Heart & lung : the journal of critical care
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To examine the evidential basis underpinning the monitoring of skin temperature and core-peripheral temperature gradient as elements of hemodynamic assessment in critically ill and adult cardiac surgical patients. ⋯ Skin temperature and core-peripheral temperature gradient should not be considered in isolation from other hemodynamic parameters when assessing cardiac status until they are validated by further large-scale prospective studies.
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Subacute bacterial endocarditis (SBE) is an infection of the heart involving damaged valves or endothelium. The most common organisms causing SBE are the viridans streptococci. Viridans streptococci differ in their propensity to cause SBE, which is related to the ability to adhere to damaged heart valves and endothelium, which is a function of extracellular matrix production. Streptococcus intermedius is a member of the S. anginosus group. S. intermedius is one of the many strains of viridans streptococci and a rare cause of SBE. SBE may result following a high-grade, sustained veridans streptococcal bacteremia in patients with predisposing cardiac lesions. Because viridans streptococci are relatively avirulent pathogens in normal hosts, they usually present as SBE. Some strains of viridans streptococci are inherently more virulent (eg, S. intermedius) and clinically resemble S. lugdunensis or S. aureus. ⋯ In this case, despite optimal antimicrobial therapy, and in the absence of resistance/tolerance, therapeutic failure was best explained on the basis of S. intermedius virulence. The take-home lesson for clinicians is that it is better to err on the side of antibiotic prophylaxis even in patients with low-risk cardiac lesions. Failure to administer antibiotic prophylaxis for dental procedures may result in SBE and have disastrous consequences for the patient, which, in this case, resulted in a cerebral vascular accident, embolic occlusion of the leg, and mitral valve replacement. In terms of virulence in patients with endocarditis, S. intermedius may resemble S. lugdenesis.
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Thrombocytopenia is common in intensive care units (ICUs), and is associated with a poor prognosis. An acute decrease in total platelet count is frequently observed in severe sepsis, followed by a relative increase indicating organ-failure recovery. However, few data are available describing this effect and its relationship with outcomes in specific subgroups of ICU patients. ⋯ Determining trends in platelet counts is of additional prognostic value, compared with single measurements.
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Comparative Study
Comparison of flow rates produced by two frequently used manual hyperinflation circuits: a benchtop study.
Manual hyperinflation is a treatment technique commonly used by physiotherapists in intensive care units to reverse or prevent atelectasis and mobilize airway secretions in intubated patients. The aim of this study was to determine which of the Magill (Rusch Manufacturing Ltd, Craigavon, UK) or Mapleson-C (CIG DF 655, CIG Medishield, Sydney, Australia) manual hyperinflation circuits was theoretically more effective at mobilizing secretions. ⋯ The results of this study suggest that the Mapleson-C manual hyperinflation circuit may be more effective at mobilizing secretions.
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A healthy young woman presented with an overwhelming hyperacute herpes simplex virus-1 pneumonia that dramatically responded to intravenous acyclovir. It is postulated that the infection was a reactivation of latent virus in the vagal ganglia, in the absence of retrograde extension of herpes labialis/gingivostomatitis, or hematogenous spread from extragenital and other sources of infection. It is also postulated that the patient's amazing improvement overnight was a real-time coincidence of spontaneous recovery from the viral infection and prompt initiation of acyclovir treatment.