scholarly journals Switching from High-dose Fentanyl to Low-doseMorphine Induced Relief of Dyspnea in a Patient with COVID-19 Pneumonia under Mechanical Ventilation: A Case Report

2021 ◽  
Vol 16 (4) ◽  
pp. 301-306
Author(s):  
Naho Ihara ◽  
Yoko Takino ◽  
Miwako Ohgishi ◽  
Mari Takeuchi ◽  
Akiko Abe ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
High Dose

scholarly journals Case Report: Enhanced Diazepam Elimination With the Molecular Adsorbents Recirculating System (MARS) in Severe Autointoxication: A Survival Case Report

2021 ◽  
Vol 8 ◽  
Author(s):  
Anna Dobisova ◽  
Peter Vavrinec ◽  
Diana Vavrincova-Yaghi ◽  
Andrea Gebhardtova ◽  
Robert H. Henning ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Plasma Level ◽  
High Dose ◽  
Mechanically Ventilated ◽  
First Case ◽  
Blood And Urine Samples ◽  
Repeated Doses ◽  
High Doses ◽  
Elimination Clearance

Objective: Due to the extensive use of diazepam worldwide, self-induced intoxication is very common, yet rarely fatal. Nevertheless, the management of intoxication caused by extremely high doses of diazepam is not known, as well as the effectiveness of flumazenil, a specific benzodiazepine (BDZ) antagonist. Here we present the first report on the enhanced elimination (clearance) of diazepam using the Molecular Adsorbents Recirculating System (MARS) following autointoxication with an extremely high dose as part of a suicide attempt.Case: A 44-year-old male patient was admitted to the ICU because of impaired consciousness following the ingestion of 20 g of diazepam. Blood and urine samples revealed high benzodiazepine levels. Repeated doses of flumazenil were without effect on consciousness. Following deterioration of the patient's clinical condition, including unconsciousness, hypoventilation, and decreased SpO2 (88%), the patient was intubated and mechanically ventilated. On the fourth day after admission, the patient was unresponsive, with no attempt to breath spontaneously. The plasma level of benzodiazepines was 1,772 μg/l. The elimination of benzodiazepines by MARS was attempted, continuing for 5 days, with one session per day. Five sessions of MARS effectively enhanced benzodiazepine elimination. After the first MARS treatment, the plasma level of benzodiazepines dropped from 1,772 to 780 μg/l. After the final MARS treatment on the eighth day, the patient was weaned from mechanical ventilation and extubated. Two days later, the patient was discharged to the internal medicine department and subsequently to the psychiatry department.Conclusions: To the best of our knowledge, this is the first case reporting successful treatment of diazepam intoxication using MARS. In severe cases of diazepam intoxication, with prolonged unconsciousness and the necessity of mechanical ventilation, we suggest considering the use of MARS elimination therapy together with the monitoring of the BDZ plasma level.

Combined Modalities in the Treatment of an Unresponsive Patient with Adult Status Asthmaticus

1995 ◽  
Vol 10 (3) ◽  
pp. 142-144
Author(s):  
Sabena Toor ◽  
Jeff Borenstein ◽  
Zab Mohsenifar
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Asthma Exacerbation ◽  
Status Asthmaticus ◽  
High Dose ◽  
Barbiturate Coma ◽  
Severe Asthma Exacerbation ◽  
Adult Status ◽  
Successful Extubation

We present a 42-year-old woman with status asthmaticus who required mechanical ventilation and a combination of maneuvers, including barbiturate coma, general anesthesia, high-dose steroids, bronchoscopic pulmonary toilet, and helium-oxygen ventilation, resulting in successful extubation and eventual hospital discharge. This case report illustrates the possible role of combination therapy in the management of severe asthma exacerbation.

scholarly journals Treatment of Tetanus in ICU: A Case Report

2013 ◽  
Vol 1 (1) ◽  
pp. 56-58
Author(s):  
Farzana Shumy ◽  
Ahmad Mursel Anam ◽  
Mohammad Mafizul Islam Polash ◽  
Md Motiul Islam ◽  
Raihan Rabbani ◽  
...  
Keyword(s):  
Mechanical Ventilation ◽  
Developing Countries ◽  
Case Report ◽  
Cause Of Death ◽  
Muscle Relaxant ◽  
Muscle Spasm ◽  
Depression Treatment ◽  
High Dose ◽  
Respiratory Complications ◽  
High Doses

Tetanus remains an important cause of death in the developing countries, like Bangladesh. The cause of death in tetanus is spasm of the larynx and muscle spasm. High dose muscle relaxant are required to prevent this which itself has side effect like respiratory depression. Treatment in ICU with the help of mechanical ventilation prevents death from respiratory complications and produce best possible therapeutic effect of the drugs. In this case, a patient of tetanus was managed in ICU with high doses of muscle relaxant along with all the medication necessary for tetanus and produced good outcome. DOI: http://dx.doi.org/10.3329/bccj.v1i1.14372 Bangladesh Crit Care J March 2013; 1: 56-58

scholarly journals Bilateral shoulder arthritis in COVID-19 patient after prolonged mechanical ventilation assist: a case report

2021 ◽  
Vol 16 (10) ◽  
pp. 2894-2898
Author(s):  
Teresa Resende Neves ◽  
Ana Luísa Lourenço ◽  
Pedro Alves ◽  
Carlos Teiga ◽  
António Proença Caetano
Keyword(s):  
Mechanical Ventilation ◽  
Case Report ◽  
Prolonged Mechanical Ventilation ◽  
Shoulder Arthritis

Refractory eosinophilic fasciitis successfully treated with infliximab: A case report

2021 ◽  
pp. 239719832110043
Author(s):  
Paulina Śmigielska ◽  
Justyna Czarny ◽  
Jacek Kowalski ◽  
Aleksandra Wilkowska ◽  
Roman J. Nowicki
Keyword(s):  
Case Report ◽  
Connective Tissue ◽  
Treatment Failure ◽  
Immunosuppressive Drugs ◽  
Unknown Etiology ◽  
High Dose ◽  
Eosinophilic Fasciitis ◽  
Line Treatment ◽  
First Line ◽  
First Line Treatment

Eosinophilic fasciitis is a rare connective tissue disease of unknown etiology. Therapeutic options include high-dose corticosteroids and other immunosuppressive drugs. We present a typical eosinophilic fasciitis case, which did not respond to first-line treatment, but improved remarkably after infliximab administration. This report demonstrates that in case of initial treatment failure, infliximab might be a relatively safe and effective way of eosinophilic fasciitis management.

scholarly journals COVID‐19 reinfection in a healthcare worker after exposure with high dose of virus: A case report

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Shahram Ahmadian ◽  
Hadis Fathizadeh ◽  
Saeid Shabestari Khiabani ◽  
Mohammad Asgharzadeh ◽  
Hossein Samadi Kafil
Keyword(s):  
Case Report ◽  
Healthcare Worker ◽  
High Dose

scholarly journals Nonepileptic Myoclonus in COVID-19: Case Report

2021 ◽  
pp. 194187442110043
Author(s):  
Henly Hewan ◽  
Annie Yang ◽  
Aparna Vaddiparti ◽  
Benison Keung
Keyword(s):  
Case Report ◽  
Critically Ill ◽  
Recovery Phase ◽  
Critically Ill Patient ◽  
High Dose ◽  
The Novel ◽  
Neurological Manifestations ◽  
Immune Mediated ◽  
Novel Coronavirus ◽  
Post Infectious

In late 2019, the novel coronavirus, SARS-CoV-2, and the disease it causes, COVID-19, was identified. Since then many different neurological manifestations of COVID-19 have been well reported. Movement abnormalities have been rarely described. We report here a critically ill patient with COVID-19 who developed generalized myoclonus during the recovery phase of the infection. Myoclonus was associated with cyclical fevers and decreased alertness. Movements were refractory to conventional anti-epileptic therapies. There was concern that myoclonus could be part of a post-infectious immune-mediated syndrome. The patient improved fully with a 4-day course of high-dose steroids. Our experience highlights a rare, generalized myoclonus syndrome associated with COVID-19 that may be immune-mediated and is responsive to treatment.

scholarly journals Early High-dose Caffeine Improves Respiratory Outcomes in Preterm Infants

Children ◽  
2021 ◽  
Vol 8 (6) ◽  
pp. 501
Author(s):  
Vineet Lamba ◽  
Oscar Winners ◽  
Prem Fort
Keyword(s):  
Mechanical Ventilation ◽  
Preterm Infants ◽  
Regression Models ◽  
High Dose ◽  
Long Term Outcomes ◽  
Logistic Regression Models ◽  
Caffeine Citrate ◽  
Timing Of Initiation ◽  
Respiratory Outcomes

The objective of the study is to determine if early high-dose caffeine (HD) therapy is associated with shorter duration of mechanical ventilation, bronchopulmonary dysplasia (BPD), or decreased need for mechanical ventilation. We conducted a single center, retrospective cohort study of 273 infants less than 32 weeks gestational age (GA). Infants receiving early HD (10 mg/kg/day maintenance) caffeine citrate started within 24 h of life were compared with those receiving LD (6 mg/kg/day) with variable timing of initiation using linear and logistic regression models. The infants in the early HD group had 91.4 (95% confidence interval (CI): −166.6, −16.1; p = 0.018) less hours of mechanical ventilation up to 36 weeks PMA or discharge as compared with the LD group. Moreover, infants in the HD group had 0.37 (95% CI: 0.14, 0.97; p = 0.042) times lower odds of developing moderate/severe BPD compared with the LD group. Infants receiving early HD caffeine had improved respiratory outcomes with no increase in measured comorbidities. Large prospective studies are needed to determine the long-term outcomes of using high-dose caffeine prophylaxis for preterm infants.

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