ABSTRACT
Lesions caused by prolonged intubation and tracheostomy when performed in critically ill patients to keep the airways opened are a permanent topic of discussion between intensive care professionals and otolaryngologists. We present a prospective study of such complications following the guidelines elaborated by the intensive care unit and the otolaryngology department of our hospital. The outcomes obtained in the first-year follow up allow us to verify a high incidence of such lesions in the initial period (87%) and a markedly decreased frequency in the following twelve months (17%). Results also show the relation between prolonged intubation and the appearance of laryngotracheal lesions. We conclude that it is very important to reduce the intubation period by performing an earlier tracheostomy.
Subject(s)
Intubation, Intratracheal/adverse effects , Larynx/physiopathology , Time Factors , Trachea/physiopathology , Tracheotomy/adverse effects , Adult , Aged , Female , Follow-Up Studies , Guidelines as Topic , Humans , Male , Middle Aged , Prognosis , Prospective StudiesABSTRACT
The risk of being infected by candidiasis in an Intensive Care Unit (ICU) is evaluated, using an algorithm which allows the establishment of an early fungicidal treatment. This is a study which includes 34 patients with a mortality of 35%. Yeasts are detected from the second week at ICU, related with the long stay of patients at ICU and the relationship between mortality and age. The first positive sample usually does not indicate disseminate candidiasis (9%) or a positive blood culture (6%). Population defined as high risk for disseminated candidiasis (HRDC) with a negative blood culture has the worst prognosis (18 cases, 50% mortality rate). The six cases with HRDC with positive blood culture showed a mortality of 17%. In seven cases there were no HRDC criteria (mortality of 14%). With said study the existence or not of a HRDC could be determined, establishing the adequate antifungal treatment.
Subject(s)
Algorithms , Candidiasis , Adolescent , Adult , Aged , Aged, 80 and over , Candidiasis/classification , Candidiasis/microbiology , Candidiasis/mortality , Female , Humans , Intensive Care Units , Male , Middle Aged , Prospective Studies , Risk FactorsABSTRACT
It is discussed the case of cerebral paludism due to Plasmodium falciparum in a patient who travelled frequently to Ivory Coast and who had done an incorrect prophylaxis of paludism. It is underlined the relationship of cerebral presentation with the presence of multisystemic failure, which was characterized by respiratory distress, hyperdynamic shock, acute renal failure and hematological and digestive disorders. Shock forced the administration of vasoactive drugs (such as dopamine, dobutamine and methoxamine), respiratory failure to establish mechanical ventilation and coagulation disorders to transfuse platelets and plasma. Clinical evolution was favorable in few days thanks to an early symptomatic and etiology therapy.
Subject(s)
Malaria, Cerebral/diagnosis , Multiple Organ Failure/diagnosis , Blood Coagulation Disorders/diagnosis , Blood Coagulation Disorders/etiology , Cote d'Ivoire , Humans , Malaria, Cerebral/complications , Male , Middle Aged , Multiple Organ Failure/etiology , Renal Insufficiency/diagnosis , Renal Insufficiency/etiology , Respiratory Distress Syndrome/drug therapy , Respiratory Distress Syndrome/etiology , Shock/diagnosis , Shock/etiology , TravelSubject(s)
Carotid Sinus , Massage , Adult , Carotid Artery Diseases/therapy , Humans , Male , SyndromeABSTRACT
We report a suicide attempt with lithium, chlorpromazine and flunitrazepam. In case of intoxication, renal excretion of lithium can be facilitated with forced diuresis by the administration of large volumes of saline solution, peritoneal dialysis or hemodialysis. In the case of our patient, treatment with saline solution was not effective, so continuous arteriovenous hemofiltration (CAVH) was performed achieving a decrease in serum lithium and obtaining a prompt clinical improvement. No secondary effects or serum lithium rebound effect were observed. We have not found any previous record of the use of CAVH in the treatment of acute lithium intoxication.
Subject(s)
Hemofiltration , Lithium/poisoning , Acute Disease , Adult , Female , Humans , Lithium/blood , Suicide, AttemptedABSTRACT
Some inflammatory processes of the 9th cranial nerve may provoke disturbances of the autonomic nervous system, with parasympathetic irritation. A unilateral intracranial lesion or section of the glossopharyngeus may produce adverse reactions such as sinus tachycardia and transitory hypertension, due to a cut-off in physiological feedback. The two cases presented developed acute hypertension after either lesion or section of the 9th cranial nerve. In one case the hypertension was of a few days duration only, while the second was rather unusual in that it was sustained over a four-month period. The physiopathologic mechanisms are described as well as the favorable response to treatment with drugs. The hypothesis that arterial hypertension is caused by an over-stimulation of the beta-adrenergic system, in particular in its effect on cardiac output is, at least in part, supported by the favorable response to propranolol. In order to either confirm or discard this hypothesis, the measurement of cardiac output in successive patients after lesion or section of the glossopharyngeus is considered to be of special interest.
