Dynamics of brain natriuretic peptide in critically ill patients with severe sepsis and septic shock

Changes of B-type natriuretic peptide [BNP] in sepsis and its utility in predicting intensive care unit outcomes remains a conflicting issue. To investigate the changes in plasma levels of BNP in patients with severe sepsis/septic shock and to study the association of BNP levels with the severity of the disease and prognosis of those patients. Thirty patients with severe sepsis or septic shock were enrolled in our study. BNP measurements and echocardiography were carried out on admission and on 4[th] and 7[th] days. Blood concentrations of BNP were measured by commercially available assays [Abbott methods]. In-hospital mortality and length of stay were recorded multivariate analyses adjusted for acute physiology and chronic health evaluation score II [APACHE II score] was used for mortality prediction. Twenty patients admitted with the diagnosis of severe sepsis and 10 patients with septic shock. The in-hospital mortality was 23.3% [7 patients]. Admission BNP was significantly higher in the non-survivors 1123 +/- 236.08 versus 592.7 +/- 347.1 [P<0.001]. By doing multivariate logestic regression, the predicatable variables for mortality was APACHE II score, BNP, and then EF. BNP concentrations were increased in patients with severe sepsis or septic shock and poor outcome was associated with high BNP levels; thus, it may serve as a useful laboratory marker to predict survival in these patients

Reported survival with severe mixed acidosis and hyperlactemia after toluene poisoning

Lactic acidosis is a recognized complication of the inhalant abuse such as toluene, especially in patients with renal insufficiency. We report a case of severe metabolic acidosis and hyperlactemia due to toluene sniffing. The favorable outcome, despite extremely poor clinical symptoms, signs, laboratory and radiological findings, was unexpected. Specific aspects of the clinical course are addressed. Toluene sniffing should be considered in evaluating sever metabolic acidosis. Favorable outcome could be achieved with early diagnosis and proper interventions

Assessment of utilization and outcomes of drotrecogin alpha [activated] for critically ill patients with sepsis at a government acute care hospital: a retrospective study

Several quality improvement projects have documented the positive outcome of protocol-driven sepsis care. Drotrecogin Alpha Activated [DAA] [recombinant human activated protein C] has been advocated and used in the treatment of septic shock in suitable patients. The primary objective of this retrospective study was to evaluate the utilization of DAA guidelines at our institution, and the financial impact of inappropriate use of this agent due to any cause. The secondary objectives were to assess outcome in terms of mortality at 28-days and the incidence of serious bleeding events during the infusion. A retrospective analysis using electronic database for patients who received DAA from June 2008 until April 2011 was conducted at our 20-bed intensive care unit [ICU] at a government hospital as a part of continued Medication-Use Evaluation [MUE] process. Among the 41 patients who received DAA, the indication was appropriate for 32 [78%]. For those patients, the mean score for the Acute Physiology And Chronic Health Evaluation-II [APACHE II] was 27 +/- 4 and the mean number of dysfunctional organs was 3 +/- 0.5. The 28-day mortality was 56% [23/41]. Of the patients who died, 39% [9/23] had poor prognosis thus were not eligible for DAA. The APACHE II score was higher than 25 in 93% [38/41] of patients. The other 3 patients had an APACHE II score of less than 25 [7%]. Inappropriate use of DAA occurred in 8 [20%] and totaled 385 mg at a cost of $25755. The rate of serious bleeding during the infusion was 10% [4/41]. The results showed that DAA protocol was not strictly followed at our institution, which had a huge financial burden. Mortality and bleeding rates were higher than those reported by randomized clinical trials, but due to the study design, results need further validation

Delayed administration of antivenin three days after snakebite saves a life

Snakebites can be deadly if not treated quickly. Some snake venoms contain hemotoxins that can result in widespread bleeding, disseminated intravascular coagulation [DIC] and a rapid death. This can be prevented by giving antivenom within hours, if not immediately. We report a case of a patient, who continued to deteriorate after 24 hours of envenomation, developed DIC and compartment syndrome within hours of the bite, in spite of the earlier treatment with polyvalent snake antivenin [PSA [Equine]]. The patient was then given a second dose of PSA [Equine] three days after envenomation which resulted correction of coagulopathy and complete improvement of the local symptoms

Acute kidney injury in patients with H1N1 admitted to ICU: Incidence, patient and renal outcomes. a multi-center perspective

Acute kidney injury [AKI] is a commonly sequel of sepsis associated with critical illness; hence, it could be anticipated to occur in H1N1 infected patients who suffer a rapidly progressive course complicated by multi-organ failure. To evaluate the rate of AKI in patients admitted to ICU with H1N1 and their outcome. We retrospectively reviewed the files of 24 consecutive patients admitted to ICU with H1N1 infection between June 1st and December 31st 2009. Signs of AKI, relevant co-morbidities and co-infections as well as outcome measures were collected. H1N1 infection was confirmed with PCR level measurements. Out of 523 patients, who presented with confirmed H1N1 infection during the study period, 24 [4.6%] were admitted to ICU. Thirteen [54%] had AKI of which 4 were previously known to have chronic renal disease, 11 had acute respiratory distress syndrome [ARDS], and 5 required hemodialysis. Four out of the 13 patients with AKI died, 5 recovered completely, 3 had partial recovery and one remained dependent on hemodialysis. Our results indicate that varying degrees of AKI occur in more than half of H1N1 patients admitted to ICU. This represents a serious complication predicting worsened outcome. Though the mortality rate was high, the majority of patients recovered partially or completely with early aggressive treatment