Journal of critical care
-
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.
-
Journal of critical care · Feb 2017
Case ReportsPeripartum cardiomyopathy, place of drug therapy, assist devices, and outcome after left ventricular assistance.
Peripartum cardiomyopathy remains a challenging obstetric and cardiologic emergency. We report 5 interesting cases of peripartum cardiomyopathy with different clinical courses, with 3 patients requiring left ventricular assist device implantation. ⋯ Two patients improved with the medical treatment alone without the need of assistance. We will review main important related issues.
-
Journal of critical care · Feb 2017
Hematologic counts as predictors of delayed cerebral ischemia after aneurysmal subarachnoid hemorrhage.
Aneurysmal subarachnoid hemorrhage (SAH) is associated with high morbidity and mortality, but currently no single clinical method or ancillary test can reliably predict which subset of patients will develop delayed cerebral ischemia (DCI). The aim of this study was to find hematologic derangements and clinical factors present during the first 7 days after bleeding that could help identify patients at risk for development of DCI. ⋯ The presence of leukocytosis and anemia during the third day after SAH was statistically correlated with the occurrence of DCI.
-
Journal of critical care · Feb 2017
Early fluid resuscitation and volume therapy in venoarterial extracorporeal membrane oxygenation.
For circulatory support, venoarterial extracorporeal membrane oxygenation (VA-ECMO) is dependent on sufficient venous drainage ensured by fluid therapy. Volume overload however is linked to poor prognosis. This study therefore evaluates volume therapy in VA-ECMO. ⋯ Higher fluid balance was consistently linked to poor survival. We found no evidence to support a liberal fluid therapy in VA-ECMO patients, especially not the early after implantation. With a retrospective study, one cannot clarify if lower fluid balance might improve outcomes or represents a prognostic marker.
-
Journal of critical care · Feb 2017
Injection of agitated saline to detect recirculation with transthoracic echocardiography during venovenous extracorporeal oxygenation: A pilot study.
We assessed the security and efficiency of intravenously injected agitated saline in conjunction with transthoracic echocardiography to identify recirculation in patients supported with a venovenous extracorporeal membrane oxygenation (VV ECMO) device. ⋯ Transthoracic echocardiography in conjunction with agitated saline administration may be a safe and easily applicable method to evaluate a recirculation phenomenon in patients supported with VV ECMO.