Cases reported "Critical Illness"

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1/21. candida albicans: an opportunistic threat to critically ill low birth weight infants.

    Major advances in the management of critically ill low birth weight (LBW) infants have increased their survival. Yet the clinical course of these infants is complicated by the emergence of opportunistic microbial pathogens. Most importantly, serious infections from opportunistic fungi, such as candida albicans, have produced systemic disease in vulnerable LBW infants. Invasive C. albicans infection is generally difficult to manage and is associated with high morbidity and mortality. Because the infection has an insidious and rapid course, the critical care nurse and advanced practice nurse need to provide key prevention and early treatment measures.
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2/21. Delayed death from pulmonary tuberculosis: unsuspected subtherapeutic drug levels.

    A patient with fulminant pulmonary tuberculosis died after 41 days of intensive care despite pansensitive organisms and no known underlying immunosuppression. Two factors leading to death in this patient were a delay in seeking medical attention and a subtherapeutic serum level of rifampin, though no obvious evidence of malabsorption existed. Malabsorption of antitubercular drugs is under-recognized and of extreme importance in the treatment of critically ill patients with active pulmonary tuberculosis. Factors associated with mortality from tuberculosis and selected aspects of critical care management are discussed.
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3/21. Special feature: exploring the benefits and myths of enteral feeding in the critically ill.

    patients in the intensive care unit setting have been nutritionally deprived for various reasons. Many patients who are critically ill cannot absorb nourishment by traditional routes. Enteral feeding should be considered for all patients who cannot meet caloric needs. There are many benefits to enteral feeding such as decreased infection, rapid wound healing, and decreased length of stay and mortality. Many critical care nurses subscribe to myths for not feeding their patients. The myths for not feeding critically ill patients involve gut motility, feeding residuals, and patient positioning. There is significant evidence both to support nutrition as integral to recovery from a critical illness and to suggest that enteral feeding is efficient and effective at providing nutrition.
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4/21. Prevention and treatment of stress ulcers in critically ill patients.

    Critically ill patients are at increased risk of developing stress-related mucosal lesions. The pathogenesis of stress-related mucosal disease is not entirely clear, but probably is associated with impairment of mucosal protective mechanisms due to compromised gastric mucosal microcirculation. Acid also plays an integral role. The incidence of gastrointestinal bleeding among intensive care unit patients has been declining over the past 30 years. Only a small proportion of patients with stress-related mucosal lesions develop clinically overt bleeding, and the majority of the overt bleedings do not lead to hemodynamic instability. However, the presence of gastrointestinal bleeding in a critically ill patient predicts markedly increased mortality. Prolonged mechanical ventilation and coagulopathy are the most important predictors of stress ulcer related bleeding. Critically ill patients with stress ulcer related bleeding should be managed in the acute setting just as patients presenting with upper gastrointestinal bleeding. Available evidence supports the use of stress ulcer prophylaxis in patients with risk factors for bleeding. Both histamine 2 receptor antagonists and sucralfate are effective forms of stress ulcer bleeding prophylaxis. More potent acid suppression by proton pump inhibitors may offer additional benefit in the prevention of stress ulcer bleeding.
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5/21. The critically ill liver patient: the variceal bleeder.

    Esophageal varices develop in patients with cirrhosis once portal pressure, measured by hepatic venous pressure gradient, and exceeds 10 mm Hg. At a portal pressure of 12 mm Hg, variceal bleeding may develop that is associated with a mortality of 30% to 50% per episode. In addition to an elevated portal pressure, other risk factors for the development of variceal hemorrhage include: variceal size, endoscopic features on the variceal wall (i.e., red wales), and child-Pugh class. In patients with suspected variceal hemorrhage, the treatment of the acute episode includes intravascular volume expansion, hemostasis through the use of pharmacological agents and endoscopy, and the prevention and treatment of potential complications associated with variceal hemorrhage such as aspiration pneumonia, spontaneous bacterial peritonitis and hepatic encephalopathy. Given a high rate of rebleeding, long-term prevention through secondary prophylaxis should be instituted in all patients who have survived an episode of variceal bleeding. Current prophylactic options include: non-selective beta-blockers alone (first line) or in combination with long-acting nitrates (isosorbide mononitrate) and/or endoscopic variceal obliteration achieved through sclerotherapy or preferably, band ligation.
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6/21. Systemic absorption of FD&C blue dye associated with patient mortality.

    The addition of FD&C blue dye to enteral feeds is a common practice in hospitals to detect aspiration. However, the degree of systemic absorption and safety of this dye in critically ill patients has not been studied. A patient with sepsis who died after systemic absorption of FD&C blue dye No1 is described.
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keywords = mortality
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7/21. Management of splenic abscess in a critically ill patient.

    Because of the increased number of immunocompromised patients within the general population, the incidence of splenic abscesses has increased over the last decade. This cohort of immune-deficient patients with splenic abscesses engenders a distinct evolution in the pathogenesis and microbiology of the disease process. Moreover, the morbidity and mortality rates for splenic abscesses are increased in this unique population. Clinically, these patients do not have a characteristic presentation. Diagnostically, computed tomography of the abdomen is the test of choice. Antibiotics and splenectomy remain the standard of care in most clinical settings. However, percutaneous drainage is reported with solitary and unilocular abscesses and in poor operative candidates. An unusual case of a patient with a splenic abscess awaiting heart transplantation is presented. This patient was successfully treated with percutaneous drainage and antibiotics. The literature regarding the presentation, diagnosis, pathogenesis, and treatment of splenic abscesses is reviewed as well.
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8/21. Humanized anti-interleukin 6 receptor antibody induced long-term remission in a patient with life-threatening refractory autoimmune hemolytic anemia.

    Refractory autoimmune hemolytic anemia (AIHA) is associated with considerable rates of mortality. Interleukin 6 (IL-6) has been reported to play a role in the pathogenesis of AIHA. This report describes a patient with AIHA who was successfully treated with a humanized anti-human IL-6 receptor (IL-6R) monoclonal antibody (MoAb). He had experienced life-threatening AIHA and had received conventional therapy with corticosteroids, azathioprine, cyclophosphamide, cyclosporin A, melphalan, plasma exchange, and irradiation to his spleen. However, the patient's symptoms and laboratory data did not show a sufficient improvement. Because his serum IL-6 level was elevated, we attempted to block IL-6 signaling by using a humanized anti-IL-6R MoAb, MRA. With 8 mg/kg of MRA administration every 2 weeks, the serum hemoglobin level gradually increased and normalized within 4 months. After 2 years of MRA treatment, the disease activity was well controlled without adverse reactions. Anti-IL-6R MoAb can be a novel and effective therapeutic agent for AIHA.
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9/21. Devastating presentations of regional enteritis (Crohn's disease): two reports of survival following severe multiple organ dysfunction syndrome.

    BACKGROUND: Regional enteritis may present in the setting of a variety of clinical symptoms. These symptoms range from mild to severe. methods: Here we describe two different presentations of regional enteritis (Crohn's disease): one in the setting of clostridium perfringens sepsis and the second in association with hemolytic-uremic syndrome. Both presentations resulted in life-threatening multiple organ dysfunction syndrome. RESULTS: Following appropriate surgical management and intensive physiologic support, both patients recovered, despite a MODS-predicted risk of mortality of 100% and 91%, respectively. CONCLUSIONS: Fulminant presentations of regional enteritis of this magnitude are rare, and highlight the resolution of severe multiple organ dysfunction for each presentation.
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10/21. Oral rehydration therapy: a Third World solution applied to intensive care.

    Oral rehydration therapy (ORT)--world health Organisation formula--has reduced the mortality of severe diarrhoea tenfold but its use in intensive care has not been reported. ORT was administered via a nasogastric tube to 3 adult intensive care patients who developed severe diarrhoea and post-operative acute renal impairment. The median intake of ORT was 2.21/day (range 1.5-3.0) and the mean duration of therapy was 7 days (range 6-10). Renal function improved (creatinine fell from 389 to 165 mmol/l) and both haemodynamic and metabolic stability (Na, K, Mg, PO4 and urea) were maintained. While it may not reduce the volume of diarrhoea, ORT provides a cheap, effective and physiological solution to severe gastrointestinal losses in intensive care and may have wider application in both adult and paediatric practice.
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