Does Hypoxia Affect Intensive Care Unit Delirium or Long-Term Cognitive Impairment After Multiple Trauma Without Intracranial Hemorrhage?
Does Hypoxia Affect Intensive Care Unit Delirium or Long-Term Cognitive Impairment After Multiple Trauma Without Intracranial Hemorrhage?
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DOI：
10.1097/ta.0b013e3182114f18
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发表时间：
2011-04-01
影响因子：
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通讯作者：
Obremskey, William T.
中科院分区：
文献类型：
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作者：
Guillamondegui, Oscar D.;Richards, Justin E.;Obremskey, William T.
背景：在创伤性脑损伤人群中，损伤早期缺氧事件会影响预后。先前的研究表明，在入院时头部计算机断层扫描未发现颅内出血的多发性损伤患者中，认知功能障碍的患病率很高。我们假设重症监护室（ICU）谵妄和长期认知障碍（LTCI）更可能发生在ICU入院后48小时内发生缺氧事件的患者中。共收治多发伤患者173例2006年7月至2007年7月期间，在一级创伤中心就诊的200名患者（损伤严重度评分[ISS] > 15）参加了一项关于长期认知缺陷的研究。97例患者需要ICU管理，所有患者均采集了连续血氧饱和度数据。每天两次收集ICU中所有患者的ICU混乱评估方法。在总入组人群中，108例（62%）在出院后12个月通过神经心理学测试进行了评估。认知障碍定义为具有2个神经心理学测试评分，低于平均值1.5个标准差或1个神经心理学测试评分，低于平均值2个标准差。人口统计学数据、ISS、初始24小时血液需求、是否存在缺氧（SpO（2））
Background: Within the traumatic brain injury population, outcomes are affected by hypoxic events in the early injury period. Previous work shows a high prevalence of cognitive deficits in patients with multiple injuries who do not have intracranial hemorrhage identified on admission head computed tomography scan. We hypothesize that intensive care unit (ICU) delirium and long-term cognitive impairment (LTCI) are more likely in patients who have a hypoxic event within the first 48 hours of ICU admission.Methods: A total of 173 patients with multiple injuries (Injury Severity Score [ISS] > 15) who presented to a Level I trauma center from July 2006 to July 2007 were enrolled in a study on long-term cognitive deficit. Ninety-seven patients required ICU management and all had continuous oxygen saturation data collected. The Confusion Assessment Method for the ICU was collected twice a day on all patients in ICU. Of the total enrolled population, 108 (62%) were evaluated 12 months after discharge by neuropsychological tests. Cognitive impairment was defined as having 2 neuropsychological test scores, 1.5 standard deviations below the mean or 1 neuropsychological test score, and 2 standard deviations below the mean. Demographic data, ISS, initial 24-hour blood requirements, presence of hypoxia (SpO(2)