Tracheal rupture caused by fall from a height

We encounter multiple cranial, thoracal, abdominal, and extremity lesions caused by traffic accidents and fall from a height. Follow-up and treatment of these cases in intensive care units (ICUs) are arranged within the discipline of approach to a case of injury. In the present case, we are dealing with a 38-year-old female patient who had head trauma caused by a fall from a minibus. The patient was presented to our ICU with tracheal rupture. Case Report A 38-year-old female patient who had an extravehicular traffic accident was sent to an external medical center and then her cerebral computed tomography (CT) was obtained because of head trauma. The patient with normal tomographic findings was admitted to ICU. When she was admitted in ICU her conscious was open; however, she was somnolent. She was consulted to neurosurgery department, which suggested her follow-up with cervical and cerebral CTs. She was spontaneously breathing through her intact respiratory tract and received oxygen ventilation at a rate of 3 L/min. Later on, she suffered from respiratory distress and underwent noninvasive intermittent mechanical positive pressure ventilation (NIMV). Control CT revealed right parieto-occipital epidural hematoma and then intracranial pressure catheter was implanted for drainage of the epidural hematoma. On the 9th day of her ICU stay when she was cooperative with improved general health state and open conscious, she was transferred from ICU to the service of neurosurgery. During her transfer to the service, she had intermittent fits of coughing which we thought to be related to airway irritation during her transfer to the service. Özet: Yüksekten düflmenin neden oldu¤u trakea rüptürü Yo¤un bak›m ünitelerinde birden fazla lezyonun izlem ve tedavisi, bir yaralanma olgusuna yaklafl›m disiplini kapsam›nda düzenlenir. Bu yaz›da, bir minibüsten düflüflün neden oldu¤u kafa travmas›na maruz kalm›fl 38 yafl›ndaki bir kad›n hastay› sunduk. Hasta yo¤un bak›m üni-temize epidural hematomla gelmesine karfl›n, izlem s›ras›nda trakea rüptürü saptanm›flt›r. Trakea yaralanmalar› ve özellikle rüptürlere a¤›r travmalarda bile s›kl›kla rastlanmamaktad›r. Travmatik olaylarda, birçok organ sistemiyle ilgili ciddi sorunlar nedeniyle trakea rüptürü-ne tan› koymak zordur. Tan› konduktan sonra daha uzun tedavi süre-ciyle ilgili nörolojik ve enfeksiyon sorunlar›na rastlamak mümkündür. Hastam›zda oldu¤u gibi entübe iken ilave solunumsal sorunlar yaflamayan hastalarda yinelenen entübasyon ve ekstübasyon dönemlerin-den saatler sonra solunum s›k›nt›s›n›n geliflmesi trakea rüptürünün varl›¤›n› düflündürmelidir. Anahtar sözcükler: Trakea rüptürü, yüksekten düflüfl, yaralanma. Abstract Follow-up and treatment of multiple lesions in intensive care units are arranged within the discipline of approach to a case of injury. Herein, we present a 38-year-old female patient who had head trauma caused by a fall from a minibus. The patient was presented to our intensive care unit with epidural hematoma; however, tracheal rupture was found during the follow-up. Tracheal injuries and especially ruptures are not frequently encountered events even in cases with severe traumas. In traumatic events, it is difficult to diagnose tracheal rupture because of serious problems related with many organ systems. After establishment of diagnosis, it is possible to encounter relevant neurological and infectious problems because of longer treatment process. As in the case with our patient, in patients without any additional previously experienced respiratory problems while intubated development of respiratory distress hours after recurrent periods of intubation and extubation should suggest the presence of tracheal rupture

Epidemiology and outcomes of hospital-acquired bloodstream infections in intensive care unit patients: the EUROBACT-2 international cohort study

Purpose In the critically ill, hospital-acquired bloodstream infections (HA-BSI) are associated with significant mortality. Granular data are required for optimizing management, and developing guidelines and clinical trials. Methods We carried out a prospective international cohort study of adult patients (≥ 18 years of age) with HA-BSI treated in intensive care units (ICUs) between June 2019 and February 2021. Results 2600 patients from 333 ICUs in 52 countries were included. 78% HA-BSI were ICU-acquired. Median Sequential Organ Failure Assessment (SOFA) score was 8 [IQR 5; 11] at HA-BSI diagnosis. Most frequent sources of infection included pneumonia (26.7%) and intravascular catheters (26.4%). Most frequent pathogens were Gram-negative bacteria (59.0%), predominantly Klebsiella spp. (27.9%), Acinetobacter spp. (20.3%), Escherichia coli (15.8%), and Pseudomonas spp. (14.3%). Carbapenem resistance was present in 37.8%, 84.6%, 7.4%, and 33.2%, respectively. Difficult-to-treat resistance (DTR) was present in 23.5% and pan-drug resistance in 1.5%. Antimicrobial therapy was deemed adequate within 24 h for 51.5%. Antimicrobial resistance was associated with longer delays to adequate antimicrobial therapy. Source control was needed in 52.5% but not achieved in 18.2%. Mortality was 37.1%, and only 16.1% had been discharged alive from hospital by day-28. Conclusions HA-BSI was frequently caused by Gram-negative, carbapenem-resistant and DTR pathogens. Antimicrobial resistance led to delays in adequate antimicrobial therapy. Mortality was high, and at day-28 only a minority of the patients were discharged alive from the hospital. Prevention of antimicrobial resistance and focusing on adequate antimicrobial therapy and source control are important to optimize patient management and outcomes