Recent Advances In Intensive Care Research Articles

Spontaneous Gastric Perforation in Neonates: A Tertiary Pediatric Surgical Center Experience

Objective: To report our experience with spontaneous neonatal gastric perforation (SNGP) in a tertiary hospital over the last 9 years.Methods: Retrospective review of neonates with SNGP treated in Bristol Royal Hospital for Children between January 2010 and December 2018 was performed. Data retrieved included demography, perinatal clinical details, operative data, and outcome. Cases with esophageal atresia, necrotizing enterocolitis or distal obstruction were excluded.Results: Of 13 cases, 4 were males and 9 females. Two neonates were full term; while 11 were preterm with median gestational age of 28 weeks. Abdominal distension and metabolic acidosis were mostly found in these patients. Patent ductus arteriosus was encountered in 53.8% of the patients. The most common site of perforation was the greater curvature (38.4%) followed by posterior wall (30.8%) of the stomach. Primary repair was performed in all cases. One neonate developed recurrent perforation in the early postoperative period. Five preterm (38.5%) neonates succumbed in our series.Conclusion: SNGP is a rare condition increasingly diagnosed in preterm neonates. Greater curvature and posterior wall of stomach are commonly involved. Despite recent advances in intensive care, the prognosis is still poor in preterm babies with multiple associated problems.

An overview of critical care in cancer patients

Intensivists often refuse admission to cancer patients needing critical care, which may result in denial of effective care for some deserving patients. A cancer patient may need admission to intensive care units for a variety of reasons. The outcomes of patients with hematological malignancies, previously dismal, have improved over last 10 years. The previously known indicators of poor outcome are no longer valid in view of recent advances in intensive care. A select group of patients with hematological malignancies may be offered aggressive therapy for a limited duration and then prognosis can be reassessed. Cancer chemotherapy can produce toxicities affecting all major organ systems. Such patients may be admitted with acute organ dysfunction or years afterwards for incidental illnesses. Knowledge of these toxicities is essential for early diagnosis, management and prognostication in such patients. The post-surgical cancer patient has unique problems, the problems of these groups are discussed. The post-surgical cancer patient may need care ranging from only monitoring; in view of supra-major surgery in some patients; to fully aggressive intensive care for post-surgical anastomotic dehiscence, mediastinitis, septic shock and multiorgan dysfunction in others. The metabolic and mechanical complications commonly seen in non-surgical cancer patients are also discussed. Intensive care should be offered to all cancer patients who have a reasonable chance of cure or palliation of their disease.

Evaluation of interferon-alfa 2b in a model of acute respiratory distress syndrome and pulmonary fibrosis induced by intratraqueal bleomycin in Wistar rats

2566 Background: The acute respiratory distress syndrome (ARDS) is a common clinical entity, characterized by severe and acute pulmonary dysfunction, caused by a non-cardiogenic pulmonary edema, secondary to an increased permeability in the alveolar-capillary barrier due to a local or systemic inflammatory reaction initiated and amplified by pro-inflammatory cytokines, mostly interleukin (IL) 1, 6 and 8, and TNF-α. Despite recent advances in intensive care, the mortality associated to this syndrome remains around 40–50%. Interferons are natural proteins with antiviral, antiproliferative, antiangiogenic and immunomodulatory properties. Interferon-α reduces the synthesis and deposition of collagen I and III in hepatic tissue in experimental models of hepatic fibrosis. Interferon-α also modulates inflammation by inhibiting the action of TNF-α. The objective of this study was to evaluate the effect of interferon-α 2b in an experimental model of bleomycin-induced pulmonary fibrosis in Wistar rats. Methods: We evaluated 34 Wistar rats that were anesthetized with ketamine 100 mg/kg by the intraperitoneal route and divided in two groups of 17 animals each. Both groups received an intratracheal instillation of 1,5U of bleomycin and 0,2ml of saline solution in the first day (D1). Starting on D1, Group B received subcutaneous interferon-α 2b in a dose of 100,000 U/Kg/day for 14 days. In the fifteenth day (D15), all rats in both groups were anesthetized with thiopental and sacrificed. Their right lungs medium lobes were prepared for histological evaluation. Hematoxylin eosin and picrosirius stains were performed on 4 μm cuts of each specimen under carefully controlled conditions. The areas of collagen in their lungs were quantified in (μm2) by digital image analysis with the Image Pro for Windows software. All statistical tests were two-sided, and P < .05 was used to indicate statistical significance. Results: The mean pulmonary fibrosis area in the group A was 28,432 μm2 versus 8,866 μm2 in group B who used interferon-α 2b (P = 0,037). Conclusions: These results shows that the use of interferon-α 2b, in this animal model of ARDS, reduced the development of pulmonary fibrosis. No significant financial relationships to disclose.

Management of acute liver failure

Acute liver failure (ALF) is a devastating syndrome that triggers a cascade of events, leading to multiple organ failure and often death. A previously normal liver may fail within days or weeks; and despite recent advances in intensive care and organ support, mortality rates remain high. In those patients with high grades of encephalopathy, the chances of survival are less than 20% with medical management alone. Early deaths in ALF are often caused by cerebral oedema or cardiovascular collapse, whereas late deaths tend to result from sepsis and multiple organ failure. Liver transplantation is the only current definitive treatment in those failing supportive medical management. However, hepatic assist devices are currently under investigation to provide liver support as a ‘bridge to transplantation’ or during recovery of the native liver.