Post-extubation dysphagia (PED) is a common complication in ICU patients and it worsens their prognosis and quality of their life after their discharge from the ICU. This pathologic condition is independently associated with adverse patient outcomes and high-risk patients should be early recognized, because this situation can lead to aspiration pneumonia. The underlying pathophysiology of dysphagia is multifactorial. A team consisted of doctors, nurses, dietologists, speech therapists and physical therapists should deal with the situation. Flexible endoscopic evaluation of swallowing and videofluoroscopy are necessary tests for the assessment. Screening ICU protocols lead in early identification and proper therapeutic interventions. Continue reading
COVID-19 has brought up the interest about hyperferritinemic syndromes. Though often seen in COVID-19, especially within the frame of COVID-CSS, hyperferritinemia needs a systematic diagnostic approach, as co-infections or other causes may also increase ferritin. In this article, we present a case report of extreme hyperferrinemia in an male criticall ill patient with COVID-19 and we perform a short synthesis of the available literature. Continue reading
Invasive fungal infections are a growing problem in critically ill patients and are associated with increased morbidity and mortality. Complex medical and surgical problems, disruption of natural barriers, multiple invasive procedures and prolonged antibiotic treatment are some of the factors contributing to the alarming increase of fungal infections in the Intensive Care Unit (ICU) setting. In terms of occurrence rates, the most important fungal infections are invasive candidiasis (IC) and invasive pulmonary aspergillosis (IPA). Invasive candidiasis in ICU patients includes mainly candidemia, primary or catheter-related, and intra-abdominal candidiasis. Candida bloodstream infections occur at highest rates in the ICU population, with this setting accounting for 33–55% of all candidemias. The epidemiology of Candida infections is not constant.
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Το γαλακτικό οξύ παράγεται στο κυτταρόπλασμα από γλυκόλυση και μεταβολίζεται κυρίως από το ήπαρ (60%) (γλυκογονογένεση και νεογλυκογένεση) και από τα νεφρά (30%), τόσο στο φλοιό (τόπος μεταβολισμού)μέσω της νεογλυκογένεσης όσο και στο μυελό (τόπος παραγωγής). Η σχέση μεταξύ πυρουβικού και γαλακτικού οξέος είναι αμφίδρομη και το παραγόμενο γαλακτικό οξύ μπορεί να μετατραπεί είτε έμμεσα από το πυρουβικό σε οξαλικό οξύ και αλανίνη είτε άμεσα σε γλυκογόνο και γλυκόζη από τα περιπυλαία ηπατικά κύτταρα με τον κύκλο του Cori. Κατά συνέπεια, η αυξημένη γλυκόλυση οδηγεί σε αυξημένη παραγωγή γαλακτικού οξέος.
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This study was undertaken to evaluate the immediate postoperative complications in renal transplant recipients requiring Intensive Care Unit (ICU) admission. All renal transplant recipients with immediate post-transplantation complications (<1 week) admitted to our ICU from 1992 to 2012 were studied. Patients’ characteristics, transplant variables and prognosis were evaluated and data were analyzed to identify factors of outcome. Over the study period 13 men and 3 women, (26.2 % of renal transplant recipients requiring ICU admission) aged 45.4±10 years, were included in the study. APACHE II and SOFA scores on ICU admission were 17.8±4.6 and 8.4±3.6 respectively.
Continue readingAcute and prolonged illness seems to result in a variety of different neuroendocrine alterations. During the acute phase of critical illness there is an actively secreting anterior pituitary gland and a peripheral resistance to anabolic hormones. In the chronic phase of critical illness there is a uniformly reduced secretion of anterior pituitary hormones, with the notable exception of cortisol.
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