were 682 patients in the ICUs on the study day, and 230 were included in the study. Three of 230 patients were excluded for missing data. A total of 1891 ETS events were performed on 227 patients during the study day, a mean of eight interventions per patient. The main triggers reported were audible (n = 385, 63%) and visible (n = 239, 39%) secretions. Less frequent triggers included following auscultation (n = 142, 23%), reduced oxygen saturations (n = 140, 22%), and ventilator waveforms (n = 53, 9%). Mean suction canister pressure was ?337 mmHg (standard deviation = 189), 67% of patients received preoxygenation (n = 413), and ETS at extubation was performed by 84% of nurses.Conclusion
Some practices were inconsistent with international guidelines, in particular concerning patient assessment for ETS and suction canister pressure. 相似文献15.
Trauma team activation criteria and outcomes of geriatric trauma: 10 year single centre cohort study
Kevin Kei-ching Hung Janice H.H. Yeung Catherine S.K. Cheung Ling-yan Leung Raymond C.H. Cheng N.K. Cheung Colin A. Graham 《The American journal of emergency medicine》2019,37(3):450-456
Background
With the aging population, the number of older patients with multiple injuries is increasing. The aim of this study was to understand the patterns and outcomes of older patients admitted to a major trauma centre in Hong Kong from 2006 to 2015, and investigate the performance of the trauma team activation (TTA) criteria for these elderly patients.Methods
This was a retrospective cohort study from a university hospital major trauma centre in Hong Kong from 2006 to 2015. Patients aged 55 or above who entered the trauma registry were included. Patients were divided into those aged 55–70, and above 70. To test the performance of the TTA criteria, we defined injured patients with severe outcomes as those having any of the following: death within 30?days; the need for surgery; or the need for intensive care unit (ICU) care.Results
2218 patients were included over the 10?year period. The 30-day mortality was 7.5% for aged 55–70 and 17.7% for those aged above 70. The sensitivity of TTA criteria for identifying severe outcomes for those aged 55 or above was 35.6%, with 91.6% specificity. The under-triage rate was 59% for age 55–70, and 69.1% for those aged above 70.Conclusion
There is a need to consider alternative TTA criteria for our geriatric trauma population, and to more clearly define the process and standards of care in Hong Kong. 相似文献16.
Ian C. Chang Angela Dispenzieri Christopher G. Scott Grace Lin Allan S. Jaffe Kyle W. Klarich Martha Grogan 《Mayo Clinic proceedings. Mayo Clinic》2019,94(3):447-454
Objective
To determine the utility of the serum free light chain (FLC) assay for routine screening of light chain amyloidosis (AL) in patients with heart failure.Patients and Methods
We studied consecutive new patients referred to the Heart Failure Clinic who had the FLC assay performed for routine screening at Mayo Clinic's campus in Rochester, Minnesota, from January 1, 2011, through December 31, 2015. An FLC ratio between 0.26 and 1.65 was considered normal.Results
Of the 1173 patients in the study (mean age, 64±15 years), 207 had an abnormal FLC ratio. Light chain amyloidosis was diagnosed in 0.5% of all patients (6 of 1173) and in 2.9% of those with an abnormal FLC ratio (6 of 207). To increase the pretest probability of an abnormal FLC ratio in predicting AL, we considered patients with an N-terminal pro B-type natriuretic peptide level of 5000 pg/mL or greater (to convert to pmol/L, multiply by 0.1182) and a left ventricular posterior wall thickness of 13 mm or greater; this increased the diagnostic yield to 66.7% (6 of 9).Conclusion
The prevalence of AL in patients with heart failure could be 0.5% or higher. Compared with the use of the serum FLC assay for routine screening, a targeted approach of the serum FLC assay in those with higher N-terminal pro B-type natriuretic peptide level (≥5000 pg/mL) and increased posterior wall thickness (≥13 mm) has a markedly higher yield for the diagnosis of AL. 相似文献17.
18.
Background
This study was conducted to assess and clarify the predictive risk factor of neurologic outcome in patients with acute carbon monoxide (CO) poisoning.Methods
A total of 453 patients with acute CO poisoning were admitted to the emergency department of Samsung Changwon Hospital from January 2010 to June 2017. Patients with acute CO poisoning who were followed for >6?months were studied. Initial Glasgow Coma Score (GCS), serum neuron-specific enolase (NSE), and lactate were measured after emergency department arrival. Patients were divided into two groups (good vs poor neurologic outcome).Results
A total of 432 patients (median age: 55?years, range: 17–91?years) were enrolled. There was a statistical difference between the good neurologic outcome group and the poor neurologic outcome group in terms of Exposure time, WBC, aspartate aminotransferase (AST), CK-MB, Troponin-I, creatinine kinase, NSE, lactate, CO-Hb, and GCS. NSE, lactate, and GCS were the early predictors of development of poor neurologic outcome. The areas under the curve in the ROC curve analysis for the GCS, NSE, and lactate were 0.842, 0.795, and 0.894, respectively.Conclusion
Initial serum lactate level may correlate with the patient neurologic outcomes and prove to be a useful prognostic factor. Also NSE, and GCS might be a useful additional parameters that could predict the neurologic outcome on acute CO poisoned patients. 相似文献19.
Elke Pucks-Faes Heinrich Matzak Gabriel Hitzenberger Eleonora Genelin Lucas-Michael Halbmayer Elena Fava Josef Fritz Leopold Saltuari 《Archives of physical medicine and rehabilitation》2019,100(5):837-843
Objective
To report our experience using continuous intrathecal baclofen (ITB) administration prior to a possible ITB device implantation.Design
Retrospective open label study. Mean duration of follow-up 64 months.Setting
Primary-care and referral center, ambulatory and hospitalized care.Participants
Patients (N=116) undergoing continuous ITB trials between 2006 and 2017.Interventions
Continuous application of baclofen via a temporary intrathecal catheter connected to an external pump.Main Outcome Measures
Assessment of the modified Ashworth Scale and range of movement prior versus end of ITB trial. According to the Barthel Index, definition of high-level patients (60-100 scoring points) and low-level patients (0-55 scoring points). Calculation of the Rivermead Mobility Index in high-level patients prior versus end of ITB trial. Evaluation of occurring adverse events.Results
A total of 119 ITB trials were performed in 116 patients (78 men, mean age 41±16), 113 patients completed the trials (31 of 113 high level, 82 of 113 low level). The median modified Ashworth scale improved from 4 (interquartile range [IQR] 3-4) to 2 (IQR 1-2; P≤.001), the range of movement from 2 (IQR 1-3) to 3 (IQR 3-3; P≤.001). The Rivermead Mobility Index increased from 9 (IQR 6-12) to 10 (IQR 7-12.5; P=.004) in high-level patients. Eighty-eight out of 113 patients (78%) were appropriate candidates for ITB device surgery, 75 of 88 (85%) proceeded to an implantation. A total of 69 adverse events occurred in 57 of 119 trials (48%), 37 of 69 (54%) were drug related, 32 of 69 (46%) were procedure related, and 42 of 69 (61%) were minor. The ITB device was implanted in 69 of 75 patients (92%) at last follow-up.Conclusions
Continuous administration of ITB is an effective and useful alternative to ITB bolus application during ITB screening period. Half of the patients experienced adverse events; the majority were minor events. 相似文献20.
Charmaine L. Blanchard Oluwatosin Ayeni Daniel S. O&#x;Neil Holly G. Prigerson Judith S. Jacobson Alfred I. Neugut Maureen Joffe Keletso Mmoledi Mpho Ratshikana-Moloko Paul E. Sackstein Paul Ruff 《Journal of pain and symptom management》2019,57(5):923-932