لقد أنهيت 🤔Quiz!
top of page
General Critical Care
Public·640 members
لقد أنهيت Quiz: 🫁 Assessment of Hypoxemia & Respiratory Failure!
What is your target hemoglobin in patients with traumatic brain injury and anemia?
7 g/dL or more
8 g/dL or more
9 g/dL or more
Dynamic Air Bronchogram on Lung Ultrasound
Definition:
A dynamic air bronchogram refers to the movement of air within the bronchi that is visible on ultrasound. It typically appears as hyperechoic (bright) lines or dots that move within a hypoechoic (dark) background representing consolidated lung tissue.
Clinical Significance:
- **Pneumonia:** Dynamic air bronchograms are most commonly associated with pneumonia. They indicate that there is still air movement within the bronchi, despite the surrounding lung tissue being consolidated (filled with fluid, inflammatory cells, or pus). This finding supports the diagnosis of an infectious process rather than atelectasis.
bottom of page
https://www.nejm.org/doi/full/10.1056/NEJMoa2404360
Population:
- Adults with moderate or severe traumatic brain injury (TBI) and anemia
- Total of 742 patients, with 371 patients in each group
Intervention:
- Liberal transfusion strategy: Transfusions initiated at a hemoglobin level of ≤10 g/dL
Comparison:
- Restrictive transfusion strategy: Transfusions initiated at a hemoglobin level of ≤7 g/dL
Outcome:
- Primary Outcome: Unfavorable outcome at 6 months assessed by the Glasgow Outcome Scale–Extended (GOSE)
- Liberal strategy: 68.4% (249/364) unfavorable outcomes
- Restrictive strategy: 73.5% (263/358) unfavorable outcomes
- Adjusted absolute difference: 5.4 percentage points (95% CI, −2.9 to 13.7)
- **Secondary Outcomes:**
- Mortality: No significant difference
- Functional independence and quality of life: Higher scores on some scales in the liberal strategy group among survivors
- Depression: No significant difference
- Venous thromboembolic events: 8.4% in both groups
- Acute respiratory distress syndrome (ARDS): 3.3% in liberal group, 0.8% in restrictive group
Insights for Medical Intensivists
- Neurological Outcomes: The liberal transfusion strategy did not significantly reduce the risk of unfavorable neurological outcomes at 6 months compared to the restrictive strategy. Both strategies had high rates of unfavorable outcomes, but the difference was not statistically significant.
- Functional Outcomes: Among survivors, some improvement in functional independence and quality of life scores was observed with the liberal transfusion strategy, although this was not consistent across all measures.
- Safety Concerns: The occurrence of venous thromboembolic events was similar in both groups, but the liberal strategy was associated with a higher incidence of ARDS.
- Clinical Practice Implication: Given the lack of significant benefit in neurological outcomes and the increased risk of ARDS with the liberal strategy, a restrictive transfusion strategy might be preferable in critically ill TBI patients with anemia to avoid additional complications without compromising overall survival and functional outcomes.