The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America

Introduction: Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with se...

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Autores: Schneider, Nick K., Sebrié, Ernesto M., Fernández Muñoz, Esteve
Tipo de recurso: artículo
Estado:Versión publicada
Fecha de publicación:2011
País:España
Institución:Universidad de Barcelona
Repositorio:Dipòsit Digital de la UB
OAI Identifier:oai:diposit.ub.edu:2445/126127
Acceso en línea:https://hdl.handle.net/2445/126127
Access Level:acceso abierto
Palabra clave:Indústria tabaquera
Tabac
Espanya
Europa
Amèrica Llatina
Tobacco industry
Tobacco
Spain
Europe
Latin America
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spelling The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin AmericaSchneider, Nick K.Sebrié, Ernesto M.Fernández Muñoz, EsteveIndústria tabaqueraTabacEspanyaEuropaAmèrica LlatinaTobacco industryTobaccoSpainEuropeLatin AmericaIntroduction: Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the ICU, the impact of these complications on mortality, and their possible correlation with TBI severity. Methods: An observational retrospective cohort study was conducted in one multidisciplinary ICU of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale (GCS) < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded. Results: Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO2) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05). Conclusions: Low initial GCS, worst first CT scan, intracranial hypertension and AKI determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5).BioMed Central2011info:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://hdl.handle.net/2445/126127Articles publicats en revistes (Ciències Clíniques)reponame:Dipòsit Digital de la UBinstname:Universidad de BarcelonaInglésReproducció del document publicat a: https://doi.org/10.1186/1471-2458-11-907BMC Public Health, 2011, vol. 11, p. 907https://doi.org/10.1186/1471-2458-11-907cc-by (c) Schneider, Nick K. et al., 2011http://creativecommons.org/licenses/by/3.0/esinfo:eu-repo/semantics/openAccessoai:diposit.ub.edu:2445/1261272026-05-27T06:46:51Z
dc.title.none.fl_str_mv The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
title The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
spellingShingle The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
Schneider, Nick K.
Indústria tabaquera
Tabac
Espanya
Europa
Amèrica Llatina
Tobacco industry
Tobacco
Spain
Europe
Latin America
title_short The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
title_full The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
title_fullStr The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
title_full_unstemmed The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
title_sort The so-called 'Spanish model' - Tobacco industry strategies and its impact in Europe and Latin America
dc.creator.none.fl_str_mv Schneider, Nick K.
Sebrié, Ernesto M.
Fernández Muñoz, Esteve
author Schneider, Nick K.
author_facet Schneider, Nick K.
Sebrié, Ernesto M.
Fernández Muñoz, Esteve
author_role author
author2 Sebrié, Ernesto M.
Fernández Muñoz, Esteve
author2_role author
author
dc.subject.none.fl_str_mv Indústria tabaquera
Tabac
Espanya
Europa
Amèrica Llatina
Tobacco industry
Tobacco
Spain
Europe
Latin America
topic Indústria tabaquera
Tabac
Espanya
Europa
Amèrica Llatina
Tobacco industry
Tobacco
Spain
Europe
Latin America
description Introduction: Non-neurological complications in patients with severe traumatic brain injury (TBI) are frequent, worsening the prognosis, but the pathophysiology of systemic complications after TBI is unclear. The purpose of this study was to analyze non-neurological complications in patients with severe TBI admitted to the ICU, the impact of these complications on mortality, and their possible correlation with TBI severity. Methods: An observational retrospective cohort study was conducted in one multidisciplinary ICU of a university hospital (35 beds); 224 consecutive adult patients with severe TBI (initial Glasgow Coma Scale (GCS) < 9) admitted to the ICU were included. Neurological and non-neurological variables were recorded. Results: Sepsis occurred in 75% of patients, respiratory infections in 68%, hypotension in 44%, severe respiratory failure (arterial oxygen pressure/oxygen inspired fraction ratio (PaO2/FiO2) < 200) in 41% and acute kidney injury (AKI) in 8%. The multivariate analysis showed that Glasgow Outcome Score (GOS) at one year was independently associated with age, initial GCS 3 to 5, worst Traumatic Coma Data Bank (TCDB) first computed tomography (CT) scan and the presence of intracranial hypertension but not AKI. Hospital mortality was independently associated with initial GSC 3 to 5, worst TCDB first CT scan, the presence of intracranial hypertension and AKI. The presence of AKI regardless of GCS multiplied risk of death 6.17 times (95% confidence interval (CI): 1.37 to 27.78) (P < 0.02), while ICU hypotension increased the risk of death in patients with initial scores of 3 to5 on the GCS 4.28 times (95% CI: 1.22 to15.07) (P < 0.05). Conclusions: Low initial GCS, worst first CT scan, intracranial hypertension and AKI determined hospital mortality in severe TBI patients. Besides the direct effect of low GCS on mortality, this neurological condition also is associated with ICU hypotension which increases hospital mortality among patients with severe TBI. These findings add to previous studies that showed that non-neurological complications increase the length of stay and morbidity in the ICU but do not increase mortality, with the exception of AKI and hypotension in low GCS (3 to 5).
publishDate 2011
dc.date.none.fl_str_mv 2011
dc.type.none.fl_str_mv info:eu-repo/semantics/article
info:eu-repo/semantics/publishedVersion
format article
status_str publishedVersion
dc.identifier.none.fl_str_mv https://hdl.handle.net/2445/126127
url https://hdl.handle.net/2445/126127
dc.language.none.fl_str_mv Inglés
language_invalid_str_mv Inglés
dc.relation.none.fl_str_mv Reproducció del document publicat a: https://doi.org/10.1186/1471-2458-11-907
BMC Public Health, 2011, vol. 11, p. 907
https://doi.org/10.1186/1471-2458-11-907
dc.rights.none.fl_str_mv cc-by (c) Schneider, Nick K. et al., 2011
http://creativecommons.org/licenses/by/3.0/es
info:eu-repo/semantics/openAccess
rights_invalid_str_mv cc-by (c) Schneider, Nick K. et al., 2011
http://creativecommons.org/licenses/by/3.0/es
eu_rights_str_mv openAccess
dc.format.none.fl_str_mv application/pdf
dc.publisher.none.fl_str_mv BioMed Central
publisher.none.fl_str_mv BioMed Central
dc.source.none.fl_str_mv Articles publicats en revistes (Ciències Clíniques)
reponame:Dipòsit Digital de la UB
instname:Universidad de Barcelona
instname_str Universidad de Barcelona
reponame_str Dipòsit Digital de la UB
collection Dipòsit Digital de la UB
repository.name.fl_str_mv
repository.mail.fl_str_mv
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score 15.300724

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