[Unusual complication of noninvasive ventilation: The œsogastric pneumatosis associated with a subcutaneous emphysema]. / Complication inhabituelle de la ventilation non invasive : la pneumatose œsogastrique associée à un emphysème sous-cutané

The non-invasive ventilation (NIV) is a technique of ventilator support to avoid endotracheal intubation and its potential complications. However, it has some complications that are usually harmless to type of erythema and/or cutaneous ulcerations, mouth or nose dryness, conjunctival irritation and rarely lesions of barotrauma, volotrauma or gastric insufflation with nausea and vomiting. We report the case of a patient who had an unusual complication of NIV: sub mucosa gastro-esophageal pneumatosis associated with subcutaneous emphysema occurring on the second day after one hepatectomy which was settled but complicated with a postoperative pulmonary aspiration syndrome.

[Systemic candidiasis in medical intensive care unit: analysis of risk factors and the contribution of colonization index]. / Les candidoses systémiques en réanimation médicale : analyse des facteurs de risque et intérêt de l'index de colonisation.

OBJECTIVES: Description of the epidemiological and clinical characteristics of the patients introducing risk factors of invasive candidiasis. Analysis of risk factors for candidiasis invasive and evaluation of the contribution of colonization index (CI) in the diagnosis of the systematic candidiasis in medical intensive care. PATIENTS AND METHODS: Prospective observational study (October 2007 to October 2009). The selected patients present risk factors of system IC candidiasis with an infectious syndrome or clinical signs suggestive of Candida infection and hospitalized more than 48 hours in medical intensive care unit. Pittet's colonization index was calculated at admission and then once a week added to a blood culture. Patients were classified according to level of evidence of Candida infection and the degree of colonization (CI<0.5, CI ≥ 0.5). RESULTS: The study included 100 patients. Mean age of our patients was 55.8 ± 18.2 years with male prevalence. Neurological disease was the most frequent pathology in admission (48%). The most common risk factors were broad-spectrum antibiotics and foreign material. In the various mycology IC specimens, Candida albicans was the most frequent, followed by C. tropicalis, then C. glabrata. The CI was greater than or equal to 0.5 at 53% of the patients, and less than 0.5 in 47% of the cases. Among the patients, 15% developed an invasive candidiasis. In multivariate analysis, the corticosteroid therapy was associated with a high colonisation (IC ≥ 0.5) and neutropenia with a high risk of systemic candidiasis. The positive predictive value of CI was 26%. The negative predictive value was 98%, the sensitivity and specificity was 93% and 48% respectively. CONCLUSION: CI has the advantage to provide a quantified data of the patient's situation in relation to the colonization. But, it isn't helpful with patients having an invasive candidiasis in medical intensive care unit.

[Unilateral bronchospasm during general anesthesia]. / Le bronchospasme unilatéral lors d'une anesthésie générale.

We report a case of unilateral bronchospasm encountered following an induction of anesthesia of healthy young man with no significant past medical or surgical history. The differential diagnosis and management are discussed. Unilateral bronchospasm was probably caused by topical lidocaine injected with a Laryngojet injector at the vocal cords.

[Acute respiratory distress syndrome secondary to influenza A (H1N1) infection: a report of a case]. / Le syndrome de détresse respiratoire aiguë secondaire à une infection par le virus de la grippe A (H1N1) : à propos d'un cas.

Through a clinical case of acute respiratory distress syndrome after infection with influenza virus H1N1 and a review of the literature the authors discuss treatment options, prognostic factors and the problems raised in support this pathology in Moroccan center.

[Central venous catheter-related bacteraemia: prospective study in a Moroccan medical intensive care unit]. / Bactériémies liées aux cathéters veineux centraux : étude prospective dans une unité de réanimation médicale marocaine.

OBJECTIVE: to determine the incidence of catheter-related bacteremia (CRB) in a Moroccan medical intensive care unit, the microbiological profile of this infection and risk factors associated with its occurrence. STUDY DESIGN: Prospective observational study. METHODS: over a period of 8 months, patients who required central venous catheter (CVC) placement for a duration greater than 48 h were included in the study. The CRB has been defined by the criteria of the SRLF Consensus Conference. The proportions of colonization and CRB were expressed as incidence density (ID). Risk factors for colonization were studied in univariate analysis. RESULTS: one hundred and two CVC were inserted in 70 patients. The average age was 54 ± 20 years with an APACHE II of 28 ± 10. The ID of colonization and CRB were respectively 34 for 1000 days of CVC use and 8 for 1000 days of CVC use. The isolated microorganisms were Gram-negative bacilli in 73 %, Gram-positive cocci in 22 % and finally yeast in 5 %. A prolonged duration of catheterization and the absence of systemic antibiotic therapy before catheterization were the main risk factors for colonization. CONCLUSION: the incidence of CRB was high. These results impose a reflection of the care team to improve protocols for prevention of such nosocomial infections.

Severe amlodipine intoxication treated by hyperinsulinemia euglycemia therapy.

The objective of this study was to report a use of hyperinsulinemia euglycemia therapy in severe amlodipine intoxication. Intoxication with 420 mg of amlodipine caused severe hypotension in a 20-year-old female patient. The patient was initially treated with fluids, calcium gluconate, and epinephrine without effect. She was then given hyperinsulinemia euglycemia therapy. We observed a rise in blood pressure (BP) approximately 30 min after insulin was given and the BP was subsequently responsive to epinephrine. The patient was weaned from pressors 5 h after insulin therapy. The trachea was extubated 24 h after ingesting amlodipine, and the patient was transferred for psychiatric treatment 3 days later. This possible positive inotropic effect of insulin therapy in patients with calcium channel blocker intoxication supports previous findings. It is suggested that hyperinsulinemia euglycemia therapy may be considered as a first-line therapy in amlodipine intoxication.

[Timing of tracheostomy and outcome of patients requiring mechanical ventilation]. / Délai de la trachéotomie et devenir des patients sous ventilation mécanique.

OBJECTIVES: To assess the impact of tracheostomy timing on outcome of critically ill patients requiring mechanical ventilation (MV). STUDY DESIGN: Retrospective clinical study in a twelve beds intensive care unit (ICU). PATIENTS AND METHODS: From January 2001 to June 2005, patients under MV who received tracheostomy were divided into 2 groups: early tracheostomy group when tracheostomy was performed before or on day 7 and late tracheostomy group when it was performed thereafter. We compared prevalence of nosocomial pneumonia, length of sedation, lengths of MV, length of stay in ICU, weaning from MV and mortality rates between the 2 groups. RESULTS: During this period of 4 years and half, 112 patients underwent tracheostomy, 62 of whom had early tracheostomy and 50 had late tracheostomy. Early tracheostomy was associated with significant reduction of length of sedation (10+/-3 vs 17+/-5 days, P<0.001), length of MV (21+/-19 vs 29+/-17 days, P=0.02) and length of stay in ICU (33+/-22 vs 42+/-18 days, P=0.042). There were no differences in prevalence of pneumonia (21% for early tracheostomy group vs 31% for late tracheostomy group, P=0, 13), weaning from MV (50 vs 36%, P=0.19), and mortality rates between the 2 groups (38 vs 54%, P=0.15). CONCLUSION: This study demonstrated that early tracheostomy (< or =7 days), was associated with shorter length of sedation, shorter duration of MV and shorter ICU length of stay, without affecting weaning from MV, prevalence of nosocomial pneumonia or survival.

[Postoperative meningitis caused by an unusual etiological agent: Salmonella enteritidis]. / Salmonella enteritidis: une cause inhabituelle de méningite post-opératoire.

Salmonella intracranial infections are unusual in adults, and particularly after neurosurgical procedures. We report a case of post-operative meningitis owing to Salmonella enteritidis. A 72-year-old man with type 2 diabetes was admitted to our unit for postoperative evaluation and management after neoplasic intracranial surgery. On the third day of admission, the patient developed infectious signs and diagnosis of postoperative meningitis was evoked. The cultivation of cerebrospinal fluid revealed Salmonella enteritidis which was also identified in several blood cultures. The treatment consisted of third-generation cephalosporin and quinolone to which Salmonella enteritidis was susceptible. However, the clinical course was poor and the patient died on day 8. This case demonstrates that postoperative meningitis can be caused by an unusual agent like Salmonella enteritidis.

[Management of hepatic injuries with multiple trauma in the emergency unit. Report of three cases]. / Prise en charge des lesions hepatiques chez le polytraumatise au service des urgences. A propos de trois cas.

The problems put by the blunt hepatic injuries at the multiple traumas are discussed after the exposition of three observations. 60% of the blunt hepatic injuries are due to the accidents of the public way. The strategy diagnosis and therapeutic facing a hepatic lesion remains guided by the patient's state haemodynamic. The exam essential to the arrival in the sieve of the emergencies is the abdominal scan that searches for one extrusion intra and possibly retroperitoneal and analyze the hepatic parenchyrma. However, it depends extensively on the experience of the echographist. The city scan stood to the first plan of the medical imagery: it permits a precise diagnosis of the parenchymateuses hepatic lesions, specify the abundance of the hemoperitoine, facilitate the therapeutic conduct in presence of associated lesions and the surveillance of the blunt hepatic injuries.