Financial Crisis - U.K. Policy and Regulatory Response

WOS: 000405283200015PubMed ID: 2875201

Retrospective review of critically ill obstetrical patients: a decade's experience

WOS: 000298197700016Aim: To investigate the reasons for the admission of obstetrical patients to the intensive care unit (ICU) and their clinical outcomes, to compare the roles of the current scoring systems in estimating the mortality of these patients, and to determine adverse prognostic factors in critically ill obstetrical patients. Materials and methods: Data were retrospectively obtained from obstetrical patients admitted to the ICU in our institution between January 1999 and April 2009. Demographic characteristics, Acute Physiology and Chronic Health Evaluation II (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, and Glasgow Coma Scale (GCS) score of patients at the time of their first ICU admission were recorded. Patients were divided into 2 groups for comparison: Group 1, patients who died in the ICU, and Group 2, patients who were discharged from the ICU. Results: Preeclampsia, eclampsia, and the hemolysis, elevated liver enzymes, and low platelet count syndrome (HELLP) were the most common diagnoses requiring ICU admission (65.1%). APACHE II, SOFA, and GCS values were significantly worse in Group 1 patients compared with Group 2 patients (P < 0.05). Conclusion: Scoring systems help to determine the probability of mortality in obstetrical patients. Utilizing these scoring systems may prevent both the unnecessary admission of low-risk patients and delayed ICU care for critically ill patients

Recurrent Spontaneous Pneumothorax during the Recovery Phase of ARDS Due to H1N1 Infection

WOS: 000317543300027PubMed ID: 25207083The pregnant patients are prone to influenza A (H1N1) virus infection, which may rapidly progress to lower respiratory tract infection and subsequent respiratory failure and acute respiratory distress syndrome (ARDS). Pneumothorax might develop in ARDS under mechanical ventilation. But post-ARDS pneumothorax in spontaneously breathing patient has not been reported in the literature. We report a 31-year old pregnant woman infected with influenza A (H1N1) virus and progressed to ARDS. Mechanical ventilation with high PEEP improved patient's gas exchange parameters within 3 weeks. However spontaneous pneumothorax was developed one week after she weaned off the ventilator. After successful drainage therapy, the patient was discharged. However she re-admitted to the hospital because of a recurrent pneumothorax one week later. She was discharged in good health after being treated with negative continuous pleural aspiration for 10 days. Influenza might cause severe pulmonary infection and death. In addition to diffuse alveolar damage, sub-pleural and intrapulmonary air cysts might occur in influenza-related ARDS and may lead to spontaneous pneumothorax. This complication should always be considered during the recovery period of ARDS and a long-term close follow-up is necessary

Neuromuscular Dysfunction in Experimental Sepsis and Glutamine

WOS: 000379332000004PubMed ID: 27308070Background: Electrophysiological studies show that critical illness polyneuromyopathy appears in the early stage of sepsis before the manifestation of clinical findings. The metabolic response observed during sepsis causes glutamine to become a relative essential amino acid. Aims: We aimed to assess the changes in neuromuscular transmission in the early stage of sepsis after glutamine supplementation. Study Design: Animal experimentation. Methods: Twenty male Sprague-Dawley rats were randomized into two groups. Rats in both groups were given normal feeding for one week. In the study group, 1 g/kg/day glutamine was added to normal feeding by feeding tube for one week. Cecal ligation and perforation (CLP) surgery was performed at the end of one week. Before and 24 hours after CLP, compound muscle action potentials were recorded from the gastrocnemius muscle. Results: Latency measurements before and 24 hours after CLP were 0.68 +/- 0.05 ms and 0.80 +/- 0.09 ms in the control group and 0.69 +/- 0.07 ms and 0.73 +/- 0.07 ms in the study group (p<0.05). Conclusion: Since enteral glutamine prevented compound muscle action potentials (CMAP) latency prolongation in the early phase of sepsis, it was concluded that enteral glutamine replacement might be promising in the prevention of neuromuscular dysfunction in sepsis; however, further studies are required

Effects of IgM-enriched immunoglobulin and fluid replacement on nerve conduction velocity in experimental sepsis

WOS: 000273855400003PubMed ID: 20209389BACKGROUND Neuromuscular abnormalities in sepsis, termed critical illness polyneuropathy (CIP), have been suggested to be induced by inflammatory mechanisms and/or relative hypovolemia. CIP is characterized by early electrophysiological findings before the clinical symptoms. This study aimed to investigate the effect of intravenous immunoglobulin (IVIG) and volume replacement therapies on the possible nerve conduction velocity (NCV) alterations in the early phase of experimental sepsis. METHODS Forty-six Sprague-Dawley rats were randomly assigned to four groups. Cecal ligation/perforation was performed to induce experimental sepsis. NCV was assessed in the tail nerve. RESULTS There was no statistically significant difference in NCV levels within and among the Sham-operated, colloid-and IVIG-treated groups. In the sepsis without treatment group, there was a statistically significant decrease in NCV levels. CONCLUSION NCV is decreased in the early stage of experimental sepsis and it may be accepted as an early electrophysiological sign in CIP. Treatment with either IgM-enriched IVIG or early volume replacement appears to prevent the decrease in NCV in the early phase of experimental sepsis. Results were statistically indistinguishable between the IVIG- and colloid-treated groups. No statistical difference between these groups is noteworthy. There is a need to clarify the mechanisms of action with further randomized, clinical and experimental trials