Saudi Critical Care Journal

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A posterior circulation stroke acquired Ondine's curse occurs following medullary infarction. Central alveolar hypoventilation, a sine qua non of this stroke, is characterized by unpredictable episodes of sleep apnea that is associated with a high mortality rate. Postcoronary artery bypass grafting, a 64-year-old male developed embolic medullary infarct leading to recurrent episodes of apnea. This was managed with tracheostomy and mechanical ventilation. Intensive respiratory monitoring is of the essence during the acute and subacute stages in these patients.

Respiratory failure from severe asthma is a potentially reversible, life-threatening condition. Since asthma involves bronchospasm and mucous plugging, it causes increased pressure difference between peak and plateau pressure. The increased pressure difference between the two can be due to the ventilatory strategy of asthma itself which involves increasing inspiratory flow rate and square flow pattern to increase expiratory time. It is important that clinicians managing such patients understand the use of mechanical ventilation since wrong interpretation may lead to inappropriate decision-making during weaning.

Systemic lupus erythematosus (SLE) with pregnancy has a high risk of maternal and fetal morbidity and mortality once they get admitted to critical care unit. We report a case of a pregnant women complicated with lupus nephritis and pneumonitis followed by acute respiratory distress leading to cardiopulmonary arrest. During her treatment in Intensive Care Unit, maternal respiratory function was improved after proper management of systemic lupus flare up and acute respiratory distress syndrome with timely induction of pregnancy.

Introduction and Background: The incidence of Acinetobacter infections has steadily increased and now has become a major threat with the emergence of its multidrug-resistant strains. Acinetobacter is notorious for their ability to spread among hospitalized patients. This study attempts to identify the intensive care unit (ICU) variables predictive of Acinetobacter sepsis. Methods: In this case–control study, we extracted data from a prospectively collected ICU database on all patients admitted with a diagnosis of sepsis from 2010 to 2015. Data identifying all Acinetobacter isolates were obtained from the section of microbiology database. Patients with Acinetobacter sepsis were compared with control patients. Approval was obtained from the Institutional Research Ethics Committee. Results: Four hundred and thirty-one patients were studied and 43 (9.9%) developed Acinetobacter sepsis. Mean APACHE II score was 26 ± 7.7; median procalcitonin level was 3.9 (interquartile range [IQR] 1.1, 18.4). Mean age was 52.5 ± 21.4 years with median ICU length of stay 6 (IQR 4, 43) days. ICU mortality was 23% (99 patients) with mortality rate of patients with Acinetobacter sepsis at 60.5% (26 patients of 43). Patients who developed Acinetobacter sepsis had a mean SOFA score 14.1 ± 3.7 with 46.5% in septic shock, 9% organ donors, and 7% postsolid organ transplant. The most common site of isolation was the respiratory tract, 34.6%, followed by bloodstream/line sepsis, 30.8%; 32.5% had a single site infected. Median duration on mechanical ventilation was 15.3 (IQR 7, 15.3) days. On univariate regression analysis, multidrug-resistant Acinetobacter sepsis was predicted by vasopressor use, odds ratio (OR) 4.1 (95% confidence interval [CI] 1.6, 9.9, P = 0.002), bloodstream infection, OR 6.3 (95% CI 3.2, 12.4, P < 0.001), single site of initial sepsis, OR 0.4 (95% CI 0.2, 0.9, P = 0.02), APACHE II score, OR 1.05 (95% CI 1.01, 1.1, P = 0.01), malignancy, OR 6 (95% CI 2.2, 15.7, P < 0.001), and appropriate empiric antibiotics, OR 0.04 (95% CI 0.01, 0.15, P < 0.001). On multivariate regression, appropriate empiric antibiotics, OR 0.04 (95% CI 0.01, 0.13, P < 0.001), vasopressor use, OR 3.1 (95% CI 1.07, 9.2, P = 0.03), bloodstream infection, OR 7.5 (95% CI 3.2, 17.4, P < 0.001), and single site of initial sepsis, OR 0.1 (95% CI 0.07, 0.4, P < 0.001) remained significant predictors of Acinetobacter sepsis. Conclusions: Acinetobacter sepsis remains a frequent and hazardous ICU acquisition with a higher risk imposed by continued vasoplegia and septicemia and protective effects from appropriate initial antibiotic coverage and limited sites involved. This study attempts to identify ICU variables predictive of Acinetobacter sepsis.

Posterior reversible encephalopathy syndrome (PRES) is a clinic neuro radiological entity presenting with headache, confusion, visual disturbances or blindness, and seizures. Parieto-occipital white matter changes due to vasogenic oedema can be observed on imaging modalities. We report a 22-years-old prime gravida with twin delivery with a history of Late onset eclampsia post-delivery, complicated by PRES. Late onset postpartum eclampsia (LPE) is defined by its onset at >48 h after delivery. In our case convulsions and hypertension happened post-delivery with a diagnosis of LPE which have been complicated by PRES. Clinical improvement with complete resolution without any complications was observed on the 6^th day after delivery with proper treatment of hypertension and Convulsions. Early diagnosis was a big asset, using clinical and radiological skills.Posterior reversible encephalopathy syndrome is reversible when early diagnosis is established and appropriate treatment is started without delay.

Online since 15^th Dec, 2016