Pulmonary Septic Shock Research Articles

Emergency surgery for traumatic brain injury in geriatric patients

Objectives: Verify the sociodemographic profile of an elderly victim of trauma due to a fall who is admitted to the ICU of a public reference hospital to determine whether there are relationships between his age, comorbidities, length of stay, complications and clinical results. A retrospective analytical study with a quantitative approach was carried out between April and October 2014 in the Intensive Care Unit (ICU) of the Hospital de Base do Distrito Federal, administered by the State Department of Health of the Federal District, DF. Using the TrakCare® computerized medical record, sociodemographic data were found on elderly people hospitalized between the fall of July 2012 and July 2014, including mechanisms of trauma, comorbidities, length of stay, use of invasive devices, vasoactive and sedative drugs, complications and clinical internships. Results: The sample was made up of 52 elderly people, the majority of whom were men and the injury was a fall in height. Lung infection, septic shock, use of blood products and acute renal failure were the main complications. Despite the high mortality observed in the study, the majority of elderly people survived the traumatic event. Male sex, traumatic brain injury (TBI), pulmonary septic shock and dialysis were the main causes of mortality. Conclusion: Falling in height, fractures and severe TBI were extremely common, and most patients had more than one complication during hospitalization. No significant difference was found between age and mortality.

COVID-19 Related Acute Respiratory Distress Syndrome versus Classical Acute Respiratory Distress Syndrome Patients: Inflammatory Biomarkers as Predictors of Mortality in Pulmonary Septic Shock.

Coronavirus disease-2019 (COVID-19)-related severe acute respiratory distress syndrome (ARDS) differs pathophysiological from other pulmonary septic shock-related ARDS. Thus, we assessed whether all-cause in-hospital mortality differs for severe COVID-19-related and classical severe ARDS and which inflammatory biomarkers can predict mortality among these patients. This single-center, retrospective, observational cohort study included pulmonary septic shock patients (n = 114) with COVID-19-related and classical severe ARDS admitted in the Intensive Care Unit. Patients with a mean age of 73 (IQR 62-82), predominantly male (63%), were divided into two groups based on outcomes: survivors (n = 50) and non-survivors (n = 64). COVID-19-related severe ARDS (n = 48) accounts for 75% of deaths. Present comorbidities like heart disease (p = 0.043), neurologic disorders (p = 0.018), and liver disease (p = 0.038) were associated with in-hospital mortality, as well. Regarding inflammatory biomarkers, the AUC/c-statistic was 0.656 (95% CI: 0.53-0.759) for leukocytes, 0.613 (95% CI: 0.509-0.717) C-reactive protein (CRP) and 0.651 (95% CI: 0.548-0.753) for procalcitonin in predicting all-cause in-hospital mortality among patients with pulmonary septic shock and severe ARDS. Patients with pulmonary septic shock and with COVID-19-related severe ARDS had a higher incidence of in-hospital mortality than those with classical severe ARDS. The high value of leukocytes, C-reactive protein, and procalcitonin were predictive for all-cause in-hospital mortality in patients with pulmonary septic shock and ARDS. Infection with COVID-19 was an independent predictor of in-hospital mortality in the presence of ARDS.

Granulomatosis with polyangiitis as a differential diagnosis.

Granulomatosis with polyangiitis, a small vessels vasculitis, involves mostly upper respiratory tract, lungs and kidneys. It’s a multisystemic pathology, with no sex predominance, affecting adults over 40 years old. Case report: K.S.D, 64 years, female, came to emergency room with dyspnea, cough and coryza, 15 days after a recurrent acute otitis media surgical treatment. A CT showed bilateral pleural effusion, consolidation and a lung mass, being admitted in Intensive Care Unit. Subsequently, developed mastoiditis and conjunctival hyperemia and used several antibiotic therapys. Patient was discharged 40 days later, with clinical improvement. One month later, was admitted again with pulmonary septic shock, in addition to sinusitis, polyarthralgia, purpura and acute renal injury, requiring hemodyalisis. Biomarkers were requested, such as c-ANCA and rheumatoid factor, with positive result and antinuclear factor, with negative result. A renal biopsy also has been solicitated, showing glomerulonephritis. The diagnosis was granulomatosis with polyangiitis, treated with methylprednisone pulse therapy and cyclophosphamide, progressing to clinical stability and receiving discharge with outpatient follow-up. Conclusion: Granulomatosis with polyangiitis is a rare condition, with that should be considered when patient presents the triad: upper and lower airways and glomerulonephritis. Early diagnosis and immunosuppressive therapy are essential to reduce its morbimortality.
 Recibido: 18-11-2017 / Aceptado: 25-01-2018