Abstract
Herpes Simplex Virus (HSV) infection may cause different disorders in patients hospitalised in intensive care. Bronchoalveolar lavage (BAL is a procedure performed almost as a routine in patients with unexplained respiratory insufficiency in our department. During the last 10 years, HSV has been isolated frequently from the respiratory tract at our 30 beds intensive care unit. The objectives of this retrospective study were to define risk factors of the population in whom HSV virus was isolated. The study concerned patients with an isolation of HSV from either bronchial aspiration (BA) or BAL in the past 5 years (1992–1997). HSV was isolated by culture on shell vials and identified by immunofluorescence after staining with monoclonal antibodies or by the conventional culture and cytopathogenic effect on Vero-cells. From the 64 cases observed, 47 HSV isolations originated from BA, 13 from BAL (of which 9 with simultaneously negative BA) and 4 from both BA and BAL. The mean age of the patients was 62 years (range from 16 to 82). Only 50% of the patients had fever at the time of the investigation. The majority of the patients (94.9%) was intubated before the isolation. The role of immunosuppression, previously recognized as a risk factor for herpes infection, was not confirmed in this study: only 20.4% had received cither corticosteroids or immunosuppressive agents. Striking is that 73.4% had undergone a surgical procedure before the isolation, mainly coronary bypass grafting or other thoracic operations. Daily chest X-rays from 2 days before till 2 days after virus isolation were reviewed blindly by the same radiologist. There was no pathognomonic image at the chest X-ray: a localized infiltrate resembling pneumonia, diffuse alveolar infiltrates or an interstitial pattern were observed and 14% of the chest X-rays were even defined as normal. Lung injury was severe: almost 60% had a PaO2/FiO2 less than 200. 28 patients received aciclovir therapy once herpes was isolated, without an effect on the outcome: 48.4% of all patients and 42.8% of those receiving aciclovir therapy (28) died. Isolation of HSV in respiratory samples from critically ill patientsis therefore more frequent than previously known. Whether these isolates contribute to illness and its evolution remains to be determined.
Highlights
Ill patients requiring intensive care are at risk of iatrogenic ocular damage
Intensive Care Unit (ICU) management of critically ill patients often includes the requirement for tracheostomy and feeding access, most often a pecutaneous endoscopic gastrostomy (PEG)
Percutaneous tracheostomy is performed routinely in many medical intensive care unit (ICU) settings, in high risk surgical and trauma patients who often have unstable cervical spine injury and tissue edema, direct visualization of the cervical structures and trachea is imperative during tracheostomy
Summary
Ill patients requiring intensive care are at risk of iatrogenic ocular damage. We designed an experimental situation where external cardiac pressure conditions were controlled and adjusted to physiological extremes to mimic clinically relevant situations, while cardiac performance was assessed using left ventricular pressure–volume relationships (LVPVR) which are relatively preload and afterload independent This prospective, controlled study was undertaken to evaluate the response to therapy aimed at achieving supranormal cardiac and oxygen transport values (cardiac index >4.5 l/min/m2, oxygen delivery >600 l/min/m2, and oxygen consumption >170 l/min/m2) in patients older than 60 or with previous severe cardiorespiratory illnesses, who have undergone elective extensive ablative surgery planned for carcinoma or abdominal aortic aneurism. Whilst some human studies conducted in the critically ill and in high risk surgical patients have suggested that dopexamine may cause an increase in tonometrically measured gastric intra-mucosal pH (pHi) and an improvement in clinical outcome, this has not been confirmed in other randomised trials. In the present study the association of platelet function to inflammatory markers indicating disease severity was investigated
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