R Strauss

Changes in quality of life after medical intensive care

Objectives: To determine outcome and changes in health-related quality of life (QOL) in medical intensive care patients. Design and setting: Prospective comparison of QOL before and 6xa0months after intensive care unit (ICU) admission in a 12-bed noncoronary medical ICU of a university hospital. Patients: All 325 consecutively admitted adult patients who spent at least 24xa0h on the ICU were eligible. Measurements and results: QOL measurements were collected before and 6xa0months after ICU admission. Comorbidity classified by the Charlson index was 2.44±1.96. Mean stay in the ICU was 10.4±15.1xa0days, mean Acute Physiology and Chronic Health Evaluationxa0II score was 23±10. Cumulative mortality was: ICU 24%, hospital 34%, 6xa0months 43%. Relative to baseline, follow-up interviews of 185 survivors revealed no significant changes in the overall QOL score (p=0.93). The subscales basic physiological activities (p=0.07) and normal daily activities (p=0.15) showed a nonsignificant deterioration. A significant improvement was noted for the domain emotional state (p=0.013). Conclusions: Six months after admission to a medical ICU most survivors had regained their preadmission health-related QOL. Multivariate analysis showed that preadmission QOL, age, and severity of illness were most strongly associated with follow-up QOL. Of the survivors 86% were living at home, and all but one of those previously in employment had returned to their former work. Most patients (94%) would undergo ICU treatment again if necessary.

Pseudomembranous Tracheobronchitis Due to Bacillus cereus

We present a case of a rapidly progressive pseudomembranous tracheobronchitis and pneumonia in a 52-year-old woman with severe aplastic anemia. Bacillus cereus was isolated from bronchoalveolar lavage fluids, blood cultures, and pseudomembrane biopsy specimens; despite intensive antibiotic treatment, the patients condition deteriorated rapidly. To our knowledge, this is the first report of a B. cereus infection that has caused pseudomembranous tracheobronchitis, possibly because of the production of bacterial toxins.

Endoscopic placement of nasojejunal tubes: A randomized, controlled, prospective trial comparing suitability and technical success for two different tubes ☆

BACKGROUNDnJejunal feeding is an attractive means for delivering nutrients to critically ill patients. Nasojejunal tubes may have different advantages and disadvantages that may have important clinical implications.nnnMETHODSnTo compare the suitability of 2 different nasojejunal feeding tubes (Tube A, Dobbhoff; Tube B, Freka-Trelumina) for use by endoscopists and nursing staff, a randomized, controlled, prospective trial was performed in 60 patients. The primary end point was time required for tube placement. Secondary end points were successful placement and nursing problems encountered during clinical use. Results of upper endoscopy were also recorded.nnnRESULTSnPlacement took significantly longer with Tube A than Tube B (95% CI for median [11.5, 20.0] minutes vs. [5.5, 7.5] minutes; p < 0.001), and was less successful (73.3% vs. 90%; p = 0.18). Nursing problems occurred significantly more often with Tube A compared with Tube B (11 vs. 1; p < 0.001). Tube B stayed in place significantly longer than Tube A (37 days vs. 21 days; p = 0.034). In 45% of the cases, upper endoscopy provided a diagnosis of potential therapeutic relevance.nnnCONCLUSIONSnSelection of a nasojejunal tube for endoscopic placement has significant implications with respect to time required for placement, duration of tube usage and the practicability for nursing staff. Diagnostic upper endoscopy performed concomitantly often reveals findings of clinical importance.

Severe ovarian hyperstimulation syndrome in a twin pregnancy after intracytoplasmic sperm injection

A 35‐year‐old woman developed bilateral jugular thrombosis in the seventh gestational week in a twin pregnancy after severe ovarian hyperstimulation syndrome (OHSS) and intracytoplasmic sperm injection (ICSI). Due to progressive thrombosis and further complications despite anticoagulation therapy, the pregnancy was terminated in the ninth gestational week. Thromboembolic events are a serious complication associated with OHSS after assisted reproduction techniques. In these cases, a pregnancy can usually be protected by administering anticoagulation therapy, but our case shows that there may be exceptions to this. Screening for thrombophilia should be considered in patients who are at risk for OHSS and deep vein thrombosis.

Changes in hepatic perfusion after administration of hydroxyethyl starch in intensive care patients assessed using color-coded Doppler sonography

Using color-coded Doppler sonography (CCDS), changes in the resistance index of the hepatic artery (HA-RI) and in the velocities of the hepatic artery, portal and splenic vein (HA-V, PV-V, SV-V) were measured after administration of hydroxyethyl starch (HES) in 50 intensive care patients. PV-V and SV-V increased, whereas HA-V and HA-RI remained unchanged. CCDS is suitable to assess liver perfusion in intensive care patients. Since HES enhances splanchnic perfusion, its application improves hepatic perfusion in intensive care patients.

Bronchoscopy and BAL in mechanically ventilated patients in an ICU at a university teaching hospital

Bronchoscopy is an important diagnostic and therapeutic tool in modern intensive care medicine. In ventilated patients it can lead to hemodynamic instability and can compromise the gas exchange.