Seval Urkmez

Critically ill obstetric patients in the intensive care unit

We aimed to determine the morbidity and mortality among obstetric patients admitted to the intensive care unit. In this study, we analyzed retrospectively all obstetric admissions to a multi-disciplinary intensive care unit over a five-year period. Obstetric patients were identified from 4733 consecutive intensive care unit admissions. Maternal age, gestation of newborns, mode of delivery, presence of coexisting medical problems, duration of stay, admission diagnosis, specific intensive care interventions (mechanical ventilation, continuous veno-venous hemofiltration, central venous catheterization, and arterial cannulation), outcome, maternal mortality, and acute physiology and chronic health evaluation (APACHE) II score were recorded. Obstetric patients (n=125) represented 2.64% of all intensive care unit admissions and 0.89% of all deliveries during the five-year period. The overall mortality of those admitted to the intensive care unit was 10.4%. Maternal age and gestation of newborns were similar in survivors and non-survivors. There were significant differences in length of stay and APACHE II score between survivors and non-survivors P < 0.05. The commonest cause of intensive care unit admission was preeclampsia/eclampsia (73.6%) followed by post-partum hemorrhage (11.2%). Intensive care specialists should be familiar with these complications of pregnancy and should work closely with obstetricians.

Crush syndrome patients after the Marmara earthquake

Background: To assess the treatment and outcome of patients with crush injury sustained in the Marmara earthquake. Methods: Seven hundred eighty three patients were transferred to a university hospital and 25 of them were admitted to the intensive care unit. The medical records of 18 crush injury patients were retrospectively reviewed. Results: The major associated injuries were in the lower extremities, upper extremities, and chest. Seven patients underwent fasciotomy and six patients had amputations. Twelve patients required mechanical ventilation. Adult respiratory distress syndrome developed in four patients. Oliguria occurred in eight patients. Hyperkalaemia was seen in six patients and four of them underwent emergency haemodialysis. One patient died because of hyperkalaemia on arrival to the intensive care unit. Renal failure was treated with haemodialysis or haemoperfusion in 13 patients. Five patients died because of multiple organ failure and two patients because of sepsis. Conclusion: Crush syndrome is a life treatening event. The authors believe that early transportation and immediate intensive care therapy would have improved the survival rate.

Chediak-Higashi syndrome in the intensive care unit.

Chediak–Higashi Syndrome is a rare autosomal recessive disease characterized by recurrent infections, giant cytoplasmic granules and oculocutaneous albinism. We describe the clinical and laboratory findings of a patient with Chediak–Higashi syndrome who was diagnosed and treated in the intensive care unit because of bleeding tendency after surgery.

Noninvasive Ventilation in Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome (ARDS) is the clinical picture of hypoxemic respiratory failure characterized by acute onset, hypoxemia that is unresponsive to oxygen therapy, and bilateral opacities on the chest X-ray. Intubation and lung-protective mechanical ventilation constitute the main treatment strategy for this syndrome. However, noninvasive positive pressure ventilation without endotracheal intubation may be an alternative to this strategy, at least in some patients. Some studies have shown promising results with noninvasive ventilation, although the results are still controversial. In some patients with ARDS who do not show an immediate need for intubation, the success of noninvasive ventilation is closely related to the degree of hypoxemia, the severity of ARDS, and the coexisting physiologic problems and complications. As in all patients with noninvasive ventilation, it should be kept in mind that failure of noninvasive ventilation and delay in intubation can increase the risk of mortality. For this reason, the benefits of noninvasive ventilation and the risk of failure should be evaluated carefully and the clinician should be ready to intubate the patient in the event of failure.