FRI0278 Life-Threatening Onset of Systemic Vasculitis Requiring Intensive Care Unit Admission: A Case Series

2015 ◽  
Vol 74 (Suppl 2) ◽  
pp. 525.2-525 ◽  
Author(s):  
S. Monti ◽  
L. Cavagna ◽  
S. Pieropan ◽  
C. Montecucco ◽  
R. Caporali
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Systemic Vasculitis ◽  
Case Series ◽  
Life Threatening

scholarly journals Life-threatening COVID-19 presenting as stroke with antiphospholipid antibodies and low ADAMTS-13 activity, and the role of therapeutic plasma exchange: A case series

2020 ◽  
Vol 8 ◽  
pp. 2050313X2096408
Author(s):  
Abdulrahman Alharthy ◽  
Fahad Faqihi ◽  
Abdullah Balhamar ◽  
Ziad A Memish ◽  
Dimitrios Karakitsos
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Plasma Exchange ◽  
Plasma Volume ◽  
Antiphospholipid Antibodies ◽  
Rescue Therapy ◽  
Antiviral Treatment ◽  
Case Series ◽  
Therapeutic Plasma Exchange ◽  
Life Threatening

We present a case series of three patients with COVID-19 who were admitted to our intensive care unit due to acute respiratory distress syndrome, brain infarction, pulmonary embolism, and antiphospholipid antibodies. We applied therapeutic plasma exchange on all cases. On intensive care unit admission, all patients had low (<10) Glasgow Coma Scale, and central nervous imaging showed multiple brain infarctions. COVID-19 was confirmed by reverse transcriptase polymerase chain reaction assays. Patients underwent rescue therapeutic plasma exchange using the Spectra OptiaTM Apheresis System (Terumo BCT Inc., USA), which operates with acid-citrate dextrose anticoagulant as per Kidney Disease Improving Global Outcomes 2019 guidelines. A dose of 1.5 plasma volume was used for the first dose and then 1 plasma volume daily for a total of five doses. Plasma was replaced with Octaplas LG® (Octapharma AG, USA), which is an artificial fresh frozen plasma product that has undergone viral inactivation by prion reduction technology. We administered ARDS-net/prone positioning ventilation, empiric antiviral treatment, therapeutic anticoagulation, and intensive care unit supportive care. Laboratory tests showed lymphocytopenia; elevated levels of D-dimer, fibrinogen, total bilirubin, C-reactive protein, lactate dehydrogenase, and ferritin; as well as low levels of ADAMTS-13 activity and antibody. Serology tests depicted positive IgM and IgG antiphospholipid antibodies (anti-cardiolipin and anti-β2-glycoprotein I antibodies). No side effects of therapeutic plasma exchange were recorded. After the completion of therapeutic plasma exchange, patients improved clinically and gradually recovered neurologically (after 27–32 days). To conclude, in life-threatening COVID-19, especially when immune dysregulation features such as antiphospholipid antibodies exist, therapeutic plasma exchange could be an effective rescue therapy.

scholarly journals ONE MONTH POST INTENSIVE CARE UNIT DISCHARGE OUTCOME

2021 ◽  
Vol 71 (Suppl-1) ◽  
pp. S224-28
Author(s):  
Nadeem Siddique ◽  
Muhammad Ahmad ◽  
Sabir Khan ◽  
Arshad Taqi ◽  
Tanvir Hussain
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Intensive Care Unit Discharge ◽  
Case Series ◽  
Bound State ◽  
Phone Call ◽  
National Hospital ◽  
Unit Discharge

Objective: To determine the outcomes of patients discharged from a general intensive care unit one month after discharge. Study Design: Descriptive case series. Place and Duration of Study: Intensive Care Unit - National Hospital and Medical Centre Lahore, from Jan 2018to Dec 2018. Methodology: All patients of both genders and age more than 12 years were included. Follow up was donethrough a phone call to the contact number provided, one-month post intensive care unit discharge. Information regarding outcome i.e. survival, bed bound state, degree of dependence for day to day activities and return to routine life. Results: A total of 106 cases were recruited, out of which 55.7% were male and 44.3% female; mean age was56.86 ± 23.16 years. At 1-month intensive care unit discharge 8.49% of the patients were dead; 73.58% cases hadreturned to pre intensive care unit admission routines, 11.32% were partially dependent on someone, 6.6% were bed bound. Death and bed bounding was highest in 60 year or older patients (p=0.03). All 9 cases who had died and 7 who were bed bound were admitted through emergency and remained admitted in the hospital for more than 7 days with p=0.0001. 77.8% of patients who died, 66.7% of patients who were partially dependent and all the bed bound patients required needed ventilation during intensive care unit admission with p=0.0001. Conclusion: In our series 20% of the patients were either dead or dependent for their daily survival one monthafter discharge from intensive care unit.Keywords: , , ,

scholarly journals Chylothorax in a Level III Neonatal Intensive Care Unit: A Case Series

2018 ◽  
Author(s):  
Rita Barreira ◽  
Maria Inês Marques ◽  
Rita Valsassina ◽  
Kátia Cardoso ◽  
Anabela Salazar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Thoracic Surgery ◽  
Neonatal Intensive Care Unit ◽  
Neonatal Intensive Care ◽  
Multiorgan Failure ◽  
Newborn Infants ◽  
Case Series ◽  
Threatening Condition ◽  
Life Threatening

INTRODUCTION: Chylothorax is a rare potentially life-threatening condition characterized by accumulation of chyle in the pleural space. It can be responsible for metabolic, nutritional and immunological complications in newborn infants. Our aim was to evaluate the clinical course and treatment of all cases of neonatal chylothorax admitted to a Portuguese tertiary perinatal unit. METHODS: Retrospective analysis of institutional records of newborn diagnosed with chylothorax between 1st of February 2007 and 31st of January 2017 in a tertiary neonatal intensive care unit. RESULTS: Six patients were included; two cases were congenital, one with prenatal diagnosis. The remaining cases were all secondary to trauma during thoracic surgery. All needed ventilation support with high positive end-expiratory pressure. Except for two cases, parenteral nutrition was implemented at diagnosis. Three cases did not improve with conservative treatment. One case was effectively treated with octreotide. Two patients died, one due to shock and multiorgan failure and the other one due to respiratory failure. DISCUSSION/CONCLUSION: In our sample, trauma (from thoracic surgery) was the main etiology, reflecting our Unit´s collaboration with the pediatric cardiology department. Concerning diagnosis and treatment there are some algorithms, however, there are no national or international accepted guidelines and there are some aspects of the therapeutic approach that remain controversial.

scholarly journals Mild thrombocytopenia indicating maternal organ damage in pre‐eclampsia: a cross‐sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Michinori Mayama ◽  
Mamoru Morikawa ◽  
Takashi Yamada ◽  
Takeshi Umazume ◽  
Kiwamu Noshiro ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Platelet Count ◽  
Intensive Care Unit Admission ◽  
Neonatal Intensive Care Unit ◽  
Preterm Delivery ◽  
Neonatal Intensive Care ◽  
Organ Damage ◽  
Severe Thrombocytopenia ◽  
Relative Risks

Abstract Background Currently, there is a disagreement between guidelines regarding platelet count cut-off values as a sign of maternal organ damage in pre-eclampsia; the American College of Obstetricians and Gynecologists guidelines state a cut-off value of < 100 × 109/L; however, the International Society for the Study of Hypertension in Pregnancy guidelines specify a cut-off of < 150 × 109/L. We evaluated the effect of mild thrombocytopenia: platelet count < 150 × 109/L and ≥ 100 × 109/L on clinical features of pre-eclampsia to examine whether mild thrombocytopenia reflects maternal organ damage in pre-eclampsia. Methods A total of 264 women were enrolled in this study. Participants were divided into three groups based on platelet count levels at delivery: normal, ≥ 150 × 109/L; mild thrombocytopenia, < 150 × 109/L and ≥ 100 × 109/L; and severe thrombocytopenia, < 100 × 109/L. Risk of severe hypertension, utero-placental dysfunction, maternal organ damage, preterm delivery, and neonatal intensive care unit admission were analyzed based on platelet count levels. Estimated relative risk was calculated with a Poisson regression analysis with a robust error. Results Platelet counts indicated normal levels in 189 patients, mild thrombocytopenia in 51 patients, and severe thrombocytopenia in 24 patients. The estimated relative risks of severe thrombocytopenia were 4.46 [95 % confidence interval, 2.59–7.68] for maternal organ damage except for thrombocytopenia, 1.61 [1.06–2.45] for preterm delivery < 34 gestational weeks, and 1.35 [1.06–1.73] for neonatal intensive care unit admission. On the other hand, the estimated relative risks of mild thrombocytopenia were 0.97 [0.41–2.26] for maternal organ damage except for thrombocytopenia, 0.91 [0.62–1.35] for preterm delivery < 34 gestational weeks, and 0.97 [0.76–1.24] for neonatal intensive care unit admission. Conclusions Mild thrombocytopenia was not associated with severe features of pre-eclampsia and would not be suitable as a sign of maternal organ damage.

scholarly journals Early prolonged neutrophil activation in critically ill patients with sepsis

2021 ◽  
Vol 27 (2) ◽  
pp. 192-200
Author(s):  
Sanna Törnblom ◽  
Sara Nisula ◽  
Suvi T Vaara ◽  
Meri Poukkanen ◽  
Sture Andersson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Intensive Care Unit Admission ◽  
Plasma Concentrations ◽  
Neutrophil Activation ◽  
Early Event ◽  
Heparin Binding ◽  
Activation Markers ◽  
Heparin Binding Protein ◽  
Pro Inflammatory Cytokines

We hypothesised that plasma concentrations of biomarkers of neutrophil activation and pro-inflammatory cytokines differ according to the phase of rapidly evolving sepsis. In an observational study, we measured heparin-binding protein (HBP), myeloperoxidase (MPO), IL-6 and IL-8 in 167 sepsis patients on intensive care unit admission. We prospectively used the emergence of the first sepsis-associated organ dysfunction (OD) as a surrogate for the sepsis phase. Fifty-five patients (of 167, 33%) developed the first OD > 1 h before, 74 (44%) within ± 1 h, and 38 (23%) > 1 h after intensive care unit admission. HBP and MPO were elevated at a median of 12 h before the first OD, remained high up to 24 h, and were not associated with sepsis phase. IL-6 and IL-8 rose and declined rapidly close to OD emergence. Elevation of neutrophil activation markers HBP and MPO was an early event in the evolution of sepsis, lasting beyond the subsidence of the pro-inflammatory cytokine reaction. Thus, as sepsis biomarkers, HBP and MPO were not as prone as IL-6 and IL-8 to the effect of sample timing.

scholarly journals 375. COVID 19 infection in a Massachusetts community hospital

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S257-S258
Author(s):  
Raul Davaro ◽  
alwyn rapose
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Essential Hypertension ◽  
Severe Acute Respiratory Syndrome ◽  
High Mortality ◽  
Case Series ◽  
World Health ◽  
Minimal Risk ◽  
The Impact

Abstract Background The ongoing pandemic of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections has led to 105690 cases and 7647 deaths in Massachusetts as of June 16. Methods The study was conducted at Saint Vincent Hospital, an academic health medical center in Worcester, Massachusetts. The institutional review board approved this case series as minimal-risk research using data collected for routine clinical practice and waived the requirement for informed consent. All consecutive patients who were sufficiently medically ill to require hospital admission with confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by positive result on polymerase chain reaction testing of a nasopharyngeal sample were included. Results A total of 109 consecutive patients with COVID 19 were admitted between March 15 and May 31. Sixty one percent were men, the mean age of the cohort was 67. Forty one patients (37%) were transferred from nursing homes. Twenty seven patients died (24%) and the majority of the dead patients were men (62%). Fifty one patients (46%) required admission to the medical intensive care unit and 34 necessitated mechanical ventilation, twenty two patients on mechanical ventilation died (63%). The most common co-morbidities were essential hypertension (65%), obesity (60%), diabetes (33%), chronic kidney disease (22%), morbid obesity (11%), congestive heart failure (16%) and COPD (14%). Five patients required hemodialysis. Fifty five patients received hydroxychloroquine, 24 received tocilizumab, 20 received convalescent plasma and 16 received remdesivir. COVID 19 appeared in China in late 2019 and was declared a pandemic by the World Health Organization on March 11, 2020. Our study showed a high mortality in patients requiring mechanical ventilation (43%) as opposed to those who did not (5.7%). Hypertension, diabetes and obesity were highly prevalent in this aging population. Our cohort was too small to explore the impact of treatment with remdesivir, tocilizumab or convalescent plasma. Conclusion In this cohort obesity, diabetes and essential hypertension are risk factors associated with high mortality. Patients admitted to the intensive care unit who need mechanical ventilation have a mortality approaching 50 %. Disclosures All Authors: No reported disclosures

scholarly journals Tick-Borne-Associated Illnesses in the Pediatric Intensive Care Unit

2020 ◽  
Vol 15 (06) ◽  
pp. 269-275
Author(s):  
Kaila Lessner ◽  
Conrad Krawiec
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Pediatric Intensive Care Unit ◽  
Early Recognition ◽  
Spotted Fever ◽  
Pediatric Intensive Care ◽  
Rocky Mountain ◽  
Rocky Mountain Spotted Fever ◽  
Life Threatening ◽  
Human Ehrlichiosis

AbstractWhen unrecognized and antibiotic delay occurs, Lyme disease, Rocky Mountain–spotted fever, babesiosis, and human ehrlichiosis and anaplasmosis can result in multiorgan system dysfunction and potentially death. This review focuses on the early recognition, evaluation, and stabilization of the rare life-threatening sequelae seen in tick-borne illnesses that require admission in the pediatric intensive care unit.

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