Femoral Neuropathy Following Spontaneous Retroperitoneal Hemorrhage After Cardiac Surgery: A Case Report.

A woman underwent ascending aortic aneurysm repair, aortic root and valve replacement, and coronary artery bypass grafting. Her postoperative course was complicated by stroke and status epilepticus. With supportive care and antiepileptics, her neurologic status improved. Intravenous heparin and aspirin were initiated. On postoperative day 13, she developed a large retroperitoneal hematoma with femoral neuropathy. Because her hematoma was not amenable to percutaneous drainage or surgical evacuation, and considering her comorbidities, a conservative approach was elected. Anticoagulation was held but not reversed, and she was transfused. Her impairment resolved fully after 3 days, and anticoagulation was restarted in staggered fashion.

Progression of organ failure in patients approaching brain stem death.

We performed a retrospective cohort study to document the progression of organ dysfunction in 182 critically ill adult patients who subsequently met criteria for brain stem death (BSD). Patients were admitted to intensive care units (ICUs) of Mayo Medical Center, Rochester, MN, between January 1996 and December 2006. Daily sequential organ failure assessment (SOFA) scores were used to assess the degree of organ dysfunction. Serial SOFA scores were analyzed using analysis of variance (ANOVA). Mean (standard deviation, SD) SOFA score on the first ICU day was 8.9 (3.2). SOFA scores did not significantly change over the course of ICU stay. 67.6% of patients donated one or more organs after BSD was declared. The median time from ICU admission to declaration of BSD was 18.8 h (interquartile range 10.3-45.0), and in those who donated organs, the time from declaration of BSD to organ retrieval was 11.8 h (9.5-17.6). The fact that mean SOFA scores did not change significantly over time, even after BSD occurred, has implications for the timing of retrieval of organs for transplantation.