Arch Surg Chicago
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To determine the frequency and clinical impact of transient systolic hypotension (systolic blood pressure < 100 mm Hg) in patients with severe anatomic head injury. ⋯ Transient hypotension is common in the ICU and is associated with increased acute mortality and decreased functional status in patients with head injury. The impact of this secondary insult is greatest in patients with less severe primary injury. Strict avoidance of hypotension through enhanced monitoring and active treatment appears to be important, especially in patients with higher presenting Glasgow Coma Scale scores.
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To prove that tracheostomy performed at the bedside in the intensive care unit is a safe, cost-effective procedure. ⋯ Bedside tracheostomy in the intensive care unit can be performed with morbidity and mortality rates comparable to operative tracheostomy. In addition, it provides a significant cost savings for the patient.
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Patients who undergo neurosurgical procedures are at high risk for perioperative deep vein thrombosis (DVT) and pulmonary embolism (PE), which have been reported in 6% to 43% of these patients. ⋯ Most perioperative DVTs were clinically silent and formed spontaneously in proximal venous segments where there would be a risk for a PE. The overall incidence of DVT (5.6%) was low, suggesting effective DVT prophylaxis. Patients who underwent spinal surgical procedures were at a significantly lower risk for DVT, and future surveillance is not indicated in this patient group unless other conditions exist (paralysis, malignancy). Patients in whom a craniotomy was performed had a significantly higher risk of DVT, particularly when other risk factors existed. The low incidence of a fatal PE (0.07%) reflected that early detection and treatment of proximal DVT were facilitated by prospective VDUS surveillance in these patients.