Spontaneous Escherichia Coli Meningitis in an Adult

Escherichia coli meningitis has been reported rarely in adult patients. Moreover, it is very rare in an adult patient without diabetes mellitus or neurosurgical shunts. Even with treatment, it carries a high mortality ranging from 27% to 90%, and mortality without treatment is 100% [1-3].
We describe a rare case of an adult patient, without known predisposing factors such as diabetes mellitus or neurosurgical shunts, who presented with E. coli meningitis.


Endotracheal Cuff Pressures in Ventilated Patients in Intensive Care

There are well over 50,000 patients who receive ventilation via an endotracheal tube in the Intensive Care Units (ICUs) in Australia and New Zealand every year. Almost all episodes of invasive ventilation in adults are associated with inflation of endotracheal cuff. While monitoring of the cuff pressure has been recommended during anaesthesia this has not been reflected in any of the minimum standards documents. Endotracheal tubes placed in the Operating Theatre (OT) are usually in situ for a matter of hours, while endotracheal intubation in ICU is more prolonged, and thus the risk of time dependent sequelae is increased.
If the Pcuff is excessively elevated the cuff has the potential to herniate or to cause direct damage through ischemia of the tracheal mucosa.


Sepsis: A Study of Physician’s Knowledge about the Surviving Sepsis Campaign in Puerto Rico

Sepsis is a clinical syndrome characterized by systemic inflammation and widespread tissue injury. It results from an excessive inflammatory host response to an infective agent which, when generalized, involves normal tissue not originally affected by the causative organism(s). There is massive release of inflammatory mediators, causing leukocytes to accumulate in organs distant from the initial infection, with further inflammation. Recent evidence recognizes the active role of a deregulated coagulation cascade in the pathophysiology of sepsis. These changes result in severe alterations of the microcirculation with the end result being tissue hypoperfusion.


Natural History and Risk Factors of the “Cholestatic Post-cardiac Surgery Syndrome”

Jaundice following cardiac surgery, frequently referred to as “post-pump jaundice,” has been reported since the 1960’s with an incidence of between 3 to 40%. The incidence of jaundice following mitral valve replacement has been reported to be as high as 55%. Jaundice following cardiac surgery has been associated with prolonged mechanical ventilation, prolonged intensive care unit (ICU) stay, and a higher mortality. The causes of jaundice following cardiac surgery include acute cholecystitis, acute pancreatitis, shocked liver, and septic shock. However, a subset of patients develop hepatic dysfunction without an obvious cause. Hepatic dysfunction in these patients is characterized by hyperbilirubinemia with a mild elevation in hepatic transaminases and no evidence of biliary obstruction on imaging. This entity has been referred to as the “cholestatic post-cardiac surgery syndrome”.


Year in Review 2006: The Critically Ill Patient in the Pediatric ICU

The care of the critically ill patient in the pediatric intensive care unit (PICU) has remained an important topic for those health care providers dealing with children. The purpose of this article is to introduce to the reader a summary of selected papers which we consider relevant to the care of the pediatric critically ill patient and that were published in the year 2006. These articles were selected on the basis of application to the PICU, overall importance and are not to be solely considered authoritative in their field. There are many other useful articles. We have attempted to choose those articles with scientific merit and rigorous methodology that we believe present interesting data in the field.


Acute Confusion: An Unusual Presentation of Miliary Tuberculosis

Clinical presentation of miliary tuberculosis is highly variable. Patients that present with central nervous system disease such as meningitis or tuberculoma is seen in up to 20% of the cases. Meningeal involvement is usually seen in up to 54% of the cases of miliary tuberculosis, and in just a few minority of patients the AFB smears are positive.