scholarly journals Puerperal Group A Streptococcal sepsis: a case report

2021 ◽  
Vol 10 (12) ◽  
pp. 4573
Author(s):  
Nithya J. ◽  
Sathyamurthy G. ◽  
Balavinoth R.
Keyword(s):  
Maternal Mortality ◽  
Clinical Signs ◽  
Vaginal Swab ◽  
Invasive Infection ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Prompt Treatment ◽  
Non Invasive Ventilation ◽  
Life Threatening ◽  
Group A

Group A Streptococcal (GAS) sepsis in puerperium is one of the recognised causes of maternal mortality. Though the onset is often insidious, it can progress rapidly to a life-threatening invasive infection, toxin-mediated shock, and end-organ failure, even before clinical signs become apparent. We report a case of puerperal GAS sepsis that was successfully managed. 24-years-old para 1 was readmitted to the intensive care unit requiring non-invasive ventilation on postnatal day 6 with clinical and biochemical features of sepsis. Blood culture, episiotomy wound swab, and high vaginal swab grew GAS. Broad-spectrum antibiotics initiated. She developed ascites that progressively increased and needed therapeutic paracentesis. She was discharged after four weeks of hospitalization. Early identification and prompt treatment are the keys to prevent severe morbidity and maternal mortality.

scholarly journals Role of Non-invasive Ventilation in Managing Life-threatening Acute Exacerbation of Interstitial Pneumonia

2010 ◽  
Vol 49 (14) ◽  
pp. 1341-1347 ◽  
Author(s):  
Keisuke Tomii ◽  
Ryo Tachikawa ◽  
Kazuo Chin ◽  
Kimihiko Murase ◽  
Tomohiro Handa ◽  
...  
Keyword(s):  
Acute Exacerbation ◽  
Interstitial Pneumonia ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Life Threatening

scholarly journals Disease Risk and Mortality Prediction in Intensive Care Patients with Pneumonia. Australian and New Zealand Practice in Intensive Care (ANZPIC II)

2005 ◽  
Vol 33 (1) ◽  
pp. 101-111 ◽  
Author(s):  
R. J. Boots ◽  
J. Lipman ◽  
R. Bellomo ◽  
D. Stephens ◽  
R. F. Heller
Keyword(s):  
Intensive Care ◽  
New Zealand ◽  
Clinical Signs ◽  
Community Acquired Pneumonia ◽  
Ventilator Associated Pneumonia ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired

This study of ventilated patients investigated pneumonia risk factors and outcome predictors in 476 episodes of pneumonia (48% community-acquired pneumonia, 24% hospital-acquired pneumonia, 28% ventilator-associated pneumonia) using a prospective survey in 14 intensive care units within Australia and New Zealand. For community acquired pneumonia, mortality increased with immunosuppression (OR 5.32, CI 95% 1.58–17.99, P<0.01), clinical signs of consolidation (OR 2.43, CI 95% 1.09–5.44, P=0.03) and Sepsis-Related Organ Failure Assessment (SOFA) scores (OR 1.19, CI 95% 1.08–1.30, P<0.001) but improved if appropriate antibiotic changes were made within three days of intensive care unit admission (OR 0.42, CI 95% 0.20–0.86, P=0.02). For hospital-acquired pneumonia, immunosuppression (OR 6.98, CI 95% 1.16–42.2, P=0.03) and non-metastatic cancer (OR 3.78, CI 95% 1.20–11.93, P=0.02) were the principal mortality predictors. Alcoholism (OR 7.80, CI 95% 1.20–17.50, P<0.001), high SOFA scores (OR 1.44, CI 95% 1.20–1.75, P=0.001) and the isolation of “high risk” organisms including Pseudomonas aeruginosa, Acinetobacter spp, Stenotrophomonas spp and methicillin resistant Staphylococcus aureus (OR 4.79, CI 95% 1.43–16.03, P=0.01), were associated with increased mortality in ventilator-associated pneumonia. The use of non-invasive ventilation was independently protective against mortality for patients with community-acquired and hospital-acquired pneumonia (OR 0.35, CI 95% 0.18–0.68, P=0.002). Mortality was similar for patients requiring both invasive and non-invasive ventilation and non-invasive ventilation alone (21% compared with 20% respectively, P=0.56). Pneumonia risks and mortality predictors in Australian and New Zealand ICUs vary with pneumonia type. A history of alcoholism is a major risk factor for mortality in ventilator-associated pneumonia, greater in magnitude than the mortality effect of immunosuppression in hospital-acquired pneumonia or community-acquired pneumonia. Non-invasive ventilation is associated with reduced ICU mortality. Clinical signs of consolidation worsen, while rationalising antibiotic therapy within three days of ICU admission improves mortality for community-acquired pneumonia patients.

scholarly journals Non-invasive ventilation in the treatment of severe polymicrobial community-acquired pneumonia

2017 ◽  
Vol 11 (1) ◽  
pp. 57
Author(s):  
Enrico Cinque ◽  
Ines Maria Grazia Piroddi ◽  
Cornelius Barlascini ◽  
Alessandro Perazzo ◽  
Antonello Nicolini
Keyword(s):  
Mechanical Ventilation ◽  
Severe Disease ◽  
Invasive Mechanical Ventilation ◽  
Clinical Signs ◽  
Case Series ◽  
Community Acquired Pneumonia ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Increased Risk

Polymicrobial pneumonia may be caused by the combination of respiratory viruses, bacteria and fungi in a host. Colonization by <em>Streptococcus pneumoniae</em> was associated with increased risk of Intensive Care Unit admission or death in the setting of influenza infection, whereas the colonization by methicillin sensible <em>Staphylococcus aureus</em> co-infection was associated with severe disease and death in adults and children. The principal association of pathogens in community-acquired pneumonia (CAP) is bacteria and viral co-infection, and accounts approximately for 39% of microbiological diagnosed cases of CAP. The differential clinical diagnosis between a viral and a bacterial CAP is not easy: no clinical signs or radiological findings help the clinician to suspect to the diagnosis. Patients with polymicrobial infections are more likely to have underlying medical conditions and have more severe outcome. Severe respiratory failure and need of mechanical ventilation occur in several cases. Non invasive ventilation (NIV) use aims to avoid invasive mechanical ventilation. NIV treatment is controversial owing to high reported treatment failure. In this case series we report three cases of severe polymicrobial CAP: all of them required NIV with a good outcome.

scholarly journals The use of non-invasive ventilation for life-threatening asthma attacks: Changes in the need for intubation

Respirology ◽  
2010 ◽  
Vol 15 (4) ◽  
pp. 714-720 ◽  
Author(s):  
Kimihiko MURASE ◽  
Keisuke TOMII ◽  
Kazuo CHIN ◽  
Tomomasa TSUBOI ◽  
Ayako SAKURAI ◽  
...  
Keyword(s):  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Life Threatening

scholarly journals Remdesivir in Severe COVID-19 and Non-Invasive Ventilation: A Real-Life Experience

Healthcare ◽  
2021 ◽  
Vol 9 (9) ◽  
pp. 1108
Author(s):  
Francesca Simioli ◽  
Carmine Nicoletta ◽  
Maria Rosaria Valentino ◽  
Maria Martino ◽  
Anna Annunziata ◽  
...  
Keyword(s):  
Clinical Improvement ◽  
Antiviral Treatment ◽  
Clinical Signs ◽  
Real Life ◽  
Lung Damage ◽  
Lung Involvement ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Markers Of Inflammation ◽  
Non Invasive Ventilation

Background: Antiviral treatment is a hot topic regarding therapy for COVID-19. Several antiviral drugs have been tested in the months since the pandemic began. Yet only Remdesivir obtained approval after first trials. The best time to administer Remdesivir is still a matter for discussion and this could also depend upon the severity of lung damage and the staging of the infection. Methods: We performed a real-life study of patients hospitalized forCOVID-19 and receiving non-invasive ventilation (NIV). In this single-center study, a 5 day course of Remdesivir was administered as compassionate use. Further therapeutic supports included antibiotics, low molecular weight heparin and steroids. Data collection included clinical signs and symptoms, gas exchange, laboratory markers of inflammation, and radiological findings. Major outcomes were de-escalation of oxygen-support requirements, clinical improvement defined by weaning from ventilation to oxygen therapy or discharge, and mortality. Adverse drug reactions were also recorded. All data were collected during hospitalization and during a 20-day follow up after treatment. Results: 51 patients were enrolled. A global clinical improvement was recorded in 22 patients (43%) at 12 days, and 36 (71%) at 20 days; in particular, at 12 days, 27 patients (53%) also had a de-escalation of oxygen-support class from a therapeutic point of view. Remdesivir use was associated with a lower hazard ratio for clinical improvement in the elderly (older than 70 years) and in subjects with more extensive lung involvement (total severity score at HRCT of more than 14). The 20-day mortality was 13%. Conclusions: Results demonstrated that Remdesivir is associated with an improvement in clinical, laboratory and radiological parameters in patients with severe COVID-19 and showed an overall mortality of 13%. We conclude that, in this cohort, Remdesivir was a beneficial add-on therapy for severe COVID-19, especially in adults with moderate lung involvement at HRCT.

scholarly journals Efficacy and Safety of Remdesivir over Two Waves of the SARS-CoV-2 Pandemic

Antibiotics ◽  
2021 ◽  
Vol 10 (12) ◽  
pp. 1477
Author(s):  
Mariacristina Poliseno ◽  
Crescenzio Gallo ◽  
Donatella Concetta Cibelli ◽  
Graziano Antonio Minafra ◽  
Irene Francesca Bottalico ◽  
...  
Keyword(s):  
Antiviral Treatment ◽  
High Rate ◽  
Efficacy And Safety ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Clinical Recovery ◽  
Non Invasive Ventilation ◽  
Group A ◽  
Group B ◽  
Low Rate

The aim of this study is to describe the features, the outcomes, and the clinical issues related to Remdesivir administration of a cohort of 220 patients (pts) with COVID-19 hospitalized throughout the last two pandemic waves in Italy. One hundred and nine pts were enrolled from 1 September 2020, to 28 February 2021 (Group A) and 111 from 1 March to 30 September 2021 (Group B). Notably, no differences were reported between the two groups neither in the timing of hospitalization. nor in the timing of Remdesivir administration from symptoms onset. Remarkably, a higher proportion of pts with severe COVID-19 was observed in Group B (25% vs. 10%, p < 0.001). At univariate and multivariate analysis, rather than the timing of Remdesivir administration, age, presence of coexisting conditions, D-dimers, and O2 flow at admission correlated positively to progression to non-invasive ventilation, especially for patients in Group B. However, the rate of admission in the Intensive Care Unit and/or death was comparable in the two groups (7% vs. 4%). Negligible variations in serum GOT, GPT, GGT, and eGFR levels were detected. A mean reduction in heart rate was noticed within the first three days of antiviral treatment (p < 0.001). Low rate of ICU admission, high rate of clinical recovery, and good drug safety were observed in COVID-19 patients treated with Remdesivir during two diverse pandemic waves.

scholarly journals Acute respiratory failure following ovarian hyperstimulation syndrome

2013 ◽  
pp. 43-47 ◽  
Author(s):  
Antonello Nicolini ◽  
Alessandro Perazzo ◽  
Piergiorgio Gatto ◽  
Mario Santo ◽  
Monica Bonfiglio
Keyword(s):  
Intensive Care ◽  
Respiratory Failure ◽  
Pleural Effusion ◽  
Ovarian Hyperstimulation Syndrome ◽  
Ovarian Hyperstimulation ◽  
Severe Respiratory Failure ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Life Threatening

Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6) ovarian hyperstimulation syndrome who presented ascites, bilateral pleural effusion and severe respiratory failure treated with non-invasive ventilation. The patient was admitted to the intensive care unit because of severe respiratory failure, ascites, and bilateral pleural effusion due to ovarian hyperstimulation syndrome. Treatment included non-invasive ventilation and three thoracentesis procedures, plus the administration of albumin, colloid solutions and high-dose furosemid. Severe form of ovarian hyperstimulation syndrome is observed in 0.5-5% of the women treated, and intensive care may be required for management of thromboembolic complications, renal failure and severe respiratory failure. Pulmonary intensive care may involve thoracentesis, oxygen supplementation and, in more severe cases, assisted ventilation. To our knowledge, there have been only two studies in English language medical literature that describe severe respiratory failure treated with non-invasive ventilation.

scholarly journals Predictors of Non-invasive Ventilation Response Do Not Indicate Response to High Flow Nasal Oxygen: A Bicentric Observational Study.

2021 ◽  
Author(s):  
Alexander Hermann ◽  
Lena-Franziska Lauschke-Leberfinger ◽  
Johann Auer ◽  
Irene Steiner ◽  
Robin Ristl ◽  
...  
Keyword(s):  
Heart Rate ◽  
Sofa Score ◽  
Base Excess ◽  
High Flow ◽  
Invasive Ventilation ◽  
Non Invasive ◽  
Non Invasive Ventilation ◽  
Rate Base ◽  
Group A ◽  
Group B

Abstract BackgroundIn patients receiving high flow nasal oxygen (HFNO), predicting chance of response is crucial in order to avoid unnecessary delay of intubation. Whether commonly used predictors of non-invasive ventilation (NIV) response may be as applicable for HFNO, is unclear.MethodsWe conducted a retrospective bi-centric analysis of adults treated with HFNO in two Austrian medical intensive care units from 01/2014 until 09/2017. Predictive value of respiratory rate, PaO2, PaCO2, SpO2, ROX index, pH, heart rate, base excess, SOFA-Score and SAPS III was analysed by means of logistic regression with HFNO responding as dependent variable. Calculations were also done separately in patients receiving HFNO as post-extubation support (Group A) and all other indications (Group B). ResultsWe registered 127 patients (m:f = 70:57, median age: 67 [IQR 53-77] years). Forty-eight patients (37.8%) received HFNO as post-extubation support and were assigned to group A. Seventy-nine patients (62.2%) received HFNO due to any other indication and were assigned to group B. Criteria of HFNO response were fulfilled by 42 patients (87.5%) of group A and 53 (67.1%) of group B patients.Whereas respiratory rate, PaO2, PaCO2, SpO2, pH, heart rate, base excess, SOFA-Score and SAPS III did not differ between responders and non-responders, ROX index showed significant association with HFNO success in all patients. With increasing ROX index, the odds for response increased (OR [95% CI]: baseline: 1.21 [1.05, 1.38], p = 0.0069, after 2 hours: 1.19 [1.05; 1.34], p = 0.0061, after 6 hours: 1.23 [1.06; 1.42], p = 0.0049). Subgroup analyses revealed similar odds ratios for ROX index (baseline: group A: 1.17 [0.90; 1.52], p = 0.24; group B: 1.22 [1.04; 1.43], p = 0.015; after 2 hours: 1.30 [0.94; 1.82], p = 0.12, group B: 1.18 [1.03; 1.34], p = 0.014; after 6 hours: 1.76 [1.01; 3.06], p = 0.047, group B: 1.19 [1.03; 1.37], p = 0.022). ConclusionsCriteria of HFNO success deviate from criteria for response to NIV. ROX index indicated HFNO response in a wide range of indications.

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