scholarly journals Self-limiting severe neutropenia in a patient with COVID-19

2021 ◽  
Vol 14 (11) ◽  
pp. e247057
Author(s):  
Ram Singh ◽  
Brajesh Kumar Ratre ◽  
Prashant Sirohiya ◽  
Sushma Bhatnagar
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Expert Opinion ◽  
Similar Case ◽  
Case Reports ◽  
Severe Neutropenia ◽  
Aggressive Approach ◽  
Close Observation ◽  
Undue Risk ◽  
Immunocompetent Patients

Neutropenia is a rare haematological complication of COVID-19 infection in immunocompetent patients. There is sparse literature on neutropenia in patients with COVID-19, except a few case reports. We encountered a similar case in an intensive care unit that developed severe neutropenia on day 24 of illness. Neutropenia resolved spontaneously on 4th day of its appearance. The patient was isolated and kept under close observation, antibiotics were upgraded and strict asepsis was maintained. Thus, we observed in a patient with no comorbidities and uncomplicated neutropenia that strict measures to prevent infection may suffice and the undue risk of hematopoietic therapy can be avoided. An expert opinion should always be sought in such cases as the presence of complications may require an aggressive approach.

scholarly journals Expert consensus-based clinical practice guidelines management of intravascular catheters in the intensive care unit

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Jean-François Timsit ◽  
Julien Baleine ◽  
Louis Bernard ◽  
Silvia Calvino-Gunther ◽  
Michael Darmon ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Expert Opinion ◽  
Therapeutic Strategies ◽  
Brachiocephalic Vein ◽  
Central Vein ◽  
Improvement Program ◽  
Femoral Access ◽  
Mechanical Complications ◽  
French Speaking

Abstract The French Society of Intensive Care Medicine (SRLF), jointly with the French-Speaking Group of Paediatric Emergency Rooms and Intensive Care Units (GFRUP) and the French-Speaking Association of Paediatric Surgical Intensivists (ADARPEF), worked out guidelines for the management of central venous catheters (CVC), arterial catheters and dialysis catheters in intensive care unit. For adult patients: Using GRADE methodology, 36 recommendations for an improved catheter management were produced by the 22 experts. Recommendations regarding catheter-related infections’ prevention included the preferential use of subclavian central vein (GRADE 1), a one-step skin disinfection(GRADE 1) using 2% chlorhexidine (CHG)-alcohol (GRADE 1), and the implementation of a quality of care improvement program. Antiseptic- or antibiotic-impregnated CVC should likely not be used (GRADE 2, for children and adults). Catheter dressings should likely not be changed before the 7th day, except when the dressing gets detached, soiled or impregnated with blood (GRADE 2− adults). CHG dressings should likely be used (GRADE 2+). For adults and children, ultrasound guidance should be used to reduce mechanical complications in case of internal jugular access (GRADE 1), subclavian access (Grade 2) and femoral venous, arterial radial and femoral access (Expert opinion). For children, an ultrasound-guided supraclavicular approach of the brachiocephalic vein was recommended to reduce the number of attempts for cannulation and mechanical complications. Based on scarce publications on diagnostic and therapeutic strategies and on their experience (expert opinion), the panel proposed definitions, and therapeutic strategies.

scholarly journals Acute toxoplasmoses in immunocompetent patients hospitalized in an intensive care unit in French Guiana

2012 ◽  
Vol 18 (7) ◽  
pp. E221-E231 ◽  
Author(s):  
M. Demar ◽  
D. Hommel ◽  
F. Djossou ◽  
C. Peneau ◽  
R. Boukhari ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
French Guiana ◽  
Immunocompetent Patients

scholarly journals Outbreak of adenovirus type 1 severe pneumonia in a French intensive care unit, September–October 2012

2014 ◽  
Vol 19 (39) ◽  
Author(s):  
N Cassir ◽  
S Hraiech ◽  
A Nougairede ◽  
C Zandotti ◽  
P E Fournier ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Severe Pneumonia ◽  
Human Adenovirus ◽  
Adenovirus Type ◽  
Rapid Identification ◽  
Healthcare Settings ◽  
Polymerase Chain ◽  
Immunocompetent Patients

We herein describe and analyse the first outbreak of severe pneumonia caused by human adenovirus type 1 (HAdV C type 1), which included immunocompetent patients in an intensive care unit (ICU) of Marseille, France, and occurred between September and October 2012. Seven successive patients were diagnosed by HAdV specific real-time polymerase chain reaction with a positive bronchoalveolar lavage. After the collection of nasopharyngeal swabs from healthcare workers, three nurses working night shifts tested positive for HAdV C including one that had exhibited respiratory signs while working one week before the outbreak. She was the most likely source of the outbreak. Our findings suggest that HAdV-1 could be considered as a possible cause of severe pneumonia even in immunocompetent patients with a potential to cause outbreaks in ICUs. HAdV rapid identification and typing is needed to curtail the spread of this pathogen. Reinforcing hand hygiene with antiseptics with demonstrated activity against non-enveloped viruses and ensuring that HCWs with febrile respiratory symptoms avoid direct patient contact are critical measures to prevent transmission of HAdV in healthcare settings.

Posaconazole as part of the antifungal armamentarium in the intensive care unit - case reports from a surgical ICU

Mycoses ◽  
2010 ◽  
Vol 54 ◽  
pp. 45-48 ◽  
Author(s):  
Dominic Störzinger ◽  
Christoph Lichtenstern ◽  
Markus A. Weigand ◽  
Torsten Hoppe-Tichy
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Reports ◽  
Surgical Icu

scholarly journals Icatibant for Angiotensin-Converting Enzyme Inhibitor-Induced Angioedema in Intubated Patients: Case Series and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-6
Author(s):  
Erin K. Yeung ◽  
Haritha Saikumar ◽  
Jose Castaneda-Nerio ◽  
Sandra G. Adams ◽  
Mark Wong
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Literature Review ◽  
Angiotensin Converting Enzyme ◽  
Angiotensin Converting Enzyme Inhibitor ◽  
Enzyme Inhibitor ◽  
Case Reports ◽  
Case Series ◽  
Converting Enzyme ◽  
Converting Enzyme Inhibitor

Purpose. A case series of icatibant use in intubated patients with angiotensin-converting enzyme inhibitor- (ACEI-) induced angioedema is presented along with a relevant literature review and recommendations for utilization. Summary. Three intubated patients admitted to the intensive care unit for ACEI-induced angioedema were treated with icatibant. A literature search identified one controlled study and four case reports describing the use of icatibant in intubated ACEI-induced angioedema patients. Conclusion. Icatibant administration in intubated patients may be beneficial in decreasing time to extubation and length of intensive care unit stay. In the three cases described, icatibant administration did not appear to elicit a response in intubated patients, which has been described in previous case reports. For clinicians considering icatibant in the treatment of ACEI-induced angioedema, earlier administration upon arrival to the ED or immediately upon arriving to the intensive care unit is strongly advised. The suggested benefit of icatibant in intubated ACEI-induced angioedema patients should be verified by randomized clinical trials and cost-benefit analyses should be performed at individual institutions.

scholarly journals Rapid resolution of severe subcutaneous emphysema causing respiratory failure with subcutaneous drain

2021 ◽  
Vol 9 ◽  
pp. 2050313X2199719
Author(s):  
Ala Mustafa ◽  
Caio Heleno ◽  
Douglas T Summerfield
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Respiratory Failure ◽  
Respiratory Distress ◽  
Critically Ill ◽  
Subcutaneous Emphysema ◽  
Case Reports ◽  
Definitive Treatment ◽  
Critically Ill Patient ◽  
Rapid Resolution

This case reports on a critically ill patient (Male, 74) with severe subcutaneous emphysema which progressed to causing respiratory distress. We document both the severity of the condition we observed and then present a novel intervention. In this case, we decompressed the patient at the intensive care unit-bedside and resolved the condition. While subcutaneous emphysema is relatively common, the severity of the condition we observed, and the lack of definitive treatment guidance have prompted us to present this case as a plausible treatment guide.

scholarly journals Staphylococcus pettenkoferi Bacteremia in an American Intensive Care Unit

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Cameron Strong ◽  
Michael Cosiano ◽  
Melanie Cabezas ◽  
J. W. Barwatt ◽  
L. Gayani Tillekeratne
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Case Reports ◽  
Bloodstream Infections ◽  
Signs And Symptoms ◽  
The United States ◽  
Coagulase Negative Staphylococci ◽  
Prosthetic Devices ◽  
Increased Risk ◽  
Clinically Significant

Coagulase-negative staphylococci (CoNS) are considered the most common cause of nosocomial bloodstream infections; yet, these species are frequently designated as contaminants in the absence of systemic signs and symptoms of infection. Immunocompromised patients or those with prosthetic devices are at increased risk for clinically significant bacteremia. With the advent of matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) in clinical practice, there has been improved specificity of CoNS isolate identification and further elucidation of underrecognized pathogenic species. Staphylococcus pettenkoferi was a novel CoNS species first identified in 2002 and thought to be misdiagnosed as other CoNS due to limitations in biochemical identification. There is increasing identification of S. pettenkoferi isolates; however, there are limited case reports of clinically significant S. pettenkoferi bacteremia and no reported cases within the United States. We present the first known case of S. pettenkoferi from an American intensive care unit.

Collaborative Practice: Development, Implementation, and Evaluation of a Weaning Protocol for Patients Receiving Mechanical Ventilation

2003 ◽  
Vol 12 (5) ◽  
pp. 454-460 ◽  
Author(s):  
Mary Jo Grap ◽  
Dale Strickland ◽  
Laura Tormey ◽  
Kim Keane ◽  
Shannon Lubin ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Length Of Stay ◽  
Spontaneous Breathing Trial ◽  
Richmond Agitation Sedation Scale ◽  
Aggressive Approach ◽  
Respiratory Intensive Care Unit ◽  
Efficient Care ◽  
Practice Development

• Background Use of protocols to reduce weaning time for patients receiving mechanical ventilation helps reduce cost and length of stay. However, implementation of this type of protocol is not easy and requires a consistent collaborative effort.• Objective To provide a systematic approach to the weaning process by developing, implementing, and evaluating a protocol for weaning patients from mechanical ventilation in a medical respiratory intensive care unit.• Methods The weaning protocol used was a modification of a protocol developed by Ely et al. Modifications included a more aggressive approach in proceeding to the spontaneous breathing trial, inclusion of the Richmond Agitation-Sedation Scale, and documentation of the production of secretions.• Results Implementation of the protocol significantly reduced the duration of mechanical ventilation as measured by 8-hour shifts and ventilator days. Although length of stay in the intensive care unit was not significantly reduced (P = .29), a continuing downward trend occurred, from a mean of 8.6 days before the protocol was implemented to 7.9 days during the last 6 months of data collection (P = .07).• Conclusions The need to provide efficient care requires the collaboration of all disciplines involved in providing patients’ care. The weaning protocol introduced in this study demonstrates the benefits of using a collaborative team to identify best practices and implement them in a practice setting.

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