Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin.

Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis.

Persevering With Prone Ventilation in Coronavirus Disease 2019 Pneumonia.

As well as placing unprecedented demands on resources and staff involved in the care of these patients, there has been significant uncertainty regarding the optimal management of patients with coronavirus disease 2019 pneumonia. Randomized controlled trials have shown clear benefits of both neuromuscular blockade and prone positioning in treating moderate to severe acute respiratory distress syndrome, as defined by the Berlin Criteria. CASE SUMMARY: We present a case of a 53-year-old patient with a severe coronavirus disease 2019 pneumonia who has made a remarkable recovery following a turbulent period on intensive care. During his stay, he was prone positioned on 16 consecutive occasions and is an exemplar of the many patients we treated who benefited considerably from this intervention. CONCLUSION: We believe that sustained administration of prone position ventilation was instrumental in saving his life. While there is associated morbidity, we encourage clinicians to continue with this strategy beyond their normal practice.