To evaluate long-term survival and functional outcome in intensive care unit survivors after mechanical ventilation for intracerebral hemorrhage.
Retrospective chart review and prospective follow-up ...study.
Outpatient follow-up.
Between 1997 and 2000, 120 patients were mechanically ventilated for an intracerebral hemorrhage at our intensive care unit. Sixty-two patients were discharged from hospital (in-hospital mortality = 48%). Sixty patients were evaluated for survival and functional outcome (two were lost to follow-up). Time between discharge and follow-up was > or =1 yr and was a mean of 27 +/- 14 months (range, 12-56).
None.
Patients' physicians were first asked about survival, and patients or proxies were interviewed by phone. Barthel Index and modified Rankin Scale scores were collected, and demographic information and general data were reviewed. The estimated life-table survival curve after discharge was 64.6% at 1 yr and 57% at 3 yrs. In the 24 patients who died, the mean time between discharge and death was 5 +/- 6 months. Probability of death after discharge significantly increased if age at admission was >65 yrs (p <.01; odds ratio, 3.5; 95% confidence interval, 1.4-9.1) and if Glasgow Coma Scale score at discharge was <15 (p <.01; odds ratio, 3.9; 95% confidence interval, 1.6-9.5). In the 36 long-term survivors, Barthel Index was 67.5 +/- 15 (median +/- median absolute dispersion) and modified Rankin Scale score was 2.6 +/- 0.5. Fifteen patients (42%) had a slight or no disability (Barthel Index > or =90 and modified Rankin Scale score < or =2), whereas 21 patients (58%) had moderate or severe disability (Barthel Index < or =85 and modified Rankin Scale score >2).
Probability of survival at 3 yrs after mechanical ventilation for an intracerebral hemorrhage was >50%. Age was an important determinant of long-term survival. Forty-two percent of long-term survivors were independent for activities of daily living. Only a few long-term survivors had a very high degree of disability.
Deficient anterior pituitary with common variable immune deficiency (DAVID) syndrome is a rare condition characterized by adrenocorticotropic hormone (ACTH) deficiency and primary ...hypogammaglobulinemia. It is due to heterozygous mutations of the nuclear factor kappa‐B subunit 2 (NFKB2) gene. Only a few isolated cases have been reported since its first description by our team. Through the international multicenter GENHYPOPIT network, we identified a new case of DAVID syndrome. We then conducted an extensive review of the DAVID syndrome cases published from 2012 to 2022. A 7‐year‐old boy was diagnosed with symptomatic hypoglycemia revealing ACTH deficiency. Laboratory tests showed asymptomatic hypogammaglobulinemia. He harbored a heterozygous point mutation in NFKB2 gene (c.2600C > T, p.Ala867Val). His management included hydrocortisone replacement treatment, and he also received subcutaneous immunoglobulins during the Covid‐19 pandemic. We analyzed 28 cases of DAVID syndrome with ACTH deficiency. ACTH deficiency was the only hormone deficiency in 79% of patients, but some patients harbored growth hormone (GH) and thyroid stimulating hormone (TSH) deficiencies. The first presenting symptoms were sinus/pulmonary infections (82%, mean age of 3 years) and alopecia (mean age of 4.7 years). ACTH deficiency was the third presenting condition (mean age at diagnosis of 8.6 years). All patients had hypogammaglobulinemia (decreased IgA and IgM levels), and 57% of patients had at least one autoimmune manifestation. Heterozygous mutations at the 3′end of the NFKB2 gene, coding for the C‐terminal domain of the protein, were identified in all cases. Better knowledge of DAVID syndrome will help clinicians make an early diagnosis to avoid life‐threatening complications.
Deficient Anterior pituitary with common Variable Immune Deficiency (DAVID) syndrome is a rare condition characterized by adrenocorticotropic hormone (ACTH) deficiency and primary hypogammaglobulinemia. It is due to heterozygous mutations of the nuclear factor kappa‐B subunit 2 (NFKB2) gene. Among28 cases published between 2012‐2022, ACTH deficiency was the only hormone deficit in 79% of patients, alopecia was present in 44% and hypogammaglobulinemia was associated with early infections and autoimmune manifestations.
Purpose
Cardiac arrest may occur unexpectedly in intensive care units (ICU). We hypothesize that certain patient characteristics and treatments are associated with survival and long-term functional ...outcome following in-ICU cardiac arrest.
Methods
Over a 12-month period, cardiac arrests with resuscitation attempts were prospectively investigated in 45 French ICUs. Survivors were followed for 6 months.
Results
In total, 677 (2.16%) of 31,399 admitted patients had at least one in-ICU cardiac arrest with resuscitation attempt, 42% of which occurred on the day of admission. In 79% cases, one or more condition(s) likely to promote the occurrence of cardiac arrest was/were identified, including hypoxia (179 patients), metabolic disorders (122), hypovolemia (94), and adverse events linked to the life-sustaining devices in place (98). Return of spontaneous circulation was achieved in 478 patients, of whom 163 were discharged alive from ICU and 146 from hospital. Six-month survival with no or moderate functional sequel (118 of 125 patients alive) correlated with a number of organ failures ≤ 2 when cardiac arrest occurred (OR 4.17 1.92–9.09), resuscitation time ≤ 5 min (3.32 2.01–5.47), shockable rhythm cardiac arrests (2.13 1.26–3.45) or related to the life-sustaining devices in place (2.11 1.22–3.65), absence of preexisting disability (1.98 1.09–3.60) or disease deemed fatal within 5 years (1.70 1.05–2.77), and sedation (1.71 1.06–2.75).
Conclusion
Only one in six patients with in-ICU cardiac arrest and resuscitation attempt was alive at 6 months with good functional status. Certain characteristics specific to cardiac arrests, resuscitation maneuvers, and the pathological context in which they happen may help clarify prognosis and inform relatives.
