Time to positivity: a useful parameter to evaluate intensive care unit blood stream infections?

We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical ventilator, adjusting the continuous airway pressure to 10cmH2O and the inspired fraction of oxygen to 100%. The oxygen saturation was maintained at 100% for 10 minutes. Posttest blood gas analysis results were as follows: pH, 6.90; partial pressure of oxygen, 284.0mmHg; partial pressure of carbon dioxide, 94.0mmHg; and oxygen saturation, 100%. The second case involved a 43-year-old woman admitted with subarachnoid hemorrhage (Hunt-Hess V and Fisher IV). Two clinical exams revealed unresponsive coma and absence of all brainstem reflexes. Brain scintigraphy showed no radioisotope uptake into the brain parenchyma. The first attempt at the apnea test was stopped after 5 minutes due to hypothermia (34.9 °C). After rewarming, the apnea test was repeated without disconnection from the mechanical ventilator, showing maintenance of the functional residual volume wit...
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research

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Authors: Ren HW, Wu Y, Dong JH, An WM, Yan T, Liu Y, Liu CC Abstract OBJECTIVE: To explore the CT imaging features/signs of patients with different clinical types of Coronavirus Disease 2019 (COVID-19) via the application of artificial intelligence (AI), thus improving the understanding of COVID-19. PANTIENTS AND METHODS: Clinical data and chest CT imaging features of 58 patients confirmed with COVID-19 in the Fifth Medical Center of PLA General Hospital were retrospectively analyzed. According to the Guidelines on Novel Coronavirus-Infected Pneumonia Diagnosis and Treatment (Provisional 6th Edition), COVID-19 ...
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Authors: Chen GF, Cheng YR, Ye L, Wang MW, Zhou MY, Zhang F, Chen J, Feng ZH Abstract OBJECTIVE: The World Health Organization reported a cluster of cases of pneumonia of unknown cause detected on December 31, 2019 in China. Unfortunately, a 34-year-old Italian nurse has committed suicide after testing positive for coronavirus. It was the second case of suicide by a nurse in an Italian hospital and occurred only a few days after the first suicide. These consecutive suicides have aroused concern, and it is necessary to investigate the psychological issues of the medical staff in Italy regarding the COVID-19. PMI...
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
CONCLUSIONS: Our results demonstrate a correlation between the required dose of metformin, BMI and hyperandrogenism. The dose of metformin should be adjusted to patients' BMI in order to obtain significant results in terms of clinical, metabolic and hormonal responses. PMID: 32767342 [PubMed - in process]
Source: European Review for Medical and Pharmacological Sciences - Category: Drugs & Pharmacology Tags: Eur Rev Med Pharmacol Sci Source Type: research
Authors: Araki K, Takeuchi R, Katada F, Fukutake T Abstract Rotatory vertigo is known to have not only peripheral causes, e.g., Meniere's disease, vestibular neuritis, and benign paroxysmal positional vertigo, but also central causes, e.g., stroke, hemorrhage, and tumor. In most cases, central rotatory vertigo is caused by a lesion in the brainstem or cerebellum, but rare cases with a cerebral lesion have also been reported. We herin describe a unique case with acute rotatory vertigo following a small hemorrhage in the left superior temporal gyrus, which probably led to a dysfunction of the visual-vestibular system...
Source: Internal Medicine - Category: Internal Medicine Tags: Intern Med Source Type: research
Conclusions: In accordance with trials with low methodological quality, Xiao'er Xiaoji Zhike oral liquid combined with azithromycin seems to be safe and superior to azithromycin alone for the treatment of MPP in children. However, further trials with rigorous methodology need to be implemented for these potential benefits. PMID: 32765636 [PubMed]
Source: Evidence-based Complementary and Alternative Medicine - Category: Complementary Medicine Tags: Evid Based Complement Alternat Med Source Type: research
CONCLUSION: Nosocomial pneumonia is a multifaced disease with features of pivotal interest in critical care medicine. Due to the worrisome data on mortality of patients with nosocomial pneumonia, further prospective studies focused on this topic are urgently needed. PMID: 32759376 [PubMed - in process]
Source: Respiratory Care - Category: Respiratory Medicine Authors: Tags: Eur Respir Rev Source Type: research
CONCLUSION: Fibroblastic sleeve is a frequent (29.9%) but asymptomatic finding in oncological and hematological patients with peripherally inserted central catheter, and-in the vast majority of cases-it occurs within 2 weeks after insertion. If compared to fibroblastic sleeve, asymptomatic catheter-related thrombosis is less frequent (5.51%); symptomatic catheter-related thrombosis is rare (
Source: The Journal of Vascular Access - Category: Surgery Tags: J Vasc Access Source Type: research
CONCLUSION: Nephrolithiasis may lead to very serious conditions such as xanthogranulomatous pyelonephritis. This condition can be easily diagnosed by ultrasound, but if not detected, it can lead to complete loss of renal function as in the case. PMID: 32779427 [PubMed - in process]
Source: The Turkish Journal of Pediatrics - Category: Pediatrics Authors: Tags: Turk J Pediatr Source Type: research
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
We describe the performance of the apnea test without disconnection from the mechanical ventilator in two patients. The first case involved an 8-year-old boy admitted with severe hypoxemia due to pneumonia. He presented with cardiorespiratory arrest, followed by unresponsive coma due to hypoxic-ischemic encephalopathy. Two clinical exams revealed the absence of brainstem reflexes, and transcranial Doppler ultrasound revealed brain circulatory arrest. Three attempts were made to perform the apnea test, which were interrupted by hypoxemia; therefore, the apnea test was performed without disconnection from the mechanical vent...
Source: Revista Brasileira de Terapia Intensiva - Category: Intensive Care Source Type: research
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