Acute bacterial endocarditis: a silent source of sepsis in the burn patient.

In the past six years, 35 patients with thermal injuries have died with a diagnosis of endocarditis. The cause of death in 21 of the 22 patients with acute bacterial endocarditis (ABE) was directly related to complications arising from the ongoing sepsis. In only three cases was the diagnosis considered pre-mortem. The endocarditis was located in the right heart in 18, left heart in 9, and both sides in 8 cases. Associated venous thrombi were present in 14 instances, and 10 of these were septic thrombi. Staphylococcus was the primary organism in the blood in 17 of 22 patients with ABE. Clinically audible murmurs were present in only two patients. In no instance was ABE superimposed upon previously existing valvular disease. ABE can serve as a silent source of sepsis in the burn patient. The diagnosis should be suspected with persistantly positive blood cultures, especially for Staphylococcus aureus, in any burn patient in whom no other foci of sepsis can be identified. Vigorous methods of diagnosis and specific treatment are recommended.

Late pulmonary function in survivors of adult respiratory distress syndrome.

Early recognition and improvements in treatment have brought an appreciable decline in mortality from the adult respiratory distress syndrome. Physiologic changes during the acute illness include restriction of lung volumes and a defect in gas transfer. Until recently, pulmonary function of long-term survivors has not been discussed. This report concerns the pulmonary function of two patients studied 19 and 22 months, respectively, after surviving an episode. No residual changes in lung volume or compliance were found. A mild decrease in diffusing capacity was noted, and alveolar-arterial oxygen gradients were at the upper limit of normal in both.