RESUMO
INTRODUCTION: We report a case of a previously healthy adult with flulike symptoms who precipitously declined due to pneumococcal sepsis complicated by disseminated intravascular coagulation (DIC) and purpura fulminans (PF). After one week of care, including ventilation support and hemodialysis, the patient was stable enough for hyperbaric oxygen (HBO2) in an attempt to salvage his threatened extremities. HBO2 resulted in reduction of ischemic tissue and demarcation of blackened tissue to the distal digits. We feel that much at-risk tissue has been spared by HBO2 as an adjunctive therapy. METHODS: Literature on the use of hyperbaric oxygen for purpura fulminans was reviewed for precipitating issues, time to treatment, protocol, other adjuncts and outcomes. RESULTS: Fifteen papers were identified representing 19 cases of PF treated with HBO2. No controlled studies exist. HBO2 was believed to be of value in most cases; the improvement was associated with timeliness and aggressiveness of initiating HBO2. CONCLUSIONS: PF is a fulminant disorder with high mortality and morbidity. Hyperbaric oxygen appears to be useful for the management of PF complications, imposing minimal side effects or complications. Aggressive therapy should be started as soon as it is safe to transfer the patient to a facility for HBO2 treatments.
Assuntos
Oxigenoterapia Hiperbárica/métodos , Púrpura Fulminante/terapia , Adulto , Terapia Combinada , Coagulação Intravascular Disseminada/complicações , Humanos , Oxigenoterapia Hiperbárica/efeitos adversos , Masculino , Infecções Pneumocócicas/complicações , Púrpura Fulminante/complicações , Púrpura Fulminante/patologia , Infecções Respiratórias/complicações , Resultado do TratamentoRESUMO
APACHE (Acute Physiology and Chronic Health Evaluation) mortality predictions and other outcomes are reported after the initiation of a telemedicine intensivist staffing program to monitor the intensive care unit patients of a rural health system. Mortality, length of ICU stay, and length of hospital stay were significantly less than predicted. Length of stay was identical to one year previously in the largest hospital reported, but the case mix index of severity had increased. More severely ill patients were being treated without increase in length of stay.
