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In both phases, each patient underwent the protocol as described in Table?1. At each step, a standard set of parameters was recorded: heart rate (HR), mean arterial pressure (MAP), ICP, CPP. In addition, at step 1, 3 and 5, arterial blood gas analysis and SjO2 were carried out; Reasons To Cilengitide Price Levels Will Remain Big at these steps, mV MCA was bilaterally measured by TCD, and mean value was reported. In the control phase, step 2 was not carried out.Table 1Study protocolAn evaluation of cough strength was performed after ETS by a semi-quantitative scale (Harris Scale; component ��Response to endotracheal suctioning��) . It ranged between 1 and 4 (Table?2).Table 2Scoring of cough strengthStatistical analysisRepeated measures analysis of variance was used in order to study physiologic parameters before, during and after ETS.
Cough reflex after ETS was evaluated by the Friedman test for repeated measures; in cases of multiple comparisons, level of significance was adjusted using the Bonferroni correction, and corrected P value was reported. Statistical calculations were performed using the Statistical Package for Social Sciences (Windows version 14.0, Microsoft Corp, Redwood, WA, USA). Results are reported as mean��standard deviation, or median and interquartile range (IQR), as appropriated; a value of P <0.05 was considered statistically significant.ResultsTwenty-one head-injured patients consecutively admitted to 18-bed general ICU of ��A. Gemelli�� Hospital between 1 January 2011 and 1 November 2011 were enrolled in the study. ��A.
Gemelli�� Hospital is a 1,200-bed university hospital located in Rome, Italy, that is a referral center for severely injured patients and serves an urban area of 1 million people.During baseline analgosedation (control group), a cough reflex was present in all patients, and all were included in the study.The sample was predominantly male (57%), with nine females (43%). The mean age was 54.6��21.2, ranging from 19 to 74?yrs. The patients�� severity of illness, as measured by the Glasgow Coma Scale (5.8��3.8) and the Simplified Acute Physiology Score II (SAPS II) score (49.7��9.2), showed severe injuries and significant comorbidities requiring high levels of medical and nursing care. At baseline, ICP was always below 25?mmHg. During the study, hyperventilation was not applied, and five patients were treated with hyperosmolar therapy.
ControlDespite deep sedation, ETS (T3) caused an increase of HR (from 74.3��14.0 to 82.1��17.6?min-1; P <0.001), MAP (from 89.0��11.6 to 96.4��13.1?mmHg; P <0.001), ICP (from 11.0��6.7 to 18.5��8.9?mmHg; P <0.001), SjO2 (from 82.3��7.5 to 89.1��5.4%; P=0.01) and mV MCA (from 76.8��20.4 to 90.2��30.2?cm/sec; P =0.04) if compared with T1. CPP did not vary with ETS (Figures?1, ?,2,2, ?,3,3, ?,44 and ?and5).5). Furthermore, ETS stimulated a strong cough reflex, with a median cough score of 2 (IQR 1 to 2) (Figure?6).