Abstract
Rev Bras Ter Intensiva. 2014;26(4):416-420
DOI 10.5935/0103-507X.20140064
The authors report a rare case of shock in a patient without significant clinical history, admitted to the intensive care unit for suspected septic shock. The patient was initially treated with fluid therapy without improvement. A hypothesis of systemic capillary leak syndrome was postulated following the confirmation of severe hypoalbuminemia, hypotension, and hemoconcentration - a combination of three symptoms typical of the disease. The authors discussed the differential diagnosis and also conducted a review of the diagnosis and treatment of the disease.
Abstract
Rev Bras Ter Intensiva. 2014;26(4):421-429
DOI 10.5935/0103-507X.20140065
On January 2013, a disaster at Santa Maria (RS) due to a fire in a confined space caused 242 deaths, most of them by inhalation injury. On November 2013, four individuals required intensive care following smoke inhalation from a fire at the Memorial da América Latina in São Paulo (SP). The present article reports the clinical progression and management of disaster victims presenting with inhalation injury. Patients ERL and OC exhibited early respiratory failure, bronchial aspiration of carbonaceous material, and carbon monoxide poisoning. Ventilation support was performed with 100% oxygen, the aspirated material was removed by bronchoscopy, and cyanide poisoning was empirically treated with sodium nitrite and sodium thiosulfate. Patient RP initially exhibited cough and retrosternal burning and subsequently progressed to respiratory failure due to upper airway swelling and early-onset pulmonary infection, which were treated with protective ventilation and antimicrobial agents. This patient was extubated following improvement of edema on bronchoscopy. Patient MA, an asthmatic, exhibited carbon monoxide poisoning and bronchospasm and was treated with normobaric hyperoxia, bronchodilators, and corticosteroids. The length of stay in the intensive care unit varied from four to 10 days, and all four patients exhibited satisfactory functional recovery. To conclude, inhalation injury has a preponderant role in fires in confined spaces. Invasive ventilation should not be delayed in cases with significant airway swelling. Hyperoxia should be induced early as a therapeutic means against carbon monoxide poisoning, in addition to empiric pharmacological treatment in suspected cases of cyanide poisoning.
Abstract
Rev Bras Ter Intensiva. 2014;26(4):430-434
DOI 10.5935/0103-507X.20140066
Nephrotic syndrome is associated with a hypercoagulable state and an increased risk of thromboembolic complications. Cerebral venous sinus thrombosis is a rare complication of nephrotic syndrome, with few cases described in the literature, although the disease may be under-diagnosis. The true incidence of cerebral venous sinus thrombosis may be underestimated because many events are asymptomatic or are not diagnosed in time. Here, we describe the case of a male child, 2 years and 10 months old, with nephrotic syndrome presenting with headache, epileptic seizures and sensory inhibition who was diagnosed with superior sagittal and transverse sinuses thrombosis. An international literature review was performed with a defined search strategy in the PubMed, SciELO and Lilacs databases using the terms ‘nephrotic syndrome’ and ‘cerebral sinovenous thrombosis’. The diagnosis of venous thrombosis should be considered in any patient with nephrotic syndrome who presents with neurological signs and symptoms, as early clinical diagnosis promotes favorable outcomes.
Abstract
Rev Bras Ter Intensiva. 2014;26(3):313-316
DOI 10.5935/0103-507X.20140044
We describe herein a case of a patient who, when in orthostatic positions, had severe hypoxemia and ventilatory dysfunction. Although the severity of symptoms required hospitalization in an intensive care setting, the initial tests only identified the presence of enlarged aortic root, which did not explain the condition. The association of these events with an unusual etiology, namely intracardiac shunt, characterized the diagnosis of platypnea-orthodeoxia syndrome. The literature review shows that, with advancing research methods, there was a progressive increase in the identification of this condition, and this association should be part of the differential diagnosis of dyspnea in patients with enlarged aortic root.
Abstract
Rev Bras Ter Intensiva. 2014;26(3):317-320
DOI 10.5935/0103-507X.20140045
Atelectasis is a pulmonary disorder that lengthens the hospitalization time of newborns in intensive care units, resulting in increased morbidity among these infants. High-flow nasal cannulae have been used in newborns to prevent atelectasis and/or expand pulmonary regions affected by atelectasis; however, to date, no evidence-based data regarding this approach have been reported. In this paper, we report on the cases of two male newborn patients. The first and second patients described in this report were hospitalized for a neurosurgical procedure and the treatment of abdominal disease, respectively, and were subjected to invasive mechanical ventilation for 4 and 36 days, respectively. After extubation, these patients continued receiving oxygen therapy but experienced clinical and radiological worsening typical of atelectasis. In both cases, by 24 hours after the implantation of an high-flow nasal cannulae to provide noninvasive support, radiological examinations revealed the complete resolution of atelectasis. In these cases, the use of an high-flow nasal cannulae was effective in reversing atelectasis. Thus, this approach may be utilized as a supplemental noninvasive ventilatory therapy to avoid unnecessary intubation.
Abstract
Rev Bras Ter Intensiva. 2013;25(2):175-180
DOI 10.5935/0103-507X.20130030
Preeclampsia, HELLP syndrome (hemolysis, elevated liver enzymes, and low-platelet count), and acute fatty liver of pregnancy are the main causes of thrombotic microangiopathy and evere liver dysfunction during pregnancy and represent different manifestations of the same pathological continuum. The case of a 35-week pregnant woman who was admitted to an intensive care unit immediately after a Cesarean section due to fetal death and the presence of nausea, vomiting, and jaundice is reported. Postpartum preeclampsia and acute fatty liver of pregnancy were diagnosed. The patient developed an acute subdural hematoma and an intracerebral hemorrhage, which were subjected to neurosurgical treatment. The patient died from refractory hemolytic anemia and spontaneous bleeding of multiple organs. Preeclampsia HELLP syndrome, and acute fatty liver of pregnancy might overlap and be associated with potentially fatal complications, including intracranial hemorrhage, as in the present case. Early detection and diagnosis are crucial to ensure management and treatment success.
Abstract
Rev Bras Ter Intensiva. 2013;25(1):63-67
DOI 10.1590/S0103-507X2013000100012
Takotsubo syndrome is characterized by predominantly medial-apical transient left ventricular dysfunction, which is typically triggered by physical or emotional stress. The present article reports the case of a 61-year-old female patient presenting with dizziness, excessive sweating, and sudden state of ill feeling following an episode involving intense emotional stress. The physical examination and electrocardiogram were normal upon admission, but the troponin I and creatine kinase-MB concentrations were increased. Acute myocardial infarction without ST segment elevation was suspected, and coronary angiography was immediately performed, which showed severe diffuse left ventricular hypokinesia, medial-apical systolic ballooning, and a lack of significant coronary injury. The patient was referred to the intensive care unit and was successfully treated with supportive therapy. As this case shows, Takotsubo syndrome might simulate the clinical manifestations of acute myocardial infarction, and coronary angiography is necessary to distinguish between both myocardial infarction and myocardial infarction in the acute stage. The present patient progressed with spontaneous resolution of the ventricular dysfunction without any sequelae.