[Prognosis of stroke patients undergoing intubation and mechanical ventilation]. / Prognosi dei pazienti con ictus sottoposti ad intubazione e ventilazione meccanica.

BACKGROUND: To determine the outcome of patients with acute stroke requiring intubation and mechanical ventilation. DESIGN: review of the medical records of 33 patients with stroke intubated at presentation in hospital and not requiring neurosurgery or angiography. SETTING: intensive care unit (ICU) of a non teaching hospital. INTERVENTIONS: none. MEASUREMENTS: the mean age (SD) was 73.3 (7.7), min 46 max 87, 18 males and 15 females, mean Glasgow coma scale (GCS) (min-max) was 4.5 (3-8). RESULTS: The hospital mortality of intubated patients was 78.7% (26/33), mortality in the ICU was 69.69% (23/33). In survivors: infarction/hemorrhage (INF/HEM) were 4/3, mean age (SD) 75.2 (5.6), males/females 4/3, mean GCS (min-max) 5.2 (3-7), days in the ICU mean (DS) 18 (20.2). In patients who died: INF/HEM were 10/16, mean age (SD) 72.8 (8.2), males/females 14/12, mean GCS (min-max) 4.3 (3-8), days in the ICU mean (DS) 5.5 (8). The difference between groups was significant (p < 0.05) only for ICU staying. The evolution to brain death was observed in 10 cases (30.3%). CONCLUSIONS: The overall prognosis of patients with acute stroke intubated and ventilated at presentation in hospital for deterioration is severe but the observed survival rate is sufficient to justify this treatment even in cases not requiring other invasive procedures like neurosurgery or angiography. A significant fraction of stroke patients is part of the potential organ donors pull.

[Multiple organ failure syndrome in infection caused by ictero-hemorragic Leptospira. Description of a clinical case]. / MOFS (multiple organs failure syndrome) in corso di infezione da Leptospira ittero-emorragica. Descrizione di un caso clinico.

A 53 years old fisherman was admitted to General Intensive Care Unit in Arezzo with signs and symptoms of Weil disease. An early acute respiratory failure developed. Radiological and haemodynamic findings confirmed a diagnosis of ARDS. The patient developed a severe jaundice, acute renal failure and ARDS (MOF multiple organs failure). To support different failures of the organs, CMV (continuous mandatory ventilation: CPPV with PEEP max 10 cm H2; IRV max 2:1) and AMV (assisted mandatory ventilation: Pressure Support Ventilation), haemofiltration, haemoperfusion and plasmapheresis were simultaneously used, that got better and better renal and respiratory performances. Haemodynamic worsening by PEEP during extracorporeal treatment was overcome by PSV very useful new ventilatory procedure even during weaning period. The patient treated in such manner survived without important disabilities. This care confirms that ARDS (non cardiogenic edema) and MOF can develop during Icterohaemorrhagic Leptospirosis.