ABSTRACT
INTRODUCTION: Tension pneumoperitoneum is a severe and rare form of pneumoperitoneum with concomitant hemodynamic instability and respiratory failure. It is a variant of abdominal compartment syndrome (ACS) causing an abrupt increase in intra-abdominal pressure. PRESENTATION OF CASE: We present a case of pneumoperitoneum, after an endoscopic mucosal resection with the development of ACS. The patient was successfully treated with percutaneous decompression. DISCUSSION: Decompressive laparotomy is the first treatment option for both most forms of pneumoperitoneum and ACS; nevertheless, this issue is controversial. Recent reports have shown that some patients may be candidates for a minimally invasive catheter decompression avoiding major decompressive surgery. Identifying these patients is vital to avoiding unnecessary surgeries. CONCLUSIONS: Tension pneumoperitoneum is a life-threatening event, early detection and intervention is critical in order to provide prompt and optimal treatment approaches.
ABSTRACT
Acid-base status is frequently assessed in severe sepsis and septic shock. Venous blood gas sampling is proposed as a less-invasive modality but lacks evidence within this population. The objective of this study was to evaluate the correlation and agreement between arterial blood gas (ABG), peripheral venous blood gas (pVBG), and central venous blood gas (cVBG) in severe sepsis and septic shock. We conducted a prospective, observational cohort study in subjects admitted to the medical intensive care unit. Simultaneous blood gas samples, including ABG, pVBG, and cVBG, were analyzed for correlation and agreement. Severity of illness scores revealed a mean (±SD) Sequential Organ Failure Assessment score of 7.9 ± 3.3, Simplified Acute Physiology II score of 49.3 ± 16.5, and a mortality rate of 11.9% in the intensive care unit and 16.4% in the hospital. We found a strong intraclass correlation (>0.85) for pH, partial pressure of carbon dioxide (pCO2), bicarbonate, and base excess for ABG/pVBG, ABG/cVBG, and pVBG/cVBG comparisons. Agreement by the Bland-Altman method was found for pH (bias ± SD, 0.03 ± 0.04, 0.03 ± 0.02, and 0.00 ± 0.03) but not for pCO2, partial pressure of oxygen, bicarbonate, base excess, and oxyhemoglobin saturation. In conclusion, adequate correlation and agreement between ABG/pVBG, ABG/cVBG, and pVBG/cVBG comparisons was found only for pH. The current level of evidence does not support the use of venous blood gas sampling in this setting.
ABSTRACT
BACKGROUND: Despite advances in medical therapies, pleural infections remain a common disease. The characteristics of this disease seem to change over time, with alterations in patient characteristics and bacteriology. The purpose of this study was to provide a retrospective descriptive analysis of pleural infections during a 9-year period. METHODS: We performed a single-center retrospective review of all culture-positive pleural infections between January 2000 and December 2008. The primary outcome was assessment of long-term survival and associated independent risk factors affecting survival. Length of survival was determined using the Social Security Death Index. Case characteristics and bacteriology were reviewed for descriptive analysis. RESULTS: During a 9-year period, 187 culture-positive pleural infections were identified. Review of bacteriology revealed gram-positive cocci as the predominate organisms, most commonly Streptococcus and Staphylococcus. Anaerobes were found in 9.1% of the cases. Independent risk factors associated with risk of death based on multivariable survival analysis were age older than 65, cirrhosis and past and present malignancy. The hospital mortality was 10.7%, and the 1-year, 3-year and 5-year estimated survival rates were 73.8%, 63.3% and 60.6%, respectively. CONCLUSIONS: Pleural infections continue to remain a major health problem and carry significant morbidly and mortality. The importance of Staphylococcus aureus in this population has yet to be fully examined, and although potentially underestimated in this study, anaerobic infections remain a common pathogen.
