PDF(Pubmed)
Abstract：
For a subset of patients with severe acute brain injury (SABI) undergoing invasive mechanical ventilation, the primary barrier to successful extubation is depressed mental status. Amantadine is a neurostimulant that has been demonstrated to increase arousal and improve functional outcomes in patients with SABI. In this case series, we describe 5 patients with SABI and invasive mechanical ventilation who received amantadine as an agent to improve mental status to allow extubation. The primary barrier to extubation for all patients was depressed mental status. Median age was 77 (range 32 to 82). Primary diagnoses were ischemic stroke (n = 1), subdural hemorrhage (n = 2), intracerebral hemorrhage (n = 1), and traumatic brain injury (n = 1). Median Glasgow Coma Score was 7T prior to administration of amantadine and 10T on the day after amantadine was initiated, with improvements in eye-opening and motor response. Four patients displayed improvement in arousal and attention and were successfully extubated 1 to 4 days after initiation of amantadine (median 2 days). The fifth patient only displayed marginal improvement in mental status after starting amantadine, but was ultimately able to be extubated 7 days later. Amantadine may improve the likelihood of or reduce the time to successful extubation in patients with SABI.
摘要：
对于接受有创机械通气的严重急性脑损伤（SABI）患者的子集，成功拔管的主要障碍是抑郁的精神状态。金刚烷胺是一种神经兴奋剂，已被证明可以增加SABI患者的唤醒并改善功能结局。在这个系列中,我们描述了5例SABI和有创机械通气患者接受金刚烷胺治疗以改善精神状态并允许拔管.所有患者拔管的主要障碍是抑郁的精神状态。中位年龄为77岁（范围32至82岁）。主要诊断为缺血性卒中（n=1），硬膜下出血（n=2），脑出血（n=1），和创伤性脑损伤（n=1）。在服用金刚烷胺前，格拉斯哥昏迷评分中位数为7T，在服用金刚烷胺后的第二天为10T。改善开眼和运动反应。四名患者的唤醒和注意力得到改善，并在开始金刚烷胺后1至4天（平均2天）成功拔管。第五名患者在开始服用金刚烷胺后精神状态仅有轻微改善，但最终能够在7天后拔管。金刚烷胺可以提高SABI患者成功拔管的可能性或减少成功拔管的时间。
