scholarly journals ACUTE SKIN FAILURE AND PRESSURE INJURY IN THE PATIENT WITH COVID-19

2021 ◽  
Author(s):  
Aline de Oliveira Ramalho ◽  
Talita dos Santos Rosa ◽  
Vera Lúcia Conceição de Gouveia Santos ◽  
Paula Cristina Nogueira
Keyword(s):  
Differential Diagnosis ◽  
Invasive Mechanical Ventilation ◽  
Hemodynamic Instability ◽  
Cardiac Insufficiency ◽  
Prolonged Fasting ◽  
Disseminated Intravascular Coagulopathy ◽  
Factors Associated ◽  
Pressure Injury ◽  
Intravascular Coagulopathy ◽  
Coronavirus Infection

Objective:report the case of a critical patient with COVID-19 and show the main findings related to the injury considered acute skin failure (ASF), as well as perform his differential diagnosis with preventable pressure injury (PI). Method: observational, longitudinal, case report type study, developed in a hospital in São Paulo, in the intensive care unit (ICU) exclusively for people diagnosed with COVID-19. Data were collected from a single patient between March and September 2020. Results: A patient with complications from COVID-19 developed a skin lesion, initially defined as PI and later reclassified as ASF. The following findings corroborated the diagnosis: prolonged invasive mechanical ventilation, respiratory, renal and cardiac insufficiency and sepsis of respiratory focus. In addition, other aggravating factors, such as the use of vasoactive drugs, hemodynamic instability with intolerance to minimal repositioning, prolonged fasting and disseminated intravascular coagulopathy associated with coronavirus infection. Conclusion: the report shows that there are difficulties for the differential diagnosis between ASF and PI in clinical practice. This is a new concept, and it is essential that health professionals recognize the main factors associated with the appearance of ASF, many of which are also related to the development of PI, highlighting the need for individualized analysis of these injuries, and ensuring the implementation of interventions for prevention and treatment.

scholarly journals Factores Asociados a Hemorragia Intraventricular En Neonatos Atendidos En Un Hospital de Segundo Nivel

2017 ◽  
Vol 13 (36) ◽  
pp. 71
Author(s):  
Miguel Ángel Martínez Camacho ◽  
Alberto Juárez Lira ◽  
Ma. de los Ángeles López Cortéz ◽  
Helios Mancera Roque
Keyword(s):  
Early Intervention ◽  
Neonatal Intensive Care ◽  
Intervention Program ◽  
Pediatric Population ◽  
Periventricular Leukomalacia ◽  
Invasive Mechanical Ventilation ◽  
Hemodynamic Instability ◽  
Early Intervention Program ◽  
Factors Associated ◽  
Intervention Service

Intraventricular hemorrhage (HIV) is a complication in neonates. It originates in the subependymal germinal matrix. This area is irrigated by a network of poorly differentiated vessels without a basement membrane. Also, it is fragile and vulnerable to the hemodynamic instability of cerebral blood flow. It is an important risk factor for periventricular leukomalacia, ventriculomegaly, and hydrocephalus. These neurological pathologies can generate sequelae in the pediatric population such as cerebral palsy (CP). Objective: To identify the factors associated with HIV in neonates treated in the early intervention program of the hospital of specialties of the child and the woman of the Secretary of Health of the State of Querétaro (HENMSESEQ). Material and Methods: Through the review of the clinical files, the factors associated with HIV present in the children attended to in the HENMSESEQ early intervention service were observed in 2015. Cases of HIV were corroborated by means of transfontanel ultrasound, statistical analysis with measures of central tendency, and comparison of the medians of children diagnosed with HIV and without diagnosis. Results: A group of 69 infants attended to in the early intervention program was studied. Out of them, 65.2% (45) were women and 34.3% (24) were men. They had a gestational age of 34.19 ± 4.22 weeks, birth weight of 2116.09 ± 859.36 g, and height of 44.06 ± 6.02 cm. Their stay in the Neonatal Intensive Care Unit (NICU) for the sample was 11.88 ± 16.84 days and they were 8.65 ± 12.20 days with invasive mechanical ventilation. There were 25 cases of HIV diagnosed by  transfontanel ultrasound. Out of the 25 cases, 7 (10%) were HIV grade I, 14 (20%) II, 4 (5.7%) III, and no cases of grade IV were diagnosed. Using the Mann-Whitney U test, a difference was found between the groups of neonates diagnosed with HIV and without diagnosis in weeks of gestation, height, weight, APGAR, days of intubation, and days of stay in NICU.

scholarly journals Scurvy in a patient with AIDS: case report

2011 ◽  
Vol 44 (1) ◽  
pp. 122-123 ◽  
Author(s):  
André Luiz Maltos ◽  
Luciana Ligia da Silva ◽  
Aderbal Garcia Bernardes Junior ◽  
Guilherme Vannucchi Portari ◽  
Daniel Ferreira da Cunha
Keyword(s):  
Laboratory Data ◽  
Serum Vitamin ◽  
Hemodynamic Instability ◽  
Disseminated Intravascular Coagulopathy ◽  
Illicit Drug User ◽  
Protein Levels ◽  
Reactive Protein ◽  
Gingival Hypertrophy ◽  
Intravascular Coagulopathy ◽  
Oral Candida

We report the case of a 35-year-old homeless alcoholic and illicit drug user, with AIDS, who was admitted to the emergency unit complaining of asthenia and a weight loss of 30kg over the preceding three months. Clinical and laboratory data confirmed a diagnosis of marasmus, bacterial pneumonia, chorioretinitis caused by Toxoplasma gondii and oral Candida infection. The patient also presented loss of tongue papillae, gingival hypertrophy, perifollicular hyperkeratosis and hemorrhage, coiled, corkscrew-like hair, anemia, hypoalbuminemia, increased C-reactive protein levels and low serum vitamin C levels. The patient developed severe gastric hemorrhage, with hemodynamic instability and terminal disseminated intravascular coagulopathy.

scholarly journals Intra-dialytic hypotension following the transition from continuous to intermittent renal replacement therapy

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
William Beaubien-Souligny ◽  
Yifan Yang ◽  
Karen E. A. Burns ◽  
Jan O. Friedrich ◽  
Alejandro Meraz-Muñoz ◽  
...  
Keyword(s):  
Renal Replacement Therapy ◽  
Hospital Mortality ◽  
Replacement Therapy ◽  
Kidney Injury ◽  
Hemodynamic Instability ◽  
Factors Associated ◽  
Definition Of ◽  
Vasopressor Use ◽  
Cumulative Fluid Balance ◽  
Intermittent Renal Replacement Therapy

Abstract Background Transition from continuous renal replacement therapy (CRRT) to intermittent renal replacement therapy (IRRT) can be associated with intra-dialytic hypotension (IDH) although data to inform the definition of IDH, its incidence and clinical implications, are lacking. We aimed to describe the incidence and factors associated with IDH during the first IRRT session following transition from CRRT and its association with hospital mortality. This was a retrospective single-center cohort study in patients with acute kidney injury for whom at least one CRRT-to-IRRT transition occurred while in intensive care. We assessed associations between multiple candidate definitions of IDH and hospital mortality. We then evaluated the factors associated with IDH. Results We evaluated 231 CRRT-to-IRRT transitions in 213 critically ill patients with AKI. Hospital mortality was 43.7% (n = 93). We defined IDH during the first IRRT session as 1) discontinuation of IRRT for hemodynamic instability; 2) any initiation or increase in vasopressor/inotropic agents or 3) a nadir systolic blood pressure of < 90 mmHg. IDH during the first IRRT session occurred in 50.2% of CRRT-to-IRRT transitions and was independently associated with hospital mortality (adjusted odds ratio [OR]: 2.71; CI 1.51–4.84, p < 0.001). Clinical variables at the time of CRRT discontinuation associated with IDH included vasopressor use, higher cumulative fluid balance, and lower urine output. Conclusions IDH events during CRRT-to-IRRT transition occurred in nearly half of patients and were independently associated with hospital mortality. We identified several characteristics that anticipate the development of IDH following the initiation of IRRT.

Disseminated Intravascular Coagulopathy in Critically Ill Patients in Amman, Jordan

2021 ◽  
pp. 109980042110172
Author(s):  
Eman Mahmoud Qasim Emleek ◽  
Amani Anwar Khalil
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Scoring System ◽  
Elevated Serum ◽  
Underlying Disease ◽  
Disseminated Intravascular Coagulopathy ◽  
Period Prevalence ◽  
Lower Baseline ◽  
Intravascular Coagulopathy

Background: The disseminated intravascular coagulation (DIC) is under-recognized in critically ill patients. The International Society of Thrombosis and Haemostasis (ISTH; DIC) provides a useful scoring system for accurate DIC identification. The study investigated the period prevalence of ISTH DIC from 2015 to 2017 in critically ill patients. Methods: In this multi-center, retrospective observational study, we included all patients identified with a DIC code or medically diagnosed with DIC during all admissions. Based on ISTH DIC scores ≥ 5, patients were classified with overt DIC. Results: A total of 220 patients were included in this study. The period prevalence of DIC was 4.45%. The point prevalence of DIC has increased from 3.49% to 5.58% from 2015 to 2017 (27.7% female; median age 61.6 years). Based on the ISTH-Overt DIC criteria, 45.2% of the sample had sepsis. Overt DIC patients had significantly lower baseline hemoglobin (HB; t = 2.137, df = 193, p = 0.034), platelet count ( t = 3.591, df = 193, p < 0.001) and elevated serum creatinine level ( M = 2.1, SD = 1.5, t = 2.203, df = 193, p = 0.029) compared to non–Overt DIC. There was a statistically significant elevation in FDPs among Overt DIC compared to non–Overt DIC (χ2 = 30.381, df = 1, p < 0.001). Overt DIC patients had significantly prolonged PT ( U = 2,298, z = 5.7, p < 0.001), PTT ( U = 2,334, z = 2.0, p = 0.045) and INR ( U = 2,541, z = 5.1, p < 0.001) compared to those with non–Overt DIC. Conclusion: The ISTH overt-DIC score can be used in critically ill patients regardless of the underlying disease. Efforts are required to predict and identify overt DIC using a valid scoring system on admission and follow-up of adult patients admitted to ICU.

Association of Ventilator Type with Hospital Mortality in Critically Ill Patients with SARS-CoV2 Infection: A Retrospective Study.

2021 ◽  
Author(s):  
Alexis FERRE ◽  
Fabien Marquion ◽  
Marc Delord ◽  
Jean-Pierre Bédos ◽  
Hugo Bellut ◽  
...  
Keyword(s):  
Hospital Mortality ◽  
Multivariate Regression ◽  
Distress Syndrome ◽  
Invasive Mechanical Ventilation ◽  
Patient Characteristics ◽  
Tertiary Hospital ◽  
Prospective Data ◽  
Factors Associated ◽  
Kaplan Meier ◽  
Patient Groups

Abstract Background: To evaluate the association between ventilator type and hospital mortality in patients with acute respiratory distress syndrome (ARDS) related to COVID-19 (SARS-CoV2 infection) during the first wave of the disease in France.Methods: We retrospectively included consecutive adults admitted to the intensive care unit (ICU) of a university-affiliated tertiary hospital for ARDS related to proven COVID-19, between March and May 2020. All patients were intubated. We compared two patient groups defined by whether an ICU ventilator or a less sophisticated ventilator such as a transport ventilator was used. Kaplan-Meier survival curves were plotted. Cox multivariate regression was performed to identify associations between patient characteristics and hospital mortality.Results: We included 82 patients (61 [74.4%] men) with a median age of 64 years [55–74], of whom 23 (28.1%) died before hospital discharge. By multivariate analysis, factors associated with in-hospital mortality were older age (HR, 1.06/year; 95%CI, 1.00–1.11; P=0.05) and diabetes mellitus (HR, 3.32; 95%CI, 1.13–9.76; P=0.03) but not ventilator type. Using non-ICU ventilator was associated neither with a longer duration of invasive mechanical ventilation (20 [12-36] vs. 25 [15-31] days; P=0.87) nor with a longer ICU stay (24 [14-40] vs. 27 [15-37] days; P=0.64).Conclusions: In patients with ARDS due to COVID-19, the use of non-ICU ventilators, such as transport ventilators, was not associated with worse outcomes. Although prospective data are needed to confirm our findings, this study suggests that transport ventilators may be valuable during COVID-19 surges that overwhelm ICU resources.

Evaluation of obstetrical patients with disseminated intravascular coagulopathy – tertiary center experience

2015 ◽  
Vol 29 (18) ◽  
pp. 2929-2933 ◽  
Author(s):  
Serdar Başaranoğlu ◽  
Mehmet Sıddık Evsen ◽  
Elif Ağaçayak ◽  
Senem Yaman Tunç ◽  
Zülfikar Yılmaz ◽  
...  
Keyword(s):  
Disseminated Intravascular Coagulopathy ◽  
Tertiary Center ◽  
Intravascular Coagulopathy
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