Journal of critical care
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Journal of critical care · Feb 2017
Case ReportsExtra-central nervous system target for assessment and treatment in refractory anti-N-methyl-d-aspartate receptor encephalitis.
Anti-N-methyl-d-aspartate-type glutamate receptor autoimmune encephalitis can arise in the setting of ovarian teratoma and often responds to resection. When it occurs in the absence of tumor, failure to respond to treatment may be more likely, and affected patients often require intensive care. To further understand the mechanisms and potential management, we present findings from an autopsy conducted on a young woman who died of refractory autoimmune encephalitis of this type. ⋯ Examination of lymph node tissue identified many plasma cells along sinusoids. These findings demonstrate that the antibody-producing cells are long-lived and can reside in lymphoid tissue. Awareness of continuing antibody production, the extra-central nervous system site, the indication for cytotoxic therapy, and the potential for biopsy assessment may lead to more effective treatment.
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Journal of critical care · Feb 2017
Value of the oxygenation index during 1-lung ventilation for predicting respiratory complications after thoracic surgery.
Thoracic surgery requiring 1-lung ventilation (OLV) is associated with significant postoperative pulmonary complications (PPCs) due to patient- and surgery-specific risk factors. The aim of this study is to determine whether the oxygenation index (OI) (fraction of inspired oxygen × mean airway pressure/partial pressure of oxygen) during OLV predicts the development of PPC. ⋯ The calculated OI during OLV is not predictive of PPC in our sample. Additional studies in a larger cohort of patients are needed to identify intraoperative ventilation parameters during OLV that can predict the risk of PPC.