Heart & lung : the journal of critical care
-
Subacute bacterial endocarditis (SBE) is an infection of the heart involving damaged valves or endothelium. The most common organisms causing SBE are the viridans streptococci. Viridans streptococci differ in their propensity to cause SBE, which is related to the ability to adhere to damaged heart valves and endothelium, which is a function of extracellular matrix production. Streptococcus intermedius is a member of the S. anginosus group. S. intermedius is one of the many strains of viridans streptococci and a rare cause of SBE. SBE may result following a high-grade, sustained veridans streptococcal bacteremia in patients with predisposing cardiac lesions. Because viridans streptococci are relatively avirulent pathogens in normal hosts, they usually present as SBE. Some strains of viridans streptococci are inherently more virulent (eg, S. intermedius) and clinically resemble S. lugdunensis or S. aureus. ⋯ In this case, despite optimal antimicrobial therapy, and in the absence of resistance/tolerance, therapeutic failure was best explained on the basis of S. intermedius virulence. The take-home lesson for clinicians is that it is better to err on the side of antibiotic prophylaxis even in patients with low-risk cardiac lesions. Failure to administer antibiotic prophylaxis for dental procedures may result in SBE and have disastrous consequences for the patient, which, in this case, resulted in a cerebral vascular accident, embolic occlusion of the leg, and mitral valve replacement. In terms of virulence in patients with endocarditis, S. intermedius may resemble S. lugdenesis.
-
Thrombocytopenia is common in intensive care units (ICUs), and is associated with a poor prognosis. An acute decrease in total platelet count is frequently observed in severe sepsis, followed by a relative increase indicating organ-failure recovery. However, few data are available describing this effect and its relationship with outcomes in specific subgroups of ICU patients. ⋯ Determining trends in platelet counts is of additional prognostic value, compared with single measurements.
-
To examine the evidential basis underpinning the monitoring of skin temperature and core-peripheral temperature gradient as elements of hemodynamic assessment in critically ill and adult cardiac surgical patients. ⋯ Skin temperature and core-peripheral temperature gradient should not be considered in isolation from other hemodynamic parameters when assessing cardiac status until they are validated by further large-scale prospective studies.
-
In spring 2009, a novel strain of influenza A originating in Veracruz, Mexico, quickly spread to the United States and throughout the world. This influenza A virus was the product of gene reassortment of 4 different genetic elements: human influenza, swine influenza, avian influenza, and Eurasian swine influenza. In the United States, New York was the epicenter of the swine influenza (H1N1) pandemic. Hospital emergency departments (EDs) were inundated with patients with influenza-like illnesses (ILIs) requesting screening for H1N1. Our ED screening, as well as many others, used a rapid screening test for influenza A (QuickVue A/B) because H1N1 was a variant of influenza A. The definitive laboratory test i.e., RT-PCR for H1N1 was developed by the Centers for Disease Control (Atlanta, GA) and subsequently distributed to health departments. Because of the extraordinary volume of test requests, health authorities restricted reverse transcription polymerase chain reaction (RT-PCR) testing. Hence most EDs, including our own, were dependent on rapid influenza diagnostic tests (RIDTs) for swine influenza. A positive rapid influenza A test was usually predictive of RT-PCR H1N1 positivity, but the rapid influenza A screening test (QuickVue A/B) was associated with 30% false negatives. The inability to rely on RIDTs for H1N1 diagnosis resulted in underdiagnosing H1N1. Confronted with adults admitted with ILIs, negative RIDTs, and restricted RT-PCR testing, there was a critical need to develop clinical criteria to diagnose probable swine influenza H1N1 pneumonia. ⋯ In hospitalized adults with ILIs and negative RIDTs, the diagnostic weighted diagnostic point score system, may be used to make a presumptive clinical diagnosis of swine influenza H1N1 pneumonia.
-
Comparative Study
Comparison of flow rates produced by two frequently used manual hyperinflation circuits: a benchtop study.
Manual hyperinflation is a treatment technique commonly used by physiotherapists in intensive care units to reverse or prevent atelectasis and mobilize airway secretions in intubated patients. The aim of this study was to determine which of the Magill (Rusch Manufacturing Ltd, Craigavon, UK) or Mapleson-C (CIG DF 655, CIG Medishield, Sydney, Australia) manual hyperinflation circuits was theoretically more effective at mobilizing secretions. ⋯ The results of this study suggest that the Mapleson-C manual hyperinflation circuit may be more effective at mobilizing secretions.