Fulminant Nonocclusive Mesenteric Ischemia Just after Hip Arthroplasty

Nonocclusive mesenteric ischemia (NOMI) is not a rare clinical entity in intensive medicine, and it can be a consequence of several clinical or surgical situations. This pathology results from reduced intestinal microvascular blood supply associated with an acute inflammatory process, culminating with bowel necrosis. This is a case on a female patient who developed immediate postsurgical NOMI following hip arthroplasty and died. Since diagnosis of this potentially fatal condition remains a dilemma, NOMI should always be considered an eventual postoperative complication in high-risk surgical patients such as elderly individuals with previous history of nicotine abuse, congestive heart failure, and essential hypertension. The present paper highlights the importance of early diagnosis and prompt adequate treatment of NOMI in subjects with diminished cardiac output and severe abdominal pain

Tétanos grave asociado con choque séptico en una paciente anciana ingresada en la unidad de cuidados intensivos

Submitted by Nuzia Santos ([email protected]) on 2014-06-03T13:34:14Z No. of bitstreams: 1 125.pdf: 1025274 bytes, checksum: e07c02b22066dbc1915e59db3967e982 (MD5)Made available in DSpace on 2014-06-03T13:34:14Z (GMT). No. of bitstreams: 1 125.pdf: 1025274 bytes, checksum: e07c02b22066dbc1915e59db3967e982 (MD5) Previous issue date: 2012Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, Brasil.Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, Brasil.Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, Brasil.Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, Brasil.Fundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Fundação Oswaldo Cruz Belo HorizonteUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, Brasil.Nós relatamos um caso de tétano grave associado a choque séptico em uma paciente de 61 anos admitida na Unidade de Terapia Intensiva (UTI) após perfurar o pé direito. A paciente apresentou perda de força muscular, paresia em membro inferior direito e disfagia. A paciente evoluiu com espasmos musculares generalizados, dispnéia e insuficiência respiratória. O espasmo intenso levou ao uso prolongado de ventilação mecânica invasiva, sedação e bloqueador neuromuscular. A evolução favorável deste caso está provavelmente relacionada aos avanços na gestão de UTI e uma equipe médica e de enfermagem bem treinadas.We report a case of severe tetanus associated with septic shock in a 61-year-old female admitted to the Intensive Care Unit (ICU) after perforating injury in the right foot. The patient presented with loss of muscle strength, paresis in the right lower limb and dysphagia. The patient’s conditions worsened, progressing to generalized muscle spasms, dyspnea, and respiratory failure. Intense spasm made the prolonged use of invasive mechanical ventilation, sedation, and neuromuscular blockers necessary. The favorable outcome in the present case is probably related to advances in ICU management and well-trained medical and nursing staff.Se presenta un caso de tétanos relacionado con choque séptico grave en una paciente de 61 años ingresada en la Unidad de Cuidados Intensivos (UCI) después de perforar el pie derecho. El paciente tenía pérdida de fuerza muscular, parálisis de la pierna derecha y disfagia. El paciente desarrolló espasmos musculares generalizados, disnea e insuficiencia respiratoria. El espasmo intenso llevó al uso prolongado de ventilación mecánica, sedación y bloqueo neuromuscular. La evolución favorable de este caso está probablemente relacionada con los avances en la gestión de cuidados intensivos y un personal médico y de enfermería bien capacitado

Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients

Submitted by Nuzia Santos ([email protected]) on 2014-02-28T13:49:46Z No. of bitstreams: 1 Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients.pdf: 437067 bytes, checksum: 8818acc72021e015c66b7a69b1c23edc (MD5)Made available in DSpace on 2014-02-28T13:49:46Z (GMT). No. of bitstreams: 1 Effect of heat and moisture exchangers on the prevention of ventilator-associated pneumonia in critically ill patients.pdf: 437067 bytes, checksum: 8818acc72021e015c66b7a69b1c23edc (MD5) Previous issue date: 2012Universidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, BrasilUniversidade de São Paulo. Escola de Enfermagem de Ribeirão Preto. Ribeirão Preto, SP, BrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, BrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, BrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Medicina Social. Ribeirão Preto, SP, BrasilFundação Oswaldo Cruz. Centro de Pesquisas René Rachou. Laboratório de Biomarcadores de Diagnóstico e Monitoração. Belo Horizonte, MG, BrasilUniversidade de São Paulo. Faculdade de Medicina de Ribeirão Preto. Hospital das Clínicas. Departamento de Cirurgia e Anatomia. Divisão de Terapia Intensiva. Ribeirão Preto, SP, BrasilVentilator-associated pneumonia (VAP) remains one of the major causes of infection in the intensive care unit (ICU) and is associated with the length of hospital stay, duration of mechanical ventilation, and use of broad-spectrum antibiotics. We compared the frequency of VAP 10 months prior to (pre-intervention group) and 13 months after (post-intervention group) initiation of the use of a heat and moisture exchanger (HME) filter. This is a study with prospective before-and-after design performed in the ICU in a tertiary university hospital. Three hundred and fourteen patients were admitted to the ICU under mechanical ventilation, 168 of whom were included in group HH (heated humidifier) and 146 in group HME. The frequency of VAP per 1000 ventilator-days was similar for both the HH and HME groups (18.7 vs 17.4, respectively; P = 0.97). Duration of mechanical ventilation (11 vs 12 days, respectively; P = 0.48) and length of ICU stay (11 vs 12 days, respectively; P = 0.39) did not differ between the HH and HME groups. The chance of developing VAP was higher in patients with a longer ICU stay and longer duration of mechanical ventilation. This finding was similar when adjusted for the use of HME. The use of HME in intensive care did not reduce the incidence of VAP, the duration of mechanical ventilation, or the length of stay in the ICU in the study population

Septic shock caused by Plesiomonas shigelloides in a patient with sickle beta-zero thalassemia

Invasive infection and extraintestinal complications are rarely caused by Plesiomonas shigelloides, a water-borne bacterium belonging to the Vibrionaceae family. We report a case of a 16-year-old female patient with sickle beta-zero thalassemia who survived septic shock caused by P. shigelloides associated with secondary acute respiratory distress syndrome and disseminated intravascular coagulation. Treatment with a carbapenem was successful, and the patient recovered without any sequelae. The previous reports of P. shigelloides sepsis are cited, and possible pathogenic mechanisms are discussed. (Heart Lung (R) 2010;39:335-339.)Fundacao de Amparo ao Ensino, Pesquisa e Assistencia (FAEPA) do Hospital das ClinicasUniversidade de São Paulo - Faculdade de Medicine de Ribeirao Preto-US