Abstract
Of the various complications of pregnancy, pregnancy-induced hypertension, pre-eclampsia and eclampsia syndrome (PE-EC) represent the most prevalent and potentially the most serious events. The adverse effects on the cardiovascular system in PE-EC syndrome comprise hypertension-induced left ventricular (LV) hypertrophy, LV diastolic dysfunction, LV failure, cerebral oedema, renal involvement and cardiac arrest. The present study is intended to assess the prevalence of cardiac involvement in PE-EC syndrome and the prognostic implications therefrom. Out of a total 70 females (mean age 26.8 ± 7.4 years) referred from the obstetric section to the Critical Care Center to handle various crises, 38 had PE-EC and 32 had no PE-EC. Following clinical evaluation, all patients were subjected to routine laboratory tests, ECG and echocardiography with follow-up during hospitalization. Hypertension was defined as blood pressure (BP) > 160/100 mmHg. Out of 38 patients with PE-EC, underlying heart disease (HD) was present in five patients (13%) (peripartum cardiomyopathy in one and rheumatic HD in four), and 33 had no underlying HD. Of 32 patients having no PE-EC, 20 (62%) had underlying HD (11 rheumatic HD, five peripartum cardiomyopathy, two ischemic HD, one congenital HD, and one ventricular tachycardia). Compared with the noneclamptic group, those with PE-EC syndrome exhibited a higher prevalence of hypertension (mean systolic BP 160 ± 62.4 vs 93.4 ± 23.1 and mean diastolic BP 104 ± 29.7 vs 65.6 ± 23.4, P < 0.05). Nevertheless, LV systolic function expressed as depressed ejection fraction (EF)< 40% was insignificantly worse in the noneclamptic group compared with the PE-EC subset with a mean EF of 32.5 ± 4.5 vs 34.3 ± 6.08, respectively. However, out of 38 patients with PE-EC syndrome 13 (32%) died, vs five patients (16%) out of 32 in the noneclamptic group. Mortality was due to cerebrovascular stroke in six patients, antepartum hemorrhage in four, systemic inflammatory syndrome in three, acute pulmonary edema in three and renal failure in nine patients.
Highlights
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today
Summary Our study demonstrated that LS is a good alternative to restore cardiac contractile function when combined with NE
The use of AVP may lead to further deteriorate sepsis-related myocardial dysfunction even when combined with a positive inotropic agent
Summary
In contrast to conventional surgical tracheostomy, percutaneous dilational tracheostomy (PDT) in different variants is spreading rapidly in intensive care units today. The objectives of the current study were (1) to assess the prognostic significance of plasma concentrations of NSE for early prediction of outcome in patients at risk for anoxic encephalopathy after cardiopulmonary resuscitation (CPR), and (2) to compare the prognostic information provided by NSE measurements with that provided by conventional risk indicators (clinical neurological examination and computerised tomography [CT] scan of the brain). Independent pulmonary ventilation was introduced in the 1930s and allows the utilization of different ventilatory strategies for each lung to improve gas exchange, respiratory mechanics or both in patients with heterogeneous lung diseases It is not clear whether the lower inflection point (LIP) on the inspiratory limb or the point of maximum curvature (PMC) on the deflation limb of the pressure–volume (PV) curve should be used for the positive end-expiratory pressure (PEEP) setting in acute lung injury (ALI). The long-term outcome, health-related quality of life (HRQL), and ICU and hospital costs of medical ICU patients were assessed
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