3 research outputs found
protocol for a prospective, observational, multi-centre patient cohort study (DACAPO)
Background Health-related quality of life (HRQoL) and return to work are
important outcomes in critical care medicine, reaching beyond mortality.
Little is known on factors predictive of HRQoL and return to work in critical
illness, including the acute respiratory distress syndrome (ARDS), and no
evidence exists on the role of quality of care (QoC) for outcomes in survivors
of ARDS. It is the aim of the DACAPO study (“Surviving ARDS: the influence of
QoC and individual patient characteristics on quality of life”) to investigate
the role of QoC and individual patient characteristics on quality of life and
return to work. Methods/Design A prospective, observational, multi-centre
patient cohort study will be performed in Germany, using hospitals from the
“ARDS Network Germany” as the main recruiting centres. It is envisaged to
recruit 2400 patients into the DACAPO study and to analyse a study population
of 1500 survivors. They will be followed up until 12 months after discharge
from hospital. QoC will be assessed as process quality, structural quality and
volume at the institutional level. The main outcomes (HRQoL and return to
work) will be assessed by self-report questionnaires. Further data collection
includes general medical and ARDS-related characteristics of patients as well
as sociodemographic and psycho-social parameters. Multilevel hierarchical
modelling will be performed to analyse the effects of QoC and individual
patient characteristics on outcomes, taking the cluster structure of the data
into account. Discussion By obtaining comprehensive data at patient and
hospital level using a prospective multi-centre design, the DACAPO-study is
the first study investigating the influence of QoC on individual outcomes of
ARDS survivors
Flow augmentation STA-MCA bypass evaluation for patients with acute stroke and unilateral large vessel occlusion: a proposal for an urgent bypass flowchart
OBJECTIVE
Endovascular recanalization trials have shown a positive impact on the preservation of ischemic penumbra in patients with acute large vessel occlusion (LVO). The concept of penumbra salvation can be extended to surgical revascularization with bypass in highly selected patients. For selecting these patients, the authors propose a flowchart based on multimodal MRI.
METHODS
All patients with acute stroke and persisting internal carotid artery (ICA) or M1 occlusion after intravenous lysis or mechanical thrombectomy undergo advanced neuroimaging in a time window of 72 hours after stroke onset including perfusion MRI, blood oxygenation level-dependent functional MRI to evaluate cerebrovascular reactivity (BOLD-CVR), and noninvasive optimal vessel analysis (NOVA) quantitative MRA to assess collateral circulation.
RESULTS
Symptomatic patients exhibiting persistent hemodynamic impairment and insufficient collateral circulation could benefit from bypass surgery. According to the flowchart, a bypass is considered for patients 1) with low or moderate neurological impairment (National Institutes of Health Stroke Scale score 1-15, modified Rankin Scale score ≤ 3), 2) without large or malignant stroke, 3) without intracranial hemorrhage, 4) with MR perfusion/diffusion mismatch > 120%, 5) with paradoxical BOLD-CVR in the occluded vascular territory, and 6) with insufficient collateral circulation.
CONCLUSIONS
The proposed flowchart is based on the patient's clinical condition and multimodal MR neuroimaging and aims to select patients with acute stroke due to LVO and persistent inadequate collateral flow, who could benefit from urgent bypass