N a t i o n a l a n d K a p o d i s t r i a n U n i v e r s i t y, M e d i c a l S c h o o l ,F i r s t C r i t i c a l C a r e D e p a r t m e n t , E v a n g e l i s m o s H o s p i t a l , A t h e n s , G r e e c e
Study Aims Results Conclusion
Please navigate using mouse/arrows or use buttons to jump to a specific slide
Methods
EPIDEMIOLOGY AND EARLY DIAGNOSIS OF HETEROTOPIC OSSIFICATION IN CRITICAL
ILL PATIENTS. PRELIMINARY DATA
A. Christakou, M. Alimatiri, I. Patsaki, A. Kouvarakos, E. Papadopoulos, K. Stefanidis, D. Karakitsos, C.S. Vrettou, V. Markaki, S. Nanas
Background and Study Aims
• Acquired neurogenic heterotopic ossification (NHO) is a well-recognized condition in intensive care unit (ICU)
(Genet et al., 2011; Simonsen et al., 2007)
• It effects patients' mobility and morbidity, time of hospitalization and cost (Van Campen et al., 2011)
• The purpose of this study was to assess the role of joint mobility, pain and ultrasonography in early diagnosis in critical ill patients in a general ICU
Results ConclusionMethods
Methods 1.: Flow chart
85 consecutive patients discharged from the ICU
Inclusion criteria: - mechanical ventilation > 72h - age 18-75 years - length of stay in ICU at least 5 days
- not previous HO
45 patients were excluded & 25 patients were deceased
20 patients were eligible for the study
Methods 2.: Baseline characteristics (mean ± SD)
• 20 patients were evaluated (M:14,F:6) (age 51±16 years)• ICU stay (days) 20.0±13.6 • Mechanical ventilation (days) 13.4 ±10.1• Apache II admission score 15.7±6.2• Sofa admission score 6.9±2.1• GCS 9.1 ± 4.1
• The patients received weekly assessment of passive range of motion (pROM) of hip, knee, shoulder and elbow joints with a goniometry
• The pain during joint mobilization was evaluated by
Behavioral Pain Scale (BPS) (Payen et al., 2009) & numeric Visual Analogue Scale (VAS)
• An ultrasonography was performed in any clinically suspected patient
• Confirmation of NHO diagnosis by ultrasonography & radiography
Methods 3.: Assessment tools
Go to
Go to
Results Conclusion
Back
Assessment of HO with goniometry
Confirmation of HO with X-Ray
Back
Results 1.: Incidence of NHO
• The incidence of NHO was 2 out of 20 cases (10%) with acquired brain injury
• NHO was located in the hip joint in one case and in the hip and elbow joints in the second case
The mean time of NHO diagnosis following their admission day in ICU was 10 ± 4 weeks
Conclusion
Go to
(mean ± SD)
[Fig.1& 2]. [Fig.3& 4]. (mean ± SD)
Variables Mean±SD One sample t-test t (df), p value
pROM of Hip -3.96±8.93 t(19)= -2.00*, p= .05pROM of Knee -.17±.77 t(19)= -1.00, p= .33pROM of Elbow -1.36±3.00 t(19)= -2.03*, p= .05pROM of Shoulder -1.50±4.25 t(19)= -1.58, p= .13Shoulder pain 6.65±12.49 t(17)= 2.26*, p= .03Elbow pain 6.56±15.96 t(17)= 1.74, p= .09Hip pain 28.45±54.10 t(17)= 2.23*, p= .03Knee pain 6.93±15.88 t(17)= 1.85, p= .08
Figure 1 & 2. Histograms of % pROM hip and elbow joints
Back
Figure 3 & 4. Histograms of % pain of hip and shoulder joints
Back
• Heterotopic ossification is a common complication in the ICU
• Ultrasonography may play a pivotal diagnostic role in the identification and early detection of NHO
• Limitation was the relatively small number of critically ill patients
• Further studies are needed to determine a valid risk profile of a critical ill patient with HO for the administration of preventive measures
Conclusions
Back to top