Acta Colombiana de Cuidado Intensivo最新文献

The use of extracorporeal membrane oxygenation (ECMO) in patients with respiratory failure has demonstrated improvement in clinical outcomes. Despite technological advances, complications related to the devices occur, including hemolysis secondary to exaggerated shear forces generated by blood flows through the circuit. The main causes are associated with thrombosis of the centrifuge cone or inappropriately high RPM (revolutions per minute). However, the oxygenation membrane must also be considered as an etiological agent. We describe a case of a young patient with severe and refractory ARDS due to SARS-CoV-2 in need of ECMO support, who developed an early clinical picture of severe acute hemolysis due to membrane dysfunction. The hemolysis resolved with its change with subsequent favorable evolution of the patient.

Neonatal diabetes mellitus is a monogenic hereditary disease in 80-90% of cases. It presents in two forms: a transient one, generally in the first week of life, characterized by the association of hyperglycemia and intrauterine growth restriction; and a permanent one that presents with severe hyperglycemia and ketoacidosis that manifests before 6 months of life. Clinical forms depend on genetic variation, which is identified by whole exome sequencing. The right treatment is based on the correction of hyperglycemia with insulin, as well as management with high doses of sulfonylureas. This case shows an infant, 1 month and 26 days old, who presents with diabetic ketoacidosis intially in delicate general condition; who was treated with insulin therapy with an adequate response to the metabolic and neurological alterations; KCNJ11 gene mutation was confirmed, suggesting permanent neonatal diabetes mellitus. Currently the patient is being treated with glibenclamide, there is no deterioration in neurodevelopment and his growth is satisfactory. We conclude that all patients under 6 months of age with a diagnosis of diabetes mellitus, regardless of the clinical manifestations, should be studied with genetic or molecular tests to identify associated mutations that will determine the severity of the disease and therefore allow to make an early diagnosis, timely treatment and avoiding long-term complications.

Objective

To characterize patients with SARS-CoV-2 infection and respiratory failure requiring high-flow nasal cannula at 2600 m above sea level.

Design

Descriptive, cross-sectional.

Frame of reference

Coronavirus disease (COVID-19) can cause respiratory failure, an alternative for its management is high-flow nasal cannula, however, it is necessary to define which patients benefit from invasive mechanical ventilation and which from high-flow nasal cannula.

Patients

One hundred and thirty six patients hospitalized in Bogotá, with diagnosis of COVID-19.

Interventions

Non-invasive ventilatory support with high-flow nasal cannula and mechanical ventilation.

Measurements

Sociodemographic and clinical characteristics, arterial and paraclinical gases at admission and on days 1, 2 and 3 in ICU, mortality in ICU.

Results

The 61.76% were men, mean age was 58.82 years, the most prevalent comorbidities were obesity (37.50%) and hypertension (33.82%). The 53.65% required invasive mechanical ventilation and mortality was 34.56%; the variable associated with the need for intubation was the lymphocyte count on admission. There was a significant statistical association between respiratory frequency, lactate, leukocytes, lymphocytes at admission and age with mortality.

Conclusions

In patients with COVID-19 who received oxygen by high-flow nasal cannula at 2600 m above sea level, male sex was predominant, comorbidities and mortality were higher in patients with COVID-19.

Acute respiratory distress syndrome (ARDS) is defined as a form of acute, diffuse, and inflammatory lung injury, associated with a wide variety of etiologies. The diagnosis is based on clinical, radiological, and analytical criteria. Despite advances in the management of this entity, it is associated with high morbidity and mortality.

We present the case of an 18-year-old patient who arrives with severe acute respiratory failure, meeting the criteria for ARDS, secondary to direct lung injury due to inhaled toxins, requiring admission to the intensive care unit and invasive ventilatory support. He was discharged in good condition.

Due to the increasing use of inhaled toxic substances, we consider appropriate to present this entity, as it is part of the wide range of diagnostic possibilities in the spectrum of respiratory distress syndrome.

Objectives

To describe the evolution of patients with Severe Acute Respiratory Distress Syndrome (ARDS) due to COVID-19 who required mechanical ventilation and prone position.

Methods

Descriptive, retrospective, cross-sectional study.

Background

COVID-19 in its severe form presents ARDS and admission to intensive care unit (ICU) for ventilatory support. Prone position is a well-known technique, which consists of ventilating the patient in the ventral position, optimizing alveolar recruitment and thus improving the oxygenation of these patients.

Patients

Adults of both sexes admitted from August 2021 to August 2022 at ICU with a diagnosis of ARDS due to COVID-19 who received orotracheal intubation, mechanical ventilation and prone position as treatment.

Results

In this period, 214 patients with COVID-19 were admitted to the intensive care unit of the Hospital de Clínicas. Of these, 127 patients (59.3%) were on invasive mechanical ventilation and prone position, with improvement in PaO2/FiO2 in 85% of them. They presented non-infectious complications: 13 patients with facial sores, while 2 patients were accidentally extubated. Pneumonia occurred in 87 patients (68%), catheter infection in 12 (9.4%), 5 of which were associated with bacteremia. Bacteremia without a known portal of entry 35 (27.5%). The mortality was 51.18%.

Conclusions

In our study, 60% of the patients required prone position with improved oxygenation in 85% of them, with a low rate of complications associated.

Objective

To understand the clinical-epidemiological profile of patients with solid organ tumors who are evaluated by intensive care physicians to determine their admission to the ICU or not.

Materials and methods

Prospective observational study in the ICU of a tertiary hospital. The study was approved by the Research Ethics Committee (CEI) of Cantabria. Patients over 18 years of age with a solid organ tumor, for whom an assessment was requested by the intensive medicine team for ICU admission, were included. The study included both patients who were admitted and those whose admission was declined. Informed consent was obtained from all patients for inclusion in the registry. Clinical data were reviewed, and patients were followed up 3 months after ICU evaluation.

Results

215 patients were evaluated, of which 173 were admitted to the ICU. The main factors associated with mortality at 3 months after ICU evaluation were the type of tumor, the status of the tumor, the presence of hypertriglyceridemia, and a functional status upon admission with an ECOG score >2 or Karnofsky < 70.

Conclusions

The main factors associated with mortality at 3 months after being evaluated by ICU were the type of tumor, the status of the tumor, the presence of hypertriglyceridemia, and a functional status upon admission with an ECOG score >2 or Karnofsky < 70.

We present the case of a 19-year-old woman, with a history of LADA type diabetes mellitus, who presented an acute decompensation of her metabolic pathology secondary to pneumonia of viral origin due to SARS COV2, with a torpid clinical evolution due to hypoxemic respiratory failure. with the need for invasive mechanical ventilation and secondary ARDS (Acute Respiratory Distress Syndrome), in whom hiccups (Singultos), ventilatory asynchrony and impaired oxygenation were evidenced.

In our patient, hiccups were considered the cause of ventilatory asynchrony, and treatment with levomepromazine was started with adequate resolution of the singultus, leading to a marked improvement in oxygenation and successful extubation.

Hiccups are a benign, common and self-limited phenomenon that affects almost all people throughout their lives, which can be associated with unfavorable results, such as malnutrition, fatigue, weight loss, insomnia, depression, anxiety, edema. and decreased quality of life and in patients with invasive mechanical ventilation it can result in respiratory alkalosis from hyperventilation, ventilator-associated pneumonia, impaired oxygenation indices, and asynchrony.

Hiccups are a little-recognized pathology in patients undergoing ventilatory support, with unfavorable results, evidenced by prolonged stays and the need for invasive mechanical ventilation and management in the intensive care unit (ICU), and of course everything that this includes.

Knowledge of hiccups, as a possible cause of asynchrony and oxygenation disorder in ventilated patients, can allow timely recognition, which allows management in the acute phase, is a fundamental part of minimizing complications associated with ventilation and prolonged stays in ICU.

Introduction

Cardiac trauma is a significant cause of death. Thoracotomy is an advanced resuscitation technique aimed at restoring cardiac output by relieving cardiac tamponade and repairing cardiac injuries.

Objective

A case report of a patient who suffered a penetrating precordial wound that was resolved with a resuscitative thoracotomy was conducted. A narrative review of the current state of the art is presented.

Conclusions

Thoracic trauma associated with cardiac injury is a potentially lethal condition. Despite early diagnosis, overall survival is anecdotal. Medical teams familiar with advanced resuscitation techniques such as resuscitative thoracotomy are required.

We present a case of a rare medical emergency with multiple risk factors and several causes, with high mortality when not diagnosed and treated in a timely manner. Knowing and linking to the description of this case can help the scientific community prepare for rare situations like this. This is a 48-year-old patient with a history of polyglandular autoimmune syndrome under treatment with corticosteroids, who consulted for asthenia, adynamia, weakness and polydipsia. Clinically, hypotension, hypoglycemia, hydroelectrolyte disturbances, acid-base imbalance, elevated thyroid stimulating hormone (TSH) with decreased free thyroxine (T4L) and low paratohormone (PTH) were identified. An adrenal crisis was diagosticated and was admitted to the ICU. During her stay in the intensive care unit (ICU), she presented with an advanced cardiac block that required a pacemaker implant with appropriate evolution. Adrenal crisis is a rare condition, diagnosis requires a high rate of suspicion even when the history of adrenal insufficiency is known. It is necessary to investigate thoroughly the history, background, clinical manifestations, adherence to corticosteroid therapy, perform a complete physical examination and request relevant paraclinical studies for a comprehensive evaluation. Recognize that cardiac block may be refractory to steroid therapy and require electrical support may be essential for patient survival.