Abstract
The Wessex Head Injury Matrix (WHIM) [1] is one of the rare behavioural scales that have been designed to follow the recovery of head-injured patients throughout the whole spectrum of altered states of consciousness, from exit of coma to complete recovery. In this study, we explored the validity of the WHIM in relation to other behavioural assessment tools – Glasgow–Liege Coma Scale (GLS) [2], Coma-Near Coma scale (CNC) [3], Western Neuro Sensory Stimulation Profile (WNSSP) [4] – as well as in relation to the Bi-Spectral Index (BIS), derived from electroencephalographic measures. Twenty-nine brain-injured comatose patients (aged 21–83 years) were followed longitudinally with these behavioural and electrophysiological measures. Overall, the evolution of the scores on the WHIM correlated significantly with the evolution of scores obtained by the GLS (r = 0.88; P < 0.01), the CNC (r = -0.8; P < 0.01), the WNSSP (r = 0.87; P < 0.01), as well as with the BIS measure (r = 0.58; P < 0.01). Relative to the GLS, CNC and WNSSP, the WHIM showed a particularly good sensitivity for documenting subtle changes in recovery for patients in a minimally conscious state. The BIS index globally evolved in parallel to the behavioural scales. However, it showed a very bad sensitivity as many patients in a coma or a vegetative state presented BIS scores that were as high as those observed for patients that had regained normal consciousness. The results confirm the usefulness of the WHIM, especially for the assessment of minimally conscious patients. However, even if a global relation is observed with behavioural scales, the validity of electrophysiological measures such as the BIS index is unsatisfactory for the assessment of altered states of consciousness.
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
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Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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