Nguyen Tina, Pope Kanisha, Capobianco Paul, Cao-Pham Mimi, Hassan Soha, Kole Matthew J, O'Connell Claire, Wessell Aaron, Strong Jonathan, Tran Quincy K
Department of Emergency Medicine, University of Maryland School of Medicine, College Park, MD, USA.
Research Associate Program in Emergency Medicine and Critical Care, University of Maryland, School of Medicine, College Park, MD, USA.
J Emerg Trauma Shock. 2020 Apr-Jun;13(2):151-160. doi: 10.4103/JETS.JETS_76_19. Epub 2020 Jun 10.
Spontaneous intracranial hemorrhage (sICH) is associated with high mortality. Little information exists to guide initial resuscitation in the emergency department (ED) setting. However, blood pressure variability (BPV) and mechanical ventilation (MV) are known risk factors for poor outcome in sICH.
The objective was to examine the associations between BPV and MV in ED (EDMV) and between two ED interventions - post-MV sedation and hyperosmolar therapy for elevated intracranial pressure - and BPV in the ED and in-hospital mortality.
We retrospectively studied adults with sICH and external ventricular drainage who were transferred to a quaternary academic medical center from other hospitals between January 2011 and September 2015. We used multivariable linear and logistic regressions to measure associations between clinical factors, BPV, and outcomes.
We analyzed ED records from 259 patients. There were 143 (55%) EDMV patients who had more severe clinical factors and significantly higher values of all BPV indices than NoEDMV patients. Two clinical factors and none of the severity scores (i.e., Hunt and Hess, World Federation of Neurological Surgeons Grades, ICH score) correlated with BPV. Hyperosmolarity therapy without fluid resuscitation positively correlated with all BPV indices, whereas propofol infusion plus a narcotic negatively correlated with one of them. Two BPV indices, i.e., successive variation of blood pressure (BP) and absolute difference in blood pressure between ED triage and departure (BP), were significantly associated with increased mortality rate.
Patients receiving MV had significantly higher BPV, perhaps related to disease severity. Good ED sedation, hyperosmolar therapy, and fluid resuscitation were associated with less BPV and lower likelihood of death.
自发性颅内出血（sICH）与高死亡率相关。在急诊科（ED）环境中，几乎没有信息可指导初始复苏。然而，血压变异性（BPV）和机械通气（MV）是sICH预后不良的已知危险因素。
目的是研究急诊科机械通气（EDMV）中BPV与MV之间的关联，以及两种急诊科干预措施——MV后镇静和用于颅内压升高的高渗疗法——与急诊科和住院死亡率中的BPV之间的关联。
我们回顾性研究了2011年1月至2015年9月期间从其他医院转入一家四级学术医疗中心的患有sICH并接受脑室外引流的成年人。我们使用多变量线性和逻辑回归来测量临床因素、BPV和结局之间的关联。
我们分析了259例患者的ED记录。有143例（55%）EDMV患者具有更严重的临床因素，并且所有BPV指标的值均显著高于非EDMV患者。两个临床因素与BPV相关，而严重程度评分（即Hunt和Hess评分、世界神经外科联合会分级、ICH评分）均与BPV无关。无液体复苏的高渗疗法与所有BPV指标呈正相关，而丙泊酚输注加麻醉剂与其中一个指标呈负相关。两个BPV指标，即血压的连续变化（BP）和急诊科分诊与出院时的血压绝对差值（BP），与死亡率增加显著相关。
接受MV的患者BPV显著更高，可能与疾病严重程度有关。良好的急诊科镇静、高渗疗法和液体复苏与较低的BPV和较低的死亡可能性相关。
