8 research outputs found
Severe acute respiratory infection with influenza A (H1N1) during pregnancy
The original publication is available at http://www.samj.org.zaABSTRACT FROM JOURNAL: Pregnant women are at high risk of severe acute
respiratory infection if infected with the influenza A (H1N1)
virus. On 14 August 2009 the first complicated H1N1 obstetric
patient was admitted to the obstetric critical care unit (OCCU)
at Tygerberg Hospital with respiratory distress. The clinical
picture was that of bronchopneumonia, and she tested positive
for H1N1. Subsequent pregnant patients admitted to the OCCU
with respiratory compromise or flu symptoms were screened
for the virus.
Eleven days later 13 cases were confirmed. Five patients
had acute lung injury and required ventilation and inotropic
support. Three of the patients with acute lung injury
subsequently died. Three patients required continuous positive
airway pressure (CPAP) support only, with no inotropics
needed. The remaining 5 patients presented early, received
oseltamivir within 48 hours and did not require critical care
admission.
All the patients admitted to the OCCU and the medical
intensive care unit (ICU) initially presented with flu symptoms,
respiratory distress and changes on the chest radiograph
indicating an active diffuse pulmonary parenchymal process.
Six patients underwent uncomplicated caesarean sections for
fetal distress after they were stabilised. Maternal and neonatal
outcomes varied. The key factor appears to be early clinical
diagnosis and oseltamivir within 48 hours of the onset of
symptoms. The demographic data and maternal and fetal
outcomes are set out in Table I
Severe acute respiratory infection with influenza A (H1N1) during pregnanacy
During an eleven day period we admitted twelve obstetric patients with complicated H1N1. Five patients had acute lung injury and required invasive ventilation and inotropic support. Three patients required Continious Positive Airway Pressure (CPAP) support with no inotropes needed. Three of the obstetric patients admitted to critical care units died. Influenza A (H1N1) should not be underestimated in pregnancy. Prevention strategies, early oseltamivir, carefull observation and early transfer to critical care facilities when indicated will decrease maternal and perinatal mortality
The comparison of non-invasive blood pressure monitoring with brachial intra-arterial blood pressure monitoring in patients with severe pre-eclampsia
Thesis (MMed)--Stellenbosch University, 2014.ENGLISH ABSTRACT: OBJECTIVE: The aim of this study was to compare the accuracy of non-invasive
brachial blood pressure measurements, using automated and manual devices, to
invasive brachial intra-arterial blood pressure measurements in patients with preeclampsia,
during acute severe hypertension.
STUDY DESIGN: A prospective descriptive cross sectional study was conducted in
the Obstetrics Critical Care Unit (OCCU) of Tygerberg Hospital. Pre-eclamptic
patients with acute severe hypertension, who required the placement of brachial
intra-arterial lines due to failed radial intra-arterial line placement, were included in
the study. Both automated oscillometric and blinded manual aneroid
sphygmomanometric blood pressures were recorded during hypertensive peaks and
after stabilization of BP using intravenous Labetalol or Nepresol. These two noninvasive
methods of blood pressure measurements were compared to brachial intraarterial
blood pressure measurements.
RESULTS:
There was weak correlation between manual and intra-arterial SBP (r = 0.27, p =
0.048) for SBP≥160mmHg. The calculated mean difference between manual SBP
compared to the intra-arterial SBP in this group was -23.19mmHg (+/- 19.40). There
was moderate correlation between automated and intra-arterial SBP (r = 0.69, p <
0.05). The calculated mean difference between automated SBP compared to the
intra-arterial SBP in this group was -16.85mmHg (+/- 11.58).
CONCLUSION:
This study of pre-eclamptic women demonstrated that both non-invasive methods of
BP measurement were inaccurate measures of the true systolic intra-arterial BP and
significantly underestimated SBP≥160mmHg when compared to brachial intra-arterial measurements. The SBP was also underestimated, to a lesser degree, for mild
moderate hypertension.
This study also demonstrated that direct invasive BP monitoring using the brachial
artery is a safe method for accurate haemodynamic monitoring.
We recommend the use of intra-arterial BP monitoring in pre-eclamptic women with
acute severe hypertension. Radial arterial cannulation should be used as the first
option and the brachial artery should be used if the first option fails.AFRIKAANSE OPSOMMING: DOELWIT: Die doel van hierdie studie was om die akuraatheid van nie indringende
bragiale bloeddruk metings, wat met outomatiese en manuele aparate geneem is, te
vergelyk met bragiale intra-arteriele bloeddruk metings gedurend akute erge
hipertensie in pasiente met pre-eklampsie,
STUDIE ONTWERP: ʼn Prospektiewe beskrywende dwarssnit studie was in die
Obstetriese Kritiese Sorg Eenheid (OCCU) van Tygerberg Hospitaal uit gevoer. Preeklamptiese
pasiente met akute erge hipertensie, wat bragiale intra-arteriele lyne
nodig gehad het, as gevolg van gefaalde radiale intra-arteriele lyn plasing, was in
hierdie studie ingesluit. Beide outomatiese ossilometriese en geblinde aneroide
sfigmomanometriese bloeddrukke, tydens hipertensiewe pieke en na stabilisering
van bloeddrukke met binneaarse Labetalol of Nepresol, was aangeteken, Die twee
nie indringende metodes van bloeddruk meting was met bragiale intra-arteriele
bloeddruk metings vergelyk.
RESULTATE:
Daar was ʼn swak korrelasie tussen manuele en intra-arteriele sistoliese bloedrukke
SBP (r = 0.27, p = 0.048) vir SBP≥160mmHg. Die berekende gemiddelde verskil
tussen manuele SBP en intra-arteriele SBP was -23.19mmHg (+/- 19.40) in hierdie
groep. Daar was ʼn matige korrelasie tussen outomatiese en intra-arteriele SBP (r =
0.69, p < 0.05). Die berekende gemiddelde verskil tussen outomaties SBP vergelyk
met intra-arteriele SBP was -16.85mmHg (+/- 11.58) in hierdie groep.
GEVOLGTREKKING:
Hierdie studie van pre-eklamptiese vrouens, het getoon dat beide nie indringende
metodes van bloeddruk meting, nie akurate metings van ware sistoliese intraarteriele
bloeddruk is nie, en SBP≥160mmHg word aansienlik onderskat wanneer dit met bragiale intra-arteriele metings vergelyk word. Die SBP was ook tot ʼn minder
mate onderskat vir matige hipertensie.
Die studie het ook getoon dat die direkte bragiale intra-arteriele metode van
bloeddruk monitering, ʼn veilige metode van hemodinamiese monitering is.
Ons beveel die gebruik van intra-arteriele bloeddruk monitering aan, in preeklamptiese
vrouens met akute erge hipertensie. Radiale arteriele kanulasie moet
gebruik word as die eerste opsie en die bragiale arterie moet gebruik word as die
eerste opsie faal
Severe acute respiratory infection with influenza A (H1N1) during pregnancy
The original publication is available at http://www.samj.org.zaABSTRACT FROM JOURNAL: Pregnant women are at high risk of severe acute
respiratory infection if infected with the influenza A (H1N1)
virus. On 14 August 2009 the first complicated H1N1 obstetric
patient was admitted to the obstetric critical care unit (OCCU)
at Tygerberg Hospital with respiratory distress. The clinical
picture was that of bronchopneumonia, and she tested positive
for H1N1. Subsequent pregnant patients admitted to the OCCU
with respiratory compromise or flu symptoms were screened
for the virus.
Eleven days later 13 cases were confirmed. Five patients
had acute lung injury and required ventilation and inotropic
support. Three of the patients with acute lung injury
subsequently died. Three patients required continuous positive
airway pressure (CPAP) support only, with no inotropics
needed. The remaining 5 patients presented early, received
oseltamivir within 48 hours and did not require critical care
admission.
All the patients admitted to the OCCU and the medical
intensive care unit (ICU) initially presented with flu symptoms,
respiratory distress and changes on the chest radiograph
indicating an active diffuse pulmonary parenchymal process.
Six patients underwent uncomplicated caesarean sections for
fetal distress after they were stabilised. Maternal and neonatal
outcomes varied. The key factor appears to be early clinical
diagnosis and oseltamivir within 48 hours of the onset of
symptoms. The demographic data and maternal and fetal
outcomes are set out in Table I
Increased incidence of Guillain-Barré syndrome after surgery
BACKGROUND AND PURPOSE: Antecedent surgery has been described to trigger Guillain/x96Barre syndrome (GBS), but its evidence is poor and based on case reports only. METHODS: We performed a retrospective analysis of 63 patients with GBS admitted to the University Hospital Basel and University Children's Hospital Basel from January 2005 to December 2010. We calculated and compared the incidences of post-surgical and non-exposed patients with GBS in the study population and those reported previously in literature. RESULTS: Six of 63 (9.5%) GBS cases had had a surgery within 6 weeks prior to GBS. The relative risk of developing GBS during the 6-week period after surgery is 13.1 times higher than the normal incidence in the study population (95% confidence interval: 5.68, 30.3; P >/= 0.0001), suggesting an attributable risk of 4.1 cases per 100 000 surgeries. In addition, the incidence of post-surgical GBS is significantly higher than influenza vaccine-associated GBS in the study population (P = 0.01) as well as in comparison with previous reported vaccine-associated GBS (P >/= 0.0001) and background incidences (P >/= 0.0001). CONCLUSION: Surgery must be considered to be a potential risk factor for developing GB