Department of Neuroanaesthesia and Neurocritical Care, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India.
Department of Anaesthesia and Critical care, St John's Medical Collage Hospital, Bengaluru, Karnataka, India.
J Clin Monit Comput. 2024 Apr;38(2):399-405. doi: 10.1007/s10877-023-01063-9. Epub 2023 Aug 3.
Infection in the neurocritical care unit ( NCCU) can cause significant mortality and morbidity. Autonomic nervous system plays an important role in defense against infection. Autonomic dysfunction causing inflammatory dysregulation can potentiate infection. We aimed to study the relationship between autonomic dysfunction and occurrence of infection in neurologically ill patients.
Fifty one patients who were on mechanical ventilation were prospectively enrolled in this study. Autonomic dysfunction was measured for three consecutive days on admission to NCCU using Ansiscope. Patients were followed up for seven days to see the occurrence of infection. Infection was defined as per centre of disease control definition.
A total of 386 patients were screened for eligibility. 68 patients satisfied the eligibility criteria and 51 patients were finally included in the study. The incidence of infection was 74.5%. The commonest infection was pulmonary infection (38.8%) followed by urinary tract infection (33.3%), blood stream infection(14.8%), central nervous system infection (11.1%) and wound site infection (3.7%). The degree of autonomic dysfunction (AD) percentage was more in infection group (37.7% (25.2-49.7)) compared to non infection group (23.5% (18-33.5)) and maximal on day 3 (P = 0.02). Patients with increasing trend of AD% from day 1 to day 3 had the highest infection rates. The length of NCCU stay (20(10-23) days and mortality (42.1%) was higher in infection group (p < 0.001).
AD assessment can be used as a tool to predict development of infection in NCCU. This can help triage and institute early investigation and treatment.
神经重症监护病房（NCCU）的感染可导致显著的死亡率和发病率。自主神经系统在抗感染中起着重要作用。自主神经功能障碍导致的炎症失调会增强感染。我们旨在研究自主神经功能障碍与神经疾病患者感染发生之间的关系。
本研究前瞻性纳入了 51 名接受机械通气的患者。使用 Ansiscope 在 NCCU 入院后连续 3 天测量自主神经功能障碍。对患者进行为期 7 天的随访，观察感染的发生情况。感染的定义根据疾病控制中心的定义。
共筛选了 386 名符合条件的患者。68 名患者符合入选标准，最终 51 名患者纳入研究。感染发生率为 74.5%。最常见的感染是肺部感染（38.8%），其次是尿路感染（33.3%）、血流感染（14.8%）、中枢神经系统感染（11.1%）和伤口部位感染（3.7%）。感染组的自主神经功能障碍（AD）程度百分比更高（37.7%（25.2-49.7）），而非感染组为 23.5%（18-33.5%），且第 3 天最大（P=0.02）。AD%从第 1 天到第 3 天呈上升趋势的患者感染率最高。感染组的 NCCU 住院时间（20（10-23）天）和死亡率（42.1%）较高（p<0.001）。
AD 评估可作为预测 NCCU 感染发生的工具。这有助于分诊，并尽早进行调查和治疗。
