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- 저자 : Anna Liveris (검색결과 2 건)
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Treatment of patients with severe traumatic brain injury: a 7-year single institution experience
Corrado P. Marini,Patrizio Petrone,John McNelis,Erin Lewis,Anna Liveris,Michael F. Stiefel 대한신경집중치료학회 2021 대한신경집중치료학회지 Vol.14 No.1
Background: This study was designed to compare the efficacy of multimodality monitoring and goal-directed therapy protocol (MM&GDTP), in patients with Glasgow Coma Scale (GCS) scores ≤8 with the conventional intracranial pressure (ICP)-cerebral perfusion pressure (CPP) treatment. Methods: The study was divided into two time periods, a 2-year historic period in which severe traumatic brain injury (sTBI) patients were treated with an ICP-CPP targeted strategy and a 5-year intervention period during which MM&GDTP was utilized. Patients with unsurvivable brain injuries were excluded. Variables of interest included mechanism of injury, age, sex, hemodynamics, GCS score, abbreviated injury score–head (AIS-H), Marshall Class, injury severity score, decompressive craniectomy, ventilator/intensive care unit days, length of stay, predicted mortality by corticosteroid randomization after significant head injury model, functional outcome, and mortality. Results: The study group comprised 810 sTBI patients, aged 14–93 years, admitted during a 7-year period; of these patients, 67 and 99 AIS-H≥4 and Marshall Class ≥III were included in control and intervention groups, respectively. The control group was treated with an ICP-CPP targeted approach, while the intervention group with an MM&GDTP. At presentation and after resuscitation, patients in the intervention group required a higher CPP to reach the endpoints of therapy. The MM&GDTP decreased mortality from 34.3% to 23.2%, yielding a 32.3% improvement in overall survival and improved functional outcome as measured by Glasgow Outcome Scale >3 (MM&GDTP vs. ICP-CPP: 50/99 vs. 15/67, P=0.003). Conclusion: Institution of MM&GDTP targeted to threshold-defined values improves functional outcomes and may reduce mortality among patients with sTBI compared to that of patients receiving an ICP-CPP–based treatment.
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Ramachandran Anirudh,Montenegro Michelle,Singh Maninder,Dixon Trevor,Kayani Waqas,Liang Timothy,Yu Nick,Reddy Srinivas,Liveris Anna,Manyapu Mallika,McEwan Alyssia A.,Nguyen Vincent T.,Sonenthal Necham 대한응급의학회 2022 Clinical and Experimental Emergency Medicine Vol.9 No.3
Objective Hip fractures are associated with significant morbidity and mortality. Ultrasound-guided peripheral nerve blocks are a safe method to manage pain and decrease opioid usage. The pericapsular nerve group (PENG) block is a novel, potentially superior block because of its motor-sparing effects. Through training, simulation, and supervision, we aim to determine whether it is feasible to perform the PENG block in the emergency department. Methods Phase 1 consisted of emergency physicians attending a workshop to demonstrate ultrasound proficiency, anatomical understanding, and procedural competency using a low-fidelity model. Phase 2 consisted of a prospective, observational, feasibility study of 10 patients with hip fractures. Pain scores, side effects, and opioid usage data were collected. Results The median pain score at time 0 (time of block) was 9 (interquartile range [IQR], 6.5–9). The median pain score at 30 minutes was 4 (IQR, 2.0–6.8) and 3.5 (IQR, 1.0–4.8) at 4 hours. All 10 patients required narcotics prior to the initiation of the PENG block with a median dosage of 6.25 morphine milligram equivalents (MME; IQR, 4.25–7.38 MME). After the PENG block, only 30% of the patients required further narcotics with a median dosage of 0 MME (IQR, 0–0.6 MME) until operative fixation. Conclusion In this feasibility study, PENG blocks were safely administered by trained emergency physicians under supervision. We demonstrated data suggesting a trend of pain relief and decreased opiate requirements, and further investigation is necessary to measure efficacy.
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