naa a22 4500 510800173 CHVBK 20180411083351.0 cr unu---uuuuu 180411e20130601xx s 000 0 eng 10.1007/s12028-013-9817-2 doi (NATIONALLICENCE)springer-10.1007/s12028-013-9817-2 Frequency and Impact of Intensive Care Unit Complications on Moderate-Severe Traumatic Brain Injury: Early Results of the Outcome Prognostication in Traumatic Brain Injury (OPTIMISM) Study [Elektronische Daten] [Susanne Muehlschlegel, Raphael Carandang, Cynthia Ouillette, Wiley Hall, Fred Anderson, Robert Goldberg] Background: Known predictors of adverse outcomes in patients with moderate-severe TBI (msTBI) explain only a relatively small proportion of patient-related outcomes. The frequency and impact of intensive care unit complications (ICU-COMPL) on msTBI-associated outcomes are poorly understood. Methods: In 213 consecutive msTBI patients admitted to a Level I Trauma Center neuro trauma ICU, twenty-eight ICU-COMPL (21 medical and 7 neurological) were prospectively collected and adjudicated by group consensus, using pre-defined criteria. We determined frequencies, and explored associations of ICU-COMPL and hospital discharge outcomes using multivariable logistic regression. Results: The average age of the study sample was 53years, and the median presenting Glasgow Coma Scale and Injury Severity Scores were 5 and 27, respectively. Hyperglycemia (79%), fever (62%), systemic inflammatory response syndrome (60%), and hypotension requiring vasopressors (42%) were the four most common medical ICU-COMPL. Herniation (39%), intracranial rebleed (39%), and brain edema requiring osmotherapy (37%) were the three most common neurological ICU-COMPL. After adjusting for admission variables, duration of ventilation, and ICU length-of-stay, patients with brain edema (OR 5.8; 95% CI 2, 16.7) had a significantly increased odds for dying during hospitalization whereas patients with hospital-acquired urinary tract infection (UTI) had a decreased odds (OR 0.05; 95% CI 0.005, 0.6). Sensitivity analysis revealed that UTI occurred later, suggesting a non-causal association with survival. Brain herniation (OR 15.7; 95% CI 2.6, 95.4) was associated with an unfavorable functional status (GOS 1-3). Conclusion: ICU-COMPL are very common after msTBI, have a considerable impact on short-term outcomes, and should be considered in the prognostication of these high risk patients. Survival associations of time-dependent complications warrant cautious interpretation. Springer Science+Business Media New York, 2013 Traumatic brain injury nationallicence Adult brain injury nationallicence Functional outcome nationallicence Intensive care unit complications nationallicence Medical complications nationallicence Muehlschlegel Susanne Division of Neurocritical Care, Departments of Neurology, Anesthesia/Critical Care and Surgery, University of Massachusetts Medical School, Worcester, MA, USA aut Carandang Raphael Division of Neurocritical Care, Departments of Neurology and Surgery, University of Massachusetts Medical School, Worcester, MA, USA aut Ouillette Cynthia Division of Neurocritical Care, Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA aut Hall Wiley Division of Neurocritical Care, Departments of Neurology and Surgery, University of Massachusetts Medical School, Worcester, MA, USA aut Anderson Fred Center for Outcomes Research, Departments of Surgery and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA aut Goldberg Robert Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA aut Neurocritical Care Humana Press Inc 18/3(2013-06-01), 318-331 1541-6933 18:3<318 2013 18 12028 https://doi.org/10.1007/s12028-013-9817-2 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s12028-013-9817-2 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Muehlschlegel Susanne Division of Neurocritical Care, Departments of Neurology, Anesthesia/Critical Care and Surgery, University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Carandang Raphael Division of Neurocritical Care, Departments of Neurology and Surgery, University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Ouillette Cynthia Division of Neurocritical Care, Department of Neurology, University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Hall Wiley Division of Neurocritical Care, Departments of Neurology and Surgery, University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Anderson Fred Center for Outcomes Research, Departments of Surgery and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 700 1- Goldberg Robert Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA aut NATIONALLICENCE 773 0- Neurocritical Care Humana Press Inc 18/3(2013-06-01), 318-331 1541-6933 18:3<318 2013 18 12028 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer