Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco) / Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country)

Objetivos: Comparar la tasa de mortalidad a 30 días en pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 vs. FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso(1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad. Nivel de evidencia: Estudio nivel III.(AU)

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-Day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. Level of evidence: Level III study.(AU)

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country) / Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco)

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-Day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.(AU)

Objetivos: Comparar la tasa de mortalidad a 30 días en pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 vs. FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso(1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad. Nivel de evidencia: Estudio nivel III.(AU)

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country). / [Artículo traducido] Mortalidad a 30 días en pacientes con fractura de fémur proximal durante la pandemia COVID-19 en Vizcaya (País Vasco).

OBJECTIVES: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. DESIGN: Retrospective comparative study. SETTING: Three university hospitals in Biscay province (Basque Country, Spain). PATIENTS: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). INTERVENTION: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. MAIN OUTCOME MEASUREMENTS: 30-Day mortality rate and risk factors for mortality. RESULTS: Of a total 77 patients, 10 were diagnosed with SARS-CoV-2 infection. Mean age was 85 years. Patients with SARS-CoV-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥ 91 years-old, ASA class IV and BMI > 25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. CONCLUSIONS: SARS-CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality. LEVEL OF EVIDENCE: Level III study.

Thirty-day mortality in patients with a proximal femur fracture during the COVID-19 pandemic in Biscay (Basque Country).

Objectives: Compare 30-day mortality rate following a proximal femur fracture (PFF) and SARS-CoV-2 infection versus a PFF and no SARS-CoV-2 infection. Design: Retrospective comparative study. Setting: Three university hospitals in Biscay province (Basque Country, Spain). Patients: 77 patients over 65 years-old with PFF (AO 31-A and 31-B). Intervention: Study conducted between 9 March and 15 April 2020. The COVID-19 group included only patients with SARS-CoV-2 infection, confirmed by a positive RT-PCR test. Main outcome measurements: 30-day mortality rate and risk factors for mortality. Results: Of a total 77 patients, 10 were diagnosed with SARS CoV-2 infection. Mean age was 85 years. Patients with SARS-Cov-2 infection had higher BMI (29.53 kg/m2) compared to patients without infection (24.09 kg/m2) (p = 0.001). No significant differences were found between both groups in terms of the Charlson Comorbidity Index, ASA score, use of oral anticoagulants or presence of cognitive impairment. Seven of the 10 patients in the COVID-19 group developed (viral) pneumonia, as compared to one single case (1/67) of (bacterial) pneumonia in the control group (p < 0.001). Thirty-days mortality was higher (p = 0.03) in COVID-19 patients (40%) than in those in the control group (11.9%). In the multivariate analysis, age ≥91 years-old, ASA class IV and BMI >25 kg/m2 were significant predictors of 30-day mortality. All deaths in the COVID-19 group occurred while the patients were hospitalized. Conclusions: SARS CoV-2 infection in patients with a PFF was seen to result in higher rates of early mortality, with COVID-19-related pneumonia being the leading direct cause of mortality.

Objetivos: Comparar la tasa de mortalidad a 30 días en los pacientes con fractura de fémur proximal (FFP) y coinfección por SARS-CoV-2 frente a FFP sin coinfección. Diseño: Estudio retrospectivo comparativo. Escenario: Tres hospitales universitarios en Vizcaya (País Vasco, España). Pacientes: Setenta y siete pacientes mayores de 65 años con FFP (AO 31-A y 31-B). Intervención: Entre el 9 de marzo y el 15 de abril de 2020. El grupo COVID-19 incluía pacientes con infección confirmada mediante el test PCR-RT. Medidas de resultados principales: Tasa de mortalidad a 30 días y factores de riesgo de mortalidad. Resultados: Diez de los 77 pacientes presentaron coinfección por SARS-CoV-2. La edad media fue de 85 años. Los pacientes infectados presentaban un IMC mayor (29,53 kg/m2) frente a los no infectados (24,09 kg/m2) (p = 0,001). No hubo diferencias significativas en el índice de comorbilidad de Charlson, la puntuación ASA, el uso de anticoagulantes o el deterioro cognitivo. Siete pacientes del grupo COVID-19 (7/10) desarrollaron neumonía (vírica), frente a un solo caso (1/67) de neumonía (bacteriana) en el grupo control (p < 0,001). La mortalidad a 30 días fue mayor (p = 0,03) en los pacientes con COVID-19 (40%) que en el grupo control (11,9%). La edad ≥ 91 años, la clase IV ASA y el IMC > 25 kg/m2 fueron predictores significativos de mortalidad a 30 días. Todas las muertes en el grupo COVID-19 ocurrieron intrahospitalariamente. Conclusiones: La infección por SARS-CoV-2 en pacientes con PFF resultó en tasas más altas de mortalidad temprana, siendo la neumonía por COVID-19 la principal causa directa de mortalidad.Nivel de evidencia: Estudio nivel III.

Antibióticos y pancreatitis aguda grave en Medicina Intensiva. Estado actual. Recomendaciones de la 7.ª Conferencia de Consenso de la SEMICYUC / Antibiotics and severe acute pancreatitisin Intensive Medicine. Current status. Recommendations of the 7th ConsensusConference of the SEMICYUC

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[Ofuji's disease: description of a case]. / Enfermedad de Ofuji: descripción de un caso.

Eosinophilic pustular folliculitis (EPF) is a rare, chronic disease of unknown cause, characterized by itchy papules or pustules and an infiltration of eosinophiles in the biopsy. EPF occurs rarely outside Japan and very few cases have been described in non-Japanese race people. The causes of the disease and its definitive treatment have not yet been established. In our patient, the presence of subcorneal pustules in the biopsies initially favored a diagnosis of pustulosis and several biopsies were necessary before a diagnosis of EPF was reached. A new case of EPF recently presented at our clinic and we have carried out an extensive revision of the disease.

Enfermedad de Ofuji: descripción de un caso / Ofuji's disease: description of a case

La foliculitis pustulosa eosinofílica (FPE) es una enfermedad crónica, rara y de causa desconocida, que cursa con pápulas y/o pústulas pruriginosas y un infiltrado de eosinófilos en la biopsia. La FPE suele ocurrir con poca frecuencia fuera de Japón y son escasos los casos descritos en pacientes de raza no japonesa. Los factores causales de la enfermedad y su tratamiento definitivo no están establecidos todavía. En nuestra paciente, inicialmente, la presencia de pústulas subcorneales en las biopsias orientaba hacia un diagnóstico de dermatosis pustular; y fueron necesarias repetidas biopsias para obtener el diagnóstico de FPE. Presentamos un nuevo caso de FPE recientemente visto en nuestra consulta y hemos realizado una revisión extensa de la enfermedad

Eosinophilic pustular folliculitis (EPF) is a rare, chronic disease of unknown cause, characterized by itchy papules or pustules and an infiltration of eosinophiles in the biopsy. EPF occurs rarely outside Japan and very few cases have been described in non-Japanese race people. The causes of the disease and its definitive treatment have not yet been established. In our patient, the presence of subcorneal pustules in the biopsies initially favored a diagnosis of pustulosis and several biopsies were necessary before a diagnosis of EPF was reached. A new case of EPF recently presented at our clinic and we have carried out an extensive revision of the disease

Síndrome de Lemierre / Lemierre syndrome

La sepsis postanginal o síndrome de Lemierre es una enfermedad rara en nuestros tiempos que ocurre después de una infección orofaríngea y se manifiesta por una tromboflebitis séptica de la vena yugular interna e infecciones metastásicas. Es producida por microorganismos anaerobios, siendo el Fusobacterium necrophorum el más frecuente. Para su diagnóstico, a parte del aislamiento microbiológico del germen, son fundamentales las pruebas de imagen como la ecografía doppler y la tomografía axial computarizada (TAC). El tratamiento consiste en antibioterapia precoz, prolongada, a dosis altas y en ocasiones la excisión quirúrgica de las venas yugulares

Postanginal sepsis or Lemierre syndrome is a rare disease in our times that occurs after an oropharyngeal infection and is manifested by septic thrombophlebitis of the internal jugular vein and metastatic infections. It is produced by anaerobic germs, Fusobacterium necrophorum being the most frequent. Besides the microbiological isolation of the germ, image tests such as Doppler ultrasound and computed-tomography (CT) scan are fundamental for its diagnosis. Treatment consists in early, prolonged antibiotic treatment at high doses and sometimes surgical excision of the jugular veins. We present the case of an adolescent who had serious septic shock that evolved to multiorganic failure after being diagnosed of this syndrome. As a special finding, we discovered the presence of thrombosis in the left external jugular vein

Recomendaciones de la 7ª Conferencia de Consenso de la SEMICYUC. Pancreatitis aguda grave en Medicina Intensiva / Recommendations of the 7th consensus conference of the SEMICYUC. Severe acute pancreatitis in Intensive Medicine

Objetivo. La pancreatitis aguda grave (PAG) no se ha estudiado desde la Medicina Intensiva y menos su manejo integral. El objetivo es consensuar el diagnóstico y tratamiento en una UCI, con todas las Sociedades implicadas y ofrecer unas recomendaciones que uniformicen el manejo integral de las PAG. Ámbito. Español. Pamplona, 11 y 12 de marzo de 2004. Participantes. Intensivistas nacionales, gastroenterólogos de la Asociación Española de Gastroenterología (AEGE) y Club Español Biliopancreático (CEBP), cirujanos de la Asociación Española de Cirugía, Sección de Infección Quirúrgica (IQ-AEC), radiólogos de la Sociedad Española de Radiología Médica (SERAM), y Sección de Imagen Abdominal (SEDIA) y miembros de la Sociedad Española de Medicina de Urgencias y Emergencias (SEMES). Niveles de evidencia y grados de recomendación. Se eligieron las escalas del Oxford Centre for Evidence based Medicine. Elaboración de las recomendaciones. Se realizó una convocatoria pública en la que se discutieron todos los temas previamente seleccionados, que se distribuyeron en 4 bloques de preguntas: 1.ª ¿Diagnóstico, criterios precoces de gravedad y de ingreso de las PAG en UCI?. 2.ª ¿Cuáles son las medidas más relevantes y aplicables en el tratamiento del paciente con PAG en UCI?. 3.ª ¿Cuál es el tratamiento actual de la PAG?. 4.ª ¿Qué actitud quirúrgica se debe adoptar ante la PAG con necrosis no-infectada y la sepsis pancreática? Tras la discusión pública el Jurado elaboró un documento de recomendaciones. Este documento fue enviado para su comentario a los miembros del Comité Organizador, a los ponentes y a los asistentes a la Conferencia de Consenso. Por último, las recomendaciones fueron de nuevo discutidas en una sesión pública y abierta en el Congreso Nacional de la SEMICYUC. Conclusiones. Recomendaciones en PAG entre las que destacamos: la disminución de la mortalidad de la PAG depende de la estratificación temprana de las formas graves a la puerta del hospital, durante las primeras 48-96 horas y del ingreso precoz en Intensivos. Los pacientes que muestran un progresivo deterioro orgánico, aunque no precisen soporte ventilatorio, deben ingresar en UCI. Cada Centro debe consensuar un protocolo interdisciplinario. Los antibióticos como profilaxis no tienen una base de evidencia potente sólo estarían indicados en las formas necrotizantes y a la espera de un nuevo ensayo doble-ciego con meropenem en marcha. El tratamiento quirúrgico se indica en la necrosis pancreática infectada o absceso identificadas por radiología o punción radiodirigida. El manejo de las formas estériles debe ser conservador

Objective. Severe acute pancreatitis (SAP) has not been studied from the point of view of Intensive Medicine and even less its integral management. The objective is to reach a consensus on the diagnosis and treatment in an ICU with all the societies involved and to offer some recommendations that make the integral management of SAP uniform. Scope. Spanish. He took place in Pamplona, the 11-12 March 2004. Participants. National Intensivists, Gastroenterologists of the Spanish Association of Gastroenterology (AEGE) and Biliopancreatic Spanish Club (CEBP), Surgeons of the Spanish Association of Surgery, Surgical Infection Section (IQ-AEC), Radiologists of the Spanish Society of Medical Radiology (SERAM), and Abdominal Image Section (SEDIA) as well as member of the Spanish Society of Urgency and Emergency Medicine (SEMES). Evidence levels and recommendation grades. The Oxford Centre for Evidence based Medicine scales were chosen. Elaboration of the recommendations. A public examination session was called in which all the previously selected subjects were discussed. They were distributed into 4 blocks of questions: 1) Diagnostic, Early Severity criteria and Admission of SAP in the ICU? 2) What are the most relevant and applicable measures in the treatment of the patients with SAP in the ICU? 3) What is the present treatment of SAP? 4) What surgical attitude should be adopted in the face of SAP with non-infected necrosis and pancreatic sepsis? After the public discussion, the Jury elaborated a recommendations document. This document was sent to the members of the Organizing Committee, to the speakers and those attending the consensus Conference for their comments. Finally, the recommendations were discussed again in a public and open session in the National Congress of SEMICYUC.Conclusions. Recommendations in SAP, among which we emphasize: Decrease in mortality of SAP depends on the early stratifying of the serious forms to the hospital door, during the first 48-96 hours and early admission in Intensive Care. Patient who have a progressive organic deterioration, although they do not require ventilatory support, should be admitted to the ICU. Each Center should agree on an interdisciplinary protocol. Antibiotics as prophylaxis do not have a strong evidence base. They would only be indicated in necrotizing forms and while waiting for a new on-going double blind clinical trial with meropenem. Surgical treatment is indicated in infected pancreatic necrosis or abscess, identified by radiology or radioguided puncture. Management of the sterile forms should be conservative

Neumonía grave por varicela / Severe chickenpox pneumonia

Objetivo. Estudio retrospectivo de los datos epidemiológicos, clínicos, diagnósticos y terapéuticos de los pacientes adultos con neumonía por varicela que precisaron ingreso en la Unidad de Medicina Intensiva (UMI) en los últimos 10 años. Material y métodos. El diagnóstico se estableció por criterios clinicorradiológicos en el curso de una varicela. Se valoraron datos como enfermedades de base, embarazo, hábito tabáquico, datos analíticos, evolución a síndrome de distrés respiratorio del adulto (SDRA), necesidad de ventilación mecánica y tratamiento farmacológico. Resultados. Se estudiaron 8 pacientes (7 mujeres y 1 hombre) con una edad media de 30 años (rango: 25-38). Sólo uno de los pacientes presentaba patología subyacente (hepatitis B crónica y alcoholismo) y otra estaba embarazada de 24 semanas. Todos eran fumadores. Los síntomas respiratorios aparecieron entre el segundo y cuarto día de iniciarse el exantema. Todos presentaron disnea y en 7 de ellos se asoció tos seca. La radiografía de tórax al ingreso presentaba en todos los pacientes un infiltrado intersticial de predominio bibasal. En 7 de los 8 casos se observó menos de 150.000 plaquetas/mm3, en 5 aumento de transaminasas y en todos elevación de la deshidrogenasa láctica (LDH). En 6 pacientes se objetivó hipoxemia (PaO2 < 60 mmHg), precisando 3 de ellos intubación orotraqueal y ventilación mecánica. Estos 3 pacientes evolucionaron a SDRA. Todos los casos estudiados fueron tratados con aciclovir intravenoso. No falleció ninguno de los pacientes ingresados. Conclusiones. La neumonía por varicela es una complicación grave que puede precisar ingreso en UMI. La gravedad de la enfermedad puede variar desde anormalidades radiológicas asintomáticas hasta SDRA. La mortalidad es alta, pero está disminuyendo en los últimos años probablemente debido al tratamiento antivírico precoz y a las adecuadas medidas de soporte (AU)

[Severe chickenpox pneumonia]. / Neumonía grave por varicela.

OBJECTIVE: Retrospective study of the epidemiological, clinical, diagnostic and therapeutic data corresponding to adult patients with chickenpox pneumonia that needed admission in the Intensive Care Unit (ICU) in the last 10 years. MATERIAL AND METHODS: The diagnosis was established through clinicoradiological criteria along the chickenpox progress. Assessed parameters are underlying diseases, pregnancy, smoking habits, analytical data, progress toward adult respiratory distress syndrome (ARDS), need for mechanical ventilation, and pharmacological treatment. RESULTS: They were studied 8 patients (7 women and 1 man) with an average age of 30 years (range: 25-38). Only one of the patients showed underlying pathology (chronic B hepatitis and alcoholism), and another patient was pregnant with 24 weeks of gestation. All of them were smokers. The respiratory symptoms appeared between the second and fourth day from the onset of the exanthema. All the patients showed dyspnea and in seven of them it was associated to dry cough. The chest x-ray at the time of the admission showed in all the patients a bilateral interstitial infiltrate of basal predominance. In 7 of the 8 cases less than 150,000 platelets/mm3 were observed, in 5 patients an increase of transaminases was detected, and all the patients showed elevation of LDH. In 6 patients hypoxemia (PaO2<60 mmHg) was detected with need in 3 of them of orotracheal intubation and mechanical ventilation. These 3 patients progressed toward ARDS. All the cases studied were treated with intravenous aciclovir. None of the hospitalized patients died. CONCLUSIONS: Chickenpox pneumonia is a serious complication that can force hospitalization in the ICU. The severity of the disease can range from the observation of asymptomatic radiological alterations up to ARDS. Mortality is high, but is probably declining in recent years due to the early antiviral treatment and to the application of appropriate support measures.