Table 1 Baseline characteristics and procedures, complications, and outcomes during ICU stay among patients requiring neurocritical care.
Characteristics | n = 1194 |
|---|---|
Baseline | |
Age, mean ± SD, years | 58.9 ± 19.4 |
Male sex, n (%) | 618 (51.8) |
Transportation to the hospitala, n (%) | |
Critical care ambulance | 376 (31.5) |
Ambulance without critical care service | 91 (7.6) |
Family members | 355 (29.7) |
Self-driven | 370 (31.0) |
Coverage of hospitalization costs, n (%) | |
Public health insurance | 591 (49.5) |
Complementary or private insurance | 603 (50.5) |
Type of ICU admission, n (%) | |
Elective | 317 (26.6) |
Emergency | 877 (73.4) |
Location before transfer to the ICU, n (%) | |
Emergency department | 567 (47.5) |
Operating room | 428 (35.8) |
Hospital ward | 81 (6.8) |
Other | 118 (9.9) |
Severity scores on ICU admission | |
Glasgow Coma Scale, Median (IQR) | 14 (9–15) |
APACHE II, median (IQR) | 11 (7–17) |
SAPS IIIb, median (IQR) | 44 (33–56) |
SOFAc, median (IQR) | 2 (1–6) |
Comorbidities | |
Hypertension, n (%) | 603 (50.5) |
Cardiopathy, n (%) | 177 (14.8) |
Chronic obstructive pulmonary disease, n (%) | 51 (4.3) |
Renal disease, n (%) | 83 (7.0) |
Diabetes mellitus, n (%) | 218 (18.3) |
Extracranial neoplasia, n (%) | 89 (7.5) |
Primary neurological diagnoses, n (%) | |
Postoperative care of elective neurosurgery | 317 (25.6) |
Traumatic brain injury | 218 (18,3) |
Ischaemic stroke | 211 (17.7) |
Encephalopathy | 155 (13) |
Seizures | 91 (7.6) |
Intracerebral haemorrhage | 77 (6.4) |
Subarachnoid haemorrhage | 70 (5.9) |
Central nervous system infection | 25 (2.1) |
Spinal cord injury | 19 (1.6) |
Neuromuscular disease | 11 (0.9) |
Potential secondary injuries (Hs) at ICU admission | |
Hypotension (MAP < 65 mmHg or SBP < 90 mmHg), n (%) | 267 (22.4) |
Hypoxemia (PaO2 < 60 mmHg or são2 < 90% or SpO2 < 90%), n (%) | 72 (6.0) |
Hyperthermia (body temperature > 37.5°C), n (%) | 126 (10.6) |
Hypercapnia (PaCO2 > 45 mmHg ou RR < 8 ipm), n (%) | 115 (9.6) |
Hypocapnia (PaCO2 < 35 mmHg), n (%) | 213 (19.3) |
Hypoglycaemia (venous or capillary glucose values < 60 mg/dL) n (%) | 32 (2.7) |
Hyponatremia (sodium < 135 mmHg), n (%) | 200 (16.8) |
Hypothermia (body temperature < 35°C), n (%) | 121 (10.1) |
Intracranial hypertension (intracranial pressure > 25 mmHg), n (%) | 89 (7.5) |
Clinical evidence of herniation, n (%) | 77 (6.4) |
Number of Hs, n (%) | |
Zero | 500 (41.9) |
One | 318 (26.6) |
Two | 203 (17.0) |
Three or more | 173 (14.5) |
Imaging tests performed on the first day of ICU admission | |
Computed tomography of the head, n (%) | 931 (78) |
Magnetic resonance of the head, n (%) | 208 (17.4) |
Cerebral arteriogram, n (%) | 87 (7.3) |
Procedures performed during the ICU stay | |
Urgent neurosurgery, n (%) | 199 (16.7) |
Placement of an external ventricular drain, n (%) | 84 (7.0) |
Invasive mechanical ventilation, n (%) | 460 (38.5) |
Tracheostomy, n (%of patients placed on invasive mechanical ventilation) | 146 (31.7) |
Noninvasive mechanical ventilation, n (%) | 77 (6.4) |
Vasoactive drug—vasopressor, n (%) | 358 (25.0) |
Vasoactive drug—vasodilator, n (%) | 82 (6.9) |
Renal replacement therapy, n (%) | 65 (5.4) |
Intracranial pressure monitoring—intraparenchymal, n (%) | 55 (4.6) |
Intracranial pressure monitoring—intraventricular, n (%) | 40 (3.3) |
Electroencephalographic monitoring, n (%) | 102 (8.5) |
Intracranial Doppler monitoring, n (%) | 37 (3.1) |
Brain tissue oxygen pressure monitoring, n (%) | 4 (0.3) |
Complications | |
Pneumonia, n (%) | 203 (17) |
Urinary tract infection, n (%) | 43 (3.6) |
Catheter-related infection, n (%) | 35 (2.9) |
Primary bloodstream infection, n (%) | 27 (2.3) |
Neurological infection, n (%) | 23 (1.9) |
Wound infection, n (%) | 15 (1.2) |
Clostridium associated diarrhoea, n (%) | 2 (0.2) |
Renal failure, n (%) | 100 (8.4) |
Acute respiratory distress syndrome, n (%) | 38 (3.2) |
Gastrointestinal bleeding, n (%) | 15 (1.3) |
Intracranial hypertension, n (%) | 129 (10.8) |
Outcome until the 30th study day, n (%) | |
ICU discharge | 832 (69.7) |
Transfer to another hospital | 22 (1.8) |
Continued hospitalization on ICU | 152 (12.7) |
Mortality | 188 (15.7) |
Brain deathd, n (%) | 48 (25.5) |
mRS on the day of the ICU outcome or until the 30th study daye, n (%) | |
0. No symptoms at all | 283 (23.7) |
1. No significant disability despite symptoms; able to carry out all usual duties and activities | 201 (16.9) |
2. Slight disability; unable to carry out all previous activities, but able to look after own affair without assistance | 121 (10.2) |
3. Moderate disability; requiring some help (e.g., with shopping/managing affairs) but able to walk without assistance | 100 (8.4) |
4. Moderately severe disability; unable to walk without assistance and unable to attend to own bodily needs without assistance | 154 (12.9) |
5. Severe disability; bedridden, incontinent, and requiring constant nursing care and attention | 140 (11.8) |
6 Dead | 188 (15.8) |
Unfavourable outcome (mRS score 4, 5, or 6)f, n (%) | 482 (40.6) |
Length of ICU stay until the 30th study day, Median (IQR) | 5 (3–16) |
