Neostigmine resolves critical illness-related colonic ileus in intensive care patients with multiple organ failure – a prospective, double-blind, placebo-controlled trial

This case report details the progress of a patient with severe disseminated gonococcal infection with associated necrotising fasciitis. His admission was punctuated by multiple surgical debridements and a prolonged intensive care stay due to multiple organ failure. An extended course of azithromycin-based antimicrobial therapy achieved a cure and the patient was eventually discharged home after 8 weeks. To our knowledge this is the first such case of histologically and microbiologically confirmed gonococcal necrotising fasciitis.

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Rehabilitation Results of Patients with Multiple Injuries and Multiple Organ Failure and Long-term Intensive Care

The Journal of Trauma: Injury, Infection, and Critical Care ◽

10.1097/00005373-199705000-00024 ◽

1997 ◽

Vol 42 (5) ◽

pp. 919-926 ◽

Cited By ~ 28

Author(s):

M. Grotz ◽

A. Hohensee ◽

D. Remmers ◽

T. O. F. Wagner ◽

G. Regel

Keyword(s):

Intensive Care ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ ◽

Multiple Injuries

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Efficiency of substitutive renal therapy in the complex intensive care of multiple organ failure in patients with polytrauma

Critical Care ◽

10.1186/cc12367 ◽

2013 ◽

Vol 17 (S2) ◽

Author(s):

S Kravtsov ◽

A Shatalin ◽

V Agadzhanyan ◽

D Skopintsev

Keyword(s):

Intensive Care ◽

Multiple Organ Failure ◽

Organ Failure ◽

Multiple Organ

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Severe form of hemolytic-uremic syndrome with multiple organ failure in a child: a case report

F1000Research ◽

10.12688/f1000research.2546.1 ◽

2014 ◽

Vol 3 ◽

pp. 79

Author(s):

Dino Mijatovic ◽

Ana Blagaic ◽

Zeljko Zupan

Keyword(s):

Intensive Care Unit ◽

Renal Failure ◽

Acute Renal Failure ◽

Intensive Care ◽

Multiple Organ Failure ◽

Hemolytic Uremic Syndrome ◽

Organ Failure ◽

Hemolytic Anemia ◽

Multiple Organ ◽

Uremic Syndrome

Introduction: Hemolytic-uremic syndrome (HUS) is a leading cause of acute renal failure in infants and young children. It is traditionally defined as a triad of acute renal failure, hemolytic anemia and thrombocytopenia that occur within a week after prodromal hemorrhagic enterocolitis. Severe cases can also be presented by acute respiratory distress syndrome (ARDS), toxic megacolon with ileus, pancreatitis, central nervous system (CNS) disorders and multiple organ failure (MOF).Case presentation: A previously healthy 4-year old Caucasian girl developed acute renal failure, thrombocytopenia and hemolytic anemia following a short episode of abdominal pain and bloody diarrhea. In the next week of, what initially appeared as typical HUS, she developed MOF, including ileus, pancreatitis, hepatitis, coma and ARDS, accompanied by hemodynamic instability and extreme leukocytosis. Nonetheless, the girl made a complete recovery after one month of the disease. She was successfully treated in the intensive care unit and significant improvement was noticed after plasmapheresis and continuous veno-venous hemodialysis.Conclusions: Early start of plasmapheresis and meticulous supportive treatment in the intensive care unit, including renal placement therapy, may be the therapy of choice in severe cases of HUS presented by MOF. Monitoring of prognostic factors is important for early performance of appropriate diagnostic and therapeutical interventions.

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Efficacy of halopeRIdol to decrease the burden of Delirium In adult Critically ill patiEnts (EuRIDICE): study protocol for a prospective randomised multi-centre double-blind placebo-controlled clinical trial in the Netherlands

BMJ Open ◽

10.1136/bmjopen-2019-036735 ◽

2020 ◽

Vol 10 (9) ◽

pp. e036735

Author(s):

Lisa Smit ◽

Zoran Trogrlić ◽

John W Devlin ◽

Robert-Jan Osse ◽

Huibert H Ponssen ◽

...

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Critically Ill Patients ◽

Controlled Trial ◽

Neurological Injury ◽

Study Endpoint ◽

Controlled Clinical Trial ◽

Double Blind ◽

Double Blind Placebo ◽

Icu Discharge

IntroductionDelirium in critically ill adults is associated with prolonged hospital stay, increased mortality and greater cognitive and functional decline. Current practice guideline recommendations advocate the use of non-pharmacological strategies to reduce delirium. The routine use of scheduled haloperidol to treat delirium is not recommended given a lack of evidence regarding its ability to resolve delirium nor improve relevant short-term and longer-term outcomes. This study aims to evaluate the efficacy and safety of haloperidol for the treatment of delirium in adult critically ill patients to reduce days spent with coma or delirium.Methods and analysisEuRIDICE is a prospective, multi-centre, randomised, double-blind, placebo-controlled trial. Study population consists of adult intensive care unit (ICU) patients without acute neurological injury who have delirium based on a positive Intensive Care Delirium Screening Checklist (ICDSC) or Confusion Assessment Method for the ICU (CAM-ICU) assessment. Intervention is intravenous haloperidol 2.5 mg (or matching placebo) every 8 hours, titrated daily based on ICDSC or CAM-ICU positivity to a maximum of 5 mg every 8 hours, until delirium resolution or ICU discharge. Main study endpoint is delirium and coma-free days (DCFD) up to 14 days after randomisation. Secondary endpoints include (1) 28-day and 1-year mortality, (2) cognitive and functional performance at 3 and 12 months, (3) patient and family delirium and ICU experience, (4) psychological sequelae during and after ICU stay, (4) safety concerns associated with haloperidol use and (5) cost-effectiveness. Differences in DCFDs between haloperidol and placebo group will be analysed using Poisson regression analysis. Study recruitment started in February 2018 and continues.Ethics and disseminationThe study has been approved by the Medical Ethics Committee of the Erasmus University Medical Centre Rotterdam (MEC2017-511) and by the Institutional Review Boards of the participating sites. Its results will be disseminated via peer-reviewed publication and conference presentations.Trial registrationNCT03628391

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Adjunctive homeopathic treatment in patients with severe sepsis: a randomized, double-blind, placebo-controlled trial in an intensive care unit

Homeopathy ◽

10.1016/j.homp.2005.01.002 ◽

2005 ◽

Vol 94 (2) ◽

pp. 75-80 ◽

Cited By ~ 32

Author(s):

M Frass ◽

M Linkesch ◽

S Banyai ◽

G Resch ◽

C Dielacher ◽

...

Keyword(s):

Intensive Care Unit ◽

Severe Sepsis ◽

Intensive Care ◽

Controlled Trial ◽

Double Blind ◽

Double Blind Placebo ◽

Homeopathic Treatment

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Use of CT-Based Scoring System in Assessment of Pancreatitis Severity

Open Access Macedonian Journal of Medical Sciences ◽

10.3889/oamjms.2019.597 ◽

2019 ◽

Vol 7 (23) ◽

pp. 3997-4003

Author(s):

Madina Ermekova

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Multiple Organ Failure ◽

Organ Failure ◽

Death Rate ◽

Clinical Laboratory ◽

Early Stage ◽

Multiple Organ ◽

Important Indicator ◽

Pancreas Necrosis

BACKGROUND: Severity of AP is an important indicator of death rate, playing a crucial role in defining a correct dealing with a patient at his/her initial admission, in deciding on the need to transfer a patient to the intensive care unit. Many studies point out a direct relation between the death rate and the number of affected organs. In light of this, looking for the new criteria of multiple organ failure is still useful in clinical practice. Typically, assessment of multiple organ failure with patients undergoing treatment in the intensive care unit is carried out with the use of various integrated scores based both on clinical laboratory assessment of patient’s condition and on data obtained by advanced imaging methods. However, many scientists point out that the facilities of diagnostic radiology, including in particularly computerised tomography, are not used to the full extent. AIM: We developed a CT score for assessment of pancreatitis severity that takes into consideration not only alterations of the pancreas but also enables evaluation of multiple organ failure with the examined patients. METHODS: We have examined 100 patients with suspected pancreatitis. Among them 30 patients had pancreatitis without alterations of the vital organs; 70 patients had alterations of the vital organs, suffered organ or multiple organ failure and received treatment in the surgery unit and intensive care unit of the Department of Surgical Conditions of Karaganda Medical University. RESULTS: Because of CT results, based on the proposed score, we assessed a degree of pancreas necrosis, analysed the relation between organ failure and degree of pancreas necrosis. Finally, we evaluated the connection between multiple organ failure and the specific failure of one organ and the presence of necrosis and death rate. CONCLUSION: The proposed score for CT-based assessment of pancreatitis severity can be used not only for identification but also for prediction of organ failure at the early stage of pancreatitis to a high accuracy as compared to conventional CT systems for assessment of the condition of patients affected by pancreatitis. It can also be used to differentiate the severity of organ failure and the number of affected organs.

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