Neurocritical care
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The optimal glucose range in patients with severe traumatic brain injury (TBI) remains unclear. The goal of this study was to examine the association of serum glucose levels on mortality in patients with severe TBI. As a secondary endpoint, we determined the risk of hyperglycemic and hypoglycemic events, and their association with mortality. ⋯ Any episode of hyperglycemia ( ≥ 11.1 mmol/l or 200 mg/dl) was associated with 3.6-fold increased risk of hospital mortality in patients with severe TBI and thus, should be avoided. Maintaining serum glucose ≤ 10 mmol/l appears to be a reasonable balance to avoid extremes of glucose control, but further studies are needed to determine the optimal glucose range.
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Massive air embolism has been described in multiple clinical scenarios, especially in critical ill patients who undergo invasive procedures. Nevertheless, air embolism is often unrecognized and a high index of suspicion is required to diagnose this entity. Two previous cases of air embolism in lung transplant patients have been described in the literature; we describe a third case of fatal massive air embolism and cardiovascular collapse in a lung transplant patient. ⋯ This case underscores the potential severe consequences of air embolism and its systemic manifestations. A high index of suspicion for cerebral air embolism is warranted in lung transplant patients who present with neurological symptoms.