Cerebral pontine infarction after postpartum hemorrhagic shock

Authors: Faisal Muchtar, Syafri Kamsul Arif, Andi Husni Tanra, Hisbullah Amin, Arif Santoso, Mardiah Tahir

Abstract

Cerebral pontine infarction is a rare complication of hemorrhagic shock. We report an unconscious 30-year-old woman that was admitted with severe postpartum hemorrhage (PPH). The patient required two surgery to control the bleeding. Focal neurologic deficit was recognized after extubation. Computed tomography (CT) scan showed findings which were consistent with acute right-side pontine infarction. The patient’s symptoms improved with anti-thrombotic therapy and she was discharged on the thirteenth day of hospitalization. A routine stroke rehabilitation program was planned.

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Association of fluid balance during first 48 hours and length of mechanical ventilation in pediatric intensive care unit

Authors: Andriamuri P. Lubis, Aridamuriany D. Lubis

Abstract

Background: Prolonged mechanical ventilation can increase mortality and morbidity rate. Study shows that positive fluid balance associated with prolonged mechanical ventilation, longer hospital length of stay, and higher mortality rate in acute lung injury. We conducted this study to show the association of fluid balance and duration of mechanical ventilation in the pediatric intensive care unit.

Methods: This was an analytic observational study in children one month to 18 years old who admitted to Pediatric Intensive Care Unit (PICU) Haji Adam Malik General Hospital Medan during April-November 2019. Fluid balance was recorded during first 48 hours in PICU. Bivariate analysis was done to analyse association of fluid balance and length of mechanical ventilation with logistic regression analysis for the mortality.

Results: One hundred and seventy-one children were included in this study. Positive fluid balance was found in 102 children (59.6%) with length of mechanical ventilation mostly under seven days (64.3%). Chi-square test showed significant association between fluid balance and duration of mechanical ventilation (p<0.001). Univariate logistic regression analysis showed that fluid balance had no significant association with mortality, but Pediatric Logistic Organ Dysfunction-2 (PELOD-2) and Pediatric Index of Mortality 2 (PIM2) had significant association with OR 2.6 (1.6-4.4) and 1.05 (1.02-1.08), respectively. Multivariate model also indicated that PELOD-2>8.5 and PIM2>30% showed significant association with mortality (OR 2.6 [1.6-4.4] and OR 1.05 [1.02-1.08], respectively).

Conclusion: Fluid balance was associated with length of mechanical ventilation, but no effect on mortality. Multivariate model showed independent association of PELOD-2>8.5 and PIM2>30% with mortality.

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Left ventricular end-diastolic volume index as a predictor of fluid responsiveness in children with shock

Authors: Ahmad Bayu Alfarizi, Antonius Hocky Pudjiadi, Rismala Dewi

Abstract
Objective: To identify role of left ventricular end-diastolic volume index as predictor of fluid responsiveness in children.
Design: This was a diagnostic study in children with shock in the Emergency Room and Pediatric Intensive Care Unit of Cipto Mangunkusumo Hospital from June to November 2018. The left ventricular end-diastolic volume index measurements were performed using ultrasonic cardiac output monitor and compared to the increase in stroke volume of ≥15% after fluid challenge as fluid responsiveness criteria. Sample categorized into fluid responsive and non-responsive.
Results: Of 40 subjects, 60 fluid challenge samples were obtained. There were 31 and 29 samples in the fluid responsive and non-responsive group, respectively. There was no significant mean difference in left ventricular end-diastolic volume index in the two groups (p=0.161). The area under the receiver operating characteristic (AUROC) of left ventricular end-diastolic volume index was 40.9% with cutoff value of 68.95 ml/m2. The sensitivity and specificity were 45.16% and 44.83%, respectively. At the left ventricular end-diastolic volume index value of 81.10 ml/m2, the specificity was 72.41% with 22.6% sensitivity.
Conclusion: This study cannot prove left ventricular end-diastolic volume index can act as a predictor of fluid responsiveness in children.

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On becoming a COVIDologist: An intensivist tale

Authors: Joseph Varon

In late December 2019, I was made aware of a novel coronavirus, which had been identified as the cause of a cluster of pneumonia and acute hypoxemic respiratory failure in Wuhan, China. As we are now aware, this coronavirus disease 2019 (COVID-19) outbreak became a global pandemic. Over the next several months, I read everything I could about this illness, from basic epidemiology to advance diagnostic and therapeutic methods.

By the end of February of 2020, a series of cases were reported in the United States, and large mass gathering events were cancelled. At that time, I knew I was going to be called upon to take care of these patients in a very short period of time.

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Under pressure… Pressure pushing down on me

Authors: Avi Ruderman, Brian T. Wessman

A 70-year-old male without significant medical history, presented to the hospital after having been trapped under a piece of industrial equipment for several hours. In addition to multiple orthopedic fractures and compartment syndrome requiring left upper extremity fasciotomies, he was found to have rhabdomyolysis and renal failure. The patient was aggressively resuscitated with crystalloid fluids. He arrived to the Surgical Intensive Care Unit (SICU) intubated and was ultimately started on continuous veno-venous hemodialysis (CVVHD) for metabolic derangements including hyperkalemia. Tube feeds were started on hospital day 1 and the patient was noted to have been having good bowel function.

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Lung injury prediction score as a predictor of acute respiratory distress syndrome in intensive care unit

Authors: Tjokorda Gde Agung Senapathi, Made Wiryana, I Made Gede Widnyana, Christopher Ryalino, Budi Hartono

Abstract

Background: Acute respiratory distress syndrome (ARDS) is a clinical syndrome characterized by acute hypoxemia and bilateral infiltrates in the lung after a triggered injury. A major obstacle in ARDS prevention is the identification of patients at risk of ARDS. The goal of this study was to assess the validity of lung injury prediction score (LIPS) as a predictor of ARDS in the intensive care unit (ICU).

Patients and methods: This is a retrospective observational study conducted in the ICU of Sanglah General Hospital (Bali, Indonesia) in 2019 with 451 subjects were eligible after a systematic random sampling method. Receiver operating characteristics (ROC) analysis was used to assess the ability of LIPS to predict ARDS and determine the best cutoff point for LIPS in predicting ARDS.

Results: The area under ROC curve (AUC) value was 0.86 (95% CI 0.81-0.91). The best cutoff point was at LIPS ≥5 (sensitivity 85.71%, specificity 80.77%). From a cross tabulation calculation, we obtained a relative risk of 18.6 (95% CI 7.4-46.77). A logistic regression analysis obtained an odds ratio of 1.71 (95% CI 1.45-2.03).

Conclusion: LIPS is valid for predicting the incidence of ARDS in ICU patients. It can be used as a screening tool to identify those with a high risk of developing ARDS.

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The use of COVID-19 IgM rapid test in the setting of negative RT-PCR to diagnose infection by SARS-CoV-2: A challenging case

Authors: Elizabeth Gamboa, Melanie Duran, Alan Araiza, Daryelle Varon, Mariya Mohiuddin, Joseph C Gathe Jr, Joseph Varon

Abstract

In December 2019, a novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) caused an outbreak of respiratory disease in Wuhan, China, that quickly spread to other countries causing a global pandemic. Although the reverse transcriptase polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection has become the standard method of diagnosis, this test has limitations that cause false negative results. The sudden onset, and spread of this virus, has created an urgency to find reliable screening and diagnostic tools to identify infected patients, prevent further transmission, and provide treatment for these patients. A rapid and accurate diagnostic tool, the COVID-19 combined IgG and IgM “Rapid” test can detect these antibodies against SARS-CoV-2 using a finger prick blood sample detecting infection in 15 minutes. We report the use of the COVID-19 IgM Rapid Test in the presence of high clinical suspicion, along with typical chest computed tomography findings suggestive of COVID-19 infection, in a patient who tested negative twice for the nasopharyngeal swab specimen RT-PCR test.

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COVID-19-induced hepatic encephalopathy: A case report

Authors: Elizabeth Gamboa, Diego Montelongo, Hussein Berjaoui, Daryelle S. Varon, Joseph C Gathe Jr, Joseph Varon

Abstract

By the end of December 2019, a single stranded ribonucleic acid (RNA) virus, Coronavirus, was said to be responsible for an outbreak of respiratory infections of unknown origin in Wuhan, China. Globally, this virus has caused over 160,000 deaths and is expected to increase as the pandemic continues. The majority of patients with the coronavirus disease 2019 (COVID-19) infection present symptomatically with fever, shortness of breath, or cough; however, given that the Coronavirus targets the angiotensin converting enzyme 2 receptors (ACE2), it has been suspected that the virus also exhibits neuroinvasive effects. We present a case of a 32-year-old man with a one-week history of progressive shortness of breath, myalgias, arthralgias, fever peaks, who tested positive for COVID-19 and developed acute hepatic encephalopathy with altered mental status.

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Early mobilization of the critically ill patient: Literature systematic review

Authors: João Vítor Vieira, Rogério Ferrinho Ferreira, Margarida Palma Goes, Henrique Oliveira, Raquel Guerreiro Pacheco, Jorge Pereira

Abstract

Introduction: The immobility and prolonged bed rest, to which the critically ill patient admitted to the intensive care unit, is subjected harmful and have potential adverse effects, especially on the musculoskeletal system and, consequently, on motor functionality.

Objectives: To characterize the impact of early mobilization on the critical patient admitted to an intensive care unit.

Method: Systematic review of the literature that used the PI[C]OD methodology to compile the research question, which led to the search in the EBSCOHost search engine, in the CINAHL Complete and MEDLINE Complete databases, for the identification of studies published between 2016 and 2019. Four systematic reviews of the literature and three randomized controlled trials were selected. This review considered the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) recommendation. Levels of evidence were secured by the levels of evidence from The Joanna Briggs Institute and methodological quality was analyzed using the Critical Appraisal Skills Program.

Results: Most of the articles included in this review point to the benefits of early mobilization in intensive care units, mainly for the improvement of motor functionality and functional capacity, and only one revision, due to the poor quality of the articles included, is inconclusive to the benefits of this intervention in this population.

Conclusions: Early mobilization is a feasible, beneficial, and safe intervention for the critical patient admitted to an intensive care unit. However, due to the lack of studies on the subject and the limitations of the studies analyzed, it is suggested that more quantitative studies, with more representative samples, be carried out.

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A primary biomarker examination in preventing progressivity of acute respiratory distress syndrome: the role of surfactant protein-D in sepsis induced ARDS

Authors: Anna Surgean Veterini

Abstract

Sepsis is one of the most unreachable conditions of hospitalization and a major contributor to hospital mortality, representing a major worldwide health burden. Sepsis is a syndrome characterized by an irregular host response to pathogens invasion, which involving hemodynamic changes that lead to multiple life-threatening organ dysfunctions. Among the injured organs, the lung is the first and most frequent organ to fail. Acute respiratory distress syndrome (ARDS) develops with many serious medical disorders. At least, mortality is 40% and there is no specific therapy. ARDS is an acute inflammatory process in the lung caused by infection direct or indirectly to the alveolar-capillary membrane. Currently, ARDS is diagnosed based on a combination of clinical and physiological variables. In this article, we will review the current understanding of surfactant protein-D as one of many biomarkers in ARDS diagnosis.

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