scholarly journals Low Incidence of Biphasic Allergic Reactions in Patients Admitted to Intensive Care after Anaphylaxis

2019 ◽  
Vol 130 (2) ◽  
pp. 284-291 ◽  
Author(s):  
Sofie Højlund ◽  
Peter Søe-Jensen ◽  
Anders Perner ◽  
Morten H. Bestle ◽  
Peder Carl ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Allergic Reaction ◽  
Respiratory Symptoms ◽  
Allergic Reactions ◽  
Total Incidence ◽  
Skin Symptoms ◽  
Initial Symptoms ◽  
Patient Groups ◽  
Low Incidence

Abstract Editor’s Perspective What We Already Know about This Topic What This Article Tells Us That Is New Background Biphasic allergic reactions—recurrence of allergy symptoms after a symptom-free period—are reported to occur in 1 to 23% of allergic reactions. Patients admitted to an intensive care unit after anaphylaxis potentially have more severe reactions and a higher risk of biphasic allergic reactions. The purpose of this study was to examine incidence, triggers, symptoms, and treatment of biphasic allergic reactions, in patients admitted to an intensive care unit. Methods Records of patients admitted to intensive care units with anaphylaxis from 2011 to 2014 were reviewed. Only patients with a reaction fulfilling internationally accepted criteria for anaphylaxis were included. Potential biphasic allergic reactions, defined as renewed allergy symptoms 1 to 72 h after initial symptoms had resolved, without further exposure to the trigger, were identified. Results A total of 83 cases of anaphylaxis were identified, and the most frequent triggers were medications (58 of 83 [70%]). Skin symptoms occurred in 69 (83%) cases, and circulatory and respiratory symptoms in 48 (58%) and 45 (54%) cases, respectively. In total, 82 (99%), 80 (96%), and 66 (80%) were treated with antihistamines, corticosteroids, and epinephrine, respectively. Only 10 patients presented with one or more relevant symptoms after the initial allergic reaction. Of these, three were possible, and one was a probable biphasic allergic reaction, giving a total incidence of 4 of 83 (4.8% [95% CI, 1.6 to 12.5]) or 1 of 83 (1.2% [95% CI, 0.1 to 7.46]), respectively. All cases were mild, presenting with skin symptoms only, occurring on average 14 h after initial reactions. Conclusions The authors observed a low incidence of biphasic reactions in patients admitted to an intensive care unit after anaphylaxis, at a rate equivalent to that reported in other patient groups.

scholarly journals Anaphylactic reaction to ethylene oxide in a hemodialysis patient

2019 ◽  
Vol 7 ◽  
pp. 2050313X1983874
Author(s):  
Bobak J Akhavan ◽  
Ugochi A Osborn ◽  
Reeba Mathew
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Ethylene Oxide ◽  
Allergic Reaction ◽  
Medical Devices ◽  
Hemodialysis Patient ◽  
Intensive Care Unit Setting ◽  
Inpatient Setting ◽  
Allergic Reactions ◽  
Systemic Allergic Reaction

We present the case of a patient who developed a severe systemic allergic reaction during initiation of hemodialysis. The reaction completely resolved by switching the dialysis filter sterilized by ethylene oxide to a steam sterilized filter. Ethylene oxide is used to sterilize heat sensitive medical devices, and although allergic reactions related to ethylene oxide have been reported before, awareness is lacking among providers in the inpatient setting, specifically in the intensive care unit setting.

scholarly journals Intensive care unit physician-delivered point of care renal tract ultrasound in acute kidney injury is feasible

2018 ◽  
Vol 19 (4) ◽  
pp. 313-318 ◽  
Author(s):  
Prashant Parulekar ◽  
Ed Neil-Gallacher ◽  
Alex Harrison
Keyword(s):  
Intensive Care Unit ◽  
Acute Kidney Injury ◽  
Intensive Care ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Point Of Care ◽  
Kidney Injury ◽  
Diagnostic Quality ◽  
The Core ◽  
Low Incidence

Acute kidney injury is common in critically ill patients, with ultrasound recommended to exclude renal tract obstruction. Intensive care unit clinicians are skilled in acquiring and interpreting ultrasound examinations. Intensive Care Medicine Trainees wish to learn renal tract ultrasound. We sought to demonstrate that intensive care unit clinicians can competently perform renal tract ultrasound on critically ill patients. Thirty patients with acute kidney injury were scanned by two intensive care unit physicians using a standard intensive care unit ultrasound machine. The archived images were reviewed by a Radiologist for adequacy and diagnostic quality. In 28 of 30 patients both kidneys were identified. Adequate archived images of both kidneys each in two planes were possible in 23 of 30 patients. The commonest reason for failure was dressings and drains from abdominal surgery. Only one patient had hydronephrosis. Our results suggest that intensive care unit clinicians can provide focussed renal tract ultrasound. The low incidence of hydronephrosis has implications for delivering the Core Ultrasound in Intensive Care competencies.

scholarly journals A 24-Year-Old Female With Anti-NMDA Receptor Encephalitis: A Case Report.

2020 ◽  
Author(s):  
Antoine Steeman ◽  
Ionut-Adrian Andriescu ◽  
Guy Mazairac
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nmda Receptor ◽  
Psychiatric Symptoms ◽  
Delayed Diagnosis ◽  
Young Patients ◽  
Tumour Resection ◽  
Female Ratio ◽  
Nmda Receptor Encephalitis ◽  
Initial Symptoms

Abstract Background: Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is a form of autoimmune encephalitis with paraneoplastic and nonparaneoplastic origin. Patients with this disease usually arrive at the intensive care unit without any diagnosis or with complications as a result of a delayed diagnosis. This disease is not well known and is underdiagnosed. Due to the variability of the initial symptoms and the lack of knowledge regarding these symptoms, anti-NMDA receptor encephalitis is not only underdiagnosed but also can be misdiagnosed as viral encephalitis or other pathologies. Anti-NMDA receptor encephalitis preferentially affects children (from 8 months) and young adults, and it has a male/female ratio of 1/4. In case of clinical suspicion, electroencephalogram (EEG) and brain magnetic resonance imaging (MRI) are useful. The diagnosis is confirmed by the detection of IgG antibodies directed against NMDA receptors in serum and CSF. Treatment for this disease includes immunosuppression and tumour resection when indicated.Case presentation: We report the case of a 24-year-old female admitted to the emergency room following the onset of acute confusion. Due to the rapid deterioration of consciousness and swallowing disorders, the patient was transferred to the intensive care unit. On day 23 after presentation, MRI suggested autoimmune limbic encephalitis. Serologic and CSF results were positive for anti-NMDA antibodies. After IV methylprednisolone therapy and plasmapheresis and a second line therapy with corticosteroid therapy and mycophenolic acid, the patient’s clinical condition gradually improved.Conclusions: Anti-NMDA receptor encephalitis typically occurs in young patients with no history of acute psychiatric symptoms. The possibility of this pathology should be taken into account before diagnosing a patient with a psychiatric illness.

scholarly journals Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection

2021 ◽  
Author(s):  
YuV Lobzin ◽  
AN Uskov ◽  
NV Skripchenko ◽  
AA Vilnits ◽  
MK Bekhtereva ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Kawasaki Disease ◽  
Infectious Diseases ◽  
Children And Adolescents ◽  
Pediatric Patients ◽  
Laboratory Data ◽  
Pediatric Research ◽  
Clinical Center ◽  
Low Incidence

Despite the low incidence, low mortality and relatively mild symptoms of COVID-19 in children, there has been a rise in pediatric patients who develop a condition resembling Kawasaki disease after COVID-19 or contact with individuals infected with SARS-CoV-2. This condition is known as the pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS). This review introduces the reader to the hypotheses of PIMS-TS pathogenesis, provides information about its diagnosis and treatment, presents clinical and laboratory data and describes treatments strategies used in children and adolescents hospitalized to the intensive care unit of the Pediatric Research and Clinical Center for Infectious Diseases. Besides, the review outlines the main diagnostic and prognostic challenges of PIMS-TS.

scholarly journals Does Anyone Ever Expect to Die?

2017 ◽  
Vol 45 (4) ◽  
pp. 466-468 ◽  
Author(s):  
M. H. R. Anstey ◽  
N. Watts ◽  
N. Orford ◽  
I. M. Seppelt ◽  
I. Mitchell
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
End Of Life ◽  
Metastatic Cancer ◽  
Outpatient Setting ◽  
Sudden Onset ◽  
Health Issues ◽  
High Likelihood ◽  
Patient Groups ◽  
Dying Patient

Patients who come to the intensive care unit are amongst the sickest patients in our hospitals. Patients can be admitted to the intensive care unit unexpectedly (following accidents or sudden onset of illness) or as unplanned but not necessarily truly ‘unexpected’ admissions. These patients often have significant underlying chronic health issues, including metastatic cancer, advanced cardiac, respiratory, renal, or hepatic failure, or frailty, with a high likelihood of death in the ensuing months. Using the Australian and New Zealand Intensive Care Society Clinical Trials Group Point Prevalence Program, a prospective single-day observational study across 46 Australian hospitals in 2014 and 2015, we found that less than 9% of intensive care unit patients (51/577) had an advance directive available. From these results, we provide two suggestions to increase intensive care's understanding of patients’ end-of-life wishes. First, systematically target ‘high risk of dying’ patient groups for goals of care conversations in the outpatient setting. Such groups include those where one would not be ‘surprised’ if they died within a year. Second, as a society, more conversations about end-of-life wishes are needed.

scholarly journals Acute Severe Asthma in Adolescent and Adult Patients: Current Perspectives on Assessment and Management

2019 ◽  
Vol 8 (9) ◽  
pp. 1283 ◽  
Author(s):  
Kostakou ◽  
Kaniaris ◽  
Filiou ◽  
Vasileiadis ◽  
Katsaounou ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Emergency Department ◽  
Intensive Care ◽  
Severe Asthma ◽  
Inflammatory Disease ◽  
Respiratory Symptoms ◽  
Severe Exacerbation ◽  
Flow Variable ◽  
Acute Severe Asthma ◽  
Asthma Exacerbations

Asthma is a chronic airway inflammatory disease that is associated with variable expiratory flow, variable respiratory symptoms, and exacerbations which sometimes require hospitalization or may be fatal. It is not only patients with severe and poorly controlled asthma that are at risk for an acute severe exacerbation, but this has also been observed in patients with otherwise mild or moderate asthma. This review discusses current aspects on the pathogenesis and pathophysiology of acute severe asthma exacerbations and provides the current perspectives on the management of acute severe asthma attacks in the emergency department and the intensive care unit.

scholarly journals Vaping-related injury and illness among Canadian children and adolescents: a one-time survey of paediatric providers

2020 ◽  
Vol 4 (1) ◽  
pp. e000840
Author(s):  
Nicholas Chadi ◽  
Charlotte Moore-Hepburn ◽  
Suzanne Beno ◽  
Sarah A Richmond
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Children And Adolescents ◽  
Respiratory Symptoms ◽  
Surveillance Programme ◽  
Clinical Presentations ◽  
Wide Range ◽  
Policy Measures

A one-time survey distributed to 2693 Canadian paediatricians enrolled in the Canadian Paediatric Surveillance Programme was conducted between October and December 2019. We identified a wide range of severe vaping-related injuries and illnesses among children ages 0–17 (n=88), which were associated with the routine use or malfunctioning of a vaping device or the ingestion of vaping substances. The most common clinical presentations were acute respiratory symptoms and nicotine toxicity and 15% (n=13) of injuries required intensive care unit admission. Our study highlights the urgent need for substantive policy measures to help protect youth against the risks associated with vaping products.

scholarly journals Reducing sound and light exposure to improve sleep on the adult intensive care unit: An inclusive narrative review

2017 ◽  
Vol 19 (2) ◽  
pp. 138-146 ◽  
Author(s):  
Victoria Bion ◽  
Alex SW Lowe ◽  
Zudin Puthucheary ◽  
Hugh Montgomery
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Units ◽  
Positive Impact ◽  
Light Exposure ◽  
Environmental Interventions ◽  
Adult Intensive Care Unit ◽  
Patient Groups ◽  
Environmental Measures ◽  
Meta Analyses

Purpose Sleep disturbance is common in intensive care units. It is associated with detrimental psychological impacts and has potential to worsen outcome. Irregular exposure to sound and light may disrupt circadian rhythm and cause frequent arousals from sleep. We sought to review the efficacy of environmental interventions to reduce sound and light exposure with the aim of improving patient sleep on adult intensive care units. Methods We searched both PubMed (1966–30 May 2017) and Embase (1974–30 May 2017) for all relevant human (adult) studies and meta-analyses published in English using search terms ((intensive care OR critical care), AND (sleep OR sleep disorders), AND (light OR noise OR sound)). Bibliographies were explored. Articles were included if reporting change in patient sleep in response to an intervention to reduce disruptive intensive care unit sound /light exposure. Results Fifteen studies were identified. Nine assessed mechanical interventions, four of which used polysomnography to assess sleep. Five studies looked at environmental measures to facilitate sleep and a further two (one already included as assessing a mechanical intervention) studied the use of sound to promote sleep. Most studies found a positive impact of the intervention on sleep. However, few studies used objective sleep assessments, sample sizes were small, methodologies sometimes imperfect and analysis limited. Data are substantially derived from specialist (neurosurgical, post-operative, cardiothoracic and cardiological) centres. Patients were often at the ‘less sick’ end of the spectrum in a variety of settings (open ward beds or side rooms). Conclusions Simple measures to reduce intensive care unit patient sound/light exposure appear effective. However, larger and more inclusive high-quality studies are required in order to identify the measures most effective in different patient groups and any impacts on outcome.

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