Severe Non-influenza Viral Pneumonia in the Critical Care Unit
Cheston B. Cunha, Burke A. Cunha in Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
MERS typically presents with fever, cough, abdominal pain, myalgia, and headache; it is frequently followed by the rapid development of pneumonia and respiratory failure [38,46]. Approximately 53%–89% of patients hospitalized with MERS-CoV require admission to CCUs, with a median duration of 7 days from symptom onset to CCU admission [47]. The majority of patients have abnormal chest radiographs with ground-glass opacities (most common), confluent consolidation, and pleural effusion [48]. Upper lobe involvement is infrequent early in the course of illness; however, radiographic progression appears to be rapid, with involvement of all lung zones, typically during peak radiographic deterioration [48]. Acute renal failure necessitating renal replacement therapy is common, occurring in over half of patients [49]. Despite intensive supportive care, mortality rates in patients with MERS admitted to CCUs remain high, ranging from 58% to 90% [47].
Practice Paper 6: Answers
Anthony B. Starr, Hiruni Jayasena, David Capewell, Saran Shantikumar in Get ahead! Medicine, 2016
Acute renal failure can be defined as the deterioration of renal function over hours or days. By far the most common cause of acute renal failure is hypoperfusion of the kidney, referred to as pre-renal acute renal failure. This is usually seen with hypovolaemia secondary to conditions such as acute blood loss, vomiting, diarrhoea and burns. It may also occur in normovolaemic patients with sepsis, cardiac failure or renal artery stenosis. Investigation demonstrates high serum urea, creatinine and potassium concentrations, and a poor urine output. Pre-renal acute renal failure is treated by correcting the underlying condition and restoring the patient’s circulating volume with intravenous fluids. If the kidneys are hypoperfused for a significant amount of time, autoregulatory mechanisms within the renal vasculature fail, causing tubular cell damage and death. This condition is known as acute tubular necrosis (ATN) and results in failure of active sodium reabsorption and failure to concentrate the urine. The urine produced in ATN typically has a high sodium concentration, a low osmolarity, a low urine: serum urea ratio and a low urine:plasma osmolarity ratio. ATN usually resolves if the underlying cause is corrected and appropriate fluid therapy is delivered, although recovery may take weeks. During recovery, there is an oliguric phase (when both glomerular filtration and tubular function are compromised), followed by a diuretic phase (when glomerular filtration recovers before tubular function is regained).
Interpretation of abnormal results
Alistair Burns, Michael A Horan, John E Clague, Gillian McLean in Geriatric Medicine for Old-Age Psychiatrists, 2005
All patients will be best managed by a physician than by a psychiatrist, and should be referred promptly. It will be appreciated that you will have not only the results of urea, creatinine and electrolyte measurements, but also the results of a full blood count and uri�e stick testing. The early symptoms in acute renal failure usually reflect the underlying cause: symptoms of the renal failure develop later and include nausea, vomiting and delirium. Bleeding can arise because of altered platelet function. Hyperkalaemia usually develops with significant renal impairment (page 41). Acidosis, which occurs because the metabolic acid load cannot be excreted adequately, causes tachypnoea. Uri�e output falls in hypotensive or infective causes (< 500 mi per 24 hours defines oliguria). With other forms of acute renal failure, oliguria is less common. Myoclonic jerks are commonly observed. Uraemic encephalopathy has a very poor prognosis: the earliest sign is asterixis.
Iron metabolism-related indicators as predictors of the incidence of acute kidney injury after cardiac surgery: a meta-analysis
Published in Renal Failure, 2023
Limei Zhao, Xiaoyu Yang, Shengchao Zhang, Xiaoshuang Zhou
Regarding the respective relationship between transferrin saturation, serum iron, urine catalytic iron and AKI after cardiac surgery, no meta-analysis was performed because only one article for each relationship was found during the literature search. Akrawinthawong K et al. [43] studied the relationship between urine catalytic iron and AKI after cardiac surgery and found that patients with AKI after cardiac surgery showed a significant increase in urine catalytic urinary iron 8 h after surgery, while creatinine levels did not change significantly until 12 h later. Thus, urine catalytic iron may predict AKI earlier than creatinine after cardiac surgery. Choi N et al. [16] found that higher transferrin saturation at 1 h after cardiopulmonary bypass was an independent predictor of acute kidney injury, and animal experiments have also revealed that intraperitoneal injection of unconjugated ferrotransferrin can reduce free iron in the circulation of ischemia–reperfusion mice, eliminate superoxide formation in the kidney, and reduce postischemic inflammation characterized by neutrophil infiltration [44], suggesting that transferrin saturation can be used as an early predictor of AKI after cardiac surgery and that unconjugated ferrotransferrin can be used to enhance endogenous iron binding capacity. These findings reveal a potential treatment strategy for acute renal failure.
Cost-effectiveness of the adjuvanted quadrivalent influenza vaccine in the elderly Belgian population
Published in Expert Review of Vaccines, 2023
Sophie Marbaix, Nicolas Dauby, Joaquin Mould-Quevedo
Respiratory diagnoses other than influenza are the most frequent complications and include bronchitis, pneumonia or any URTI, and acute exacerbation of COPD. Myocarditis, MI, renal or CNS complications, and stroke are the nonrespiratory complications associated with influenza infection. Renal complications refer to acute renal failure, glomerulonephritis, and nephrotic syndrome. CNS complications include meningitis, psychosis, epilepsy and Guillain-Barré syndrome. The probabilities of developing these complications were mainly derived from an observational study conducted in the United Kingdom [4] and adapted for a previous cost-effectiveness analysis [20]. The nature of the complications and the risk of hospitalization due to complications were validated by Belgian experts. All nonrespiratory complications were assumed to require hospitalization. Bronchitis and URTIs were mainly managed in outpatient settings. The risk of hospitalization due to pneumonia was derived from a previous Belgian cost-effectiveness analysis [38]. A similar risk of hospitalization was assumed in the case of COPD exacerbations based on the number of hospitalizations due to influenza in combination with pneumonia and COPD diagnoses [3].
Clinical characterisation and management outcome of obstetric patients following intensive care unit admission for COVID-19 pneumonia
Published in Journal of Obstetrics and Gynaecology, 2023
Esra Aktiz Bıçak, Süleyman Cemil Oğlak
The CT reports of patients interpreted by the radiology unit revealed that 17 (54.8%) had mild pulmonary involvement, 6 (19.4%) had moderate pulmonary involvement and 8 (25.8%) had severe pulmonary involvement (Figures 2, 3). Sixteen (51.6%) patients required HFOT, 6 (19.3%) patients required CPAP, and 5 (16.1%) patients required invasive mechanical ventilation. One intubated patient was extubated, and the others resulted in mortality. Six patients were transferred to the tertiary ICU due to the need for advanced follow-up and treatment. Sepsis complicated by septic shock and multiorgan failure occurred in 4 of those. Renal replacement therapy was performed on two of the patients with acute renal failure. Spontaneous pneumothorax developed in one patient and a left chest tube was inserted. Vasopressor therapy was performed in 3 patients with developed septic shock. The mean length of stay in the ICU and hospital was 4.9 ± 4.3 (1–18) days and 10.4 ± 5.1 (3–21) days, respectively (Table 2).
Related Knowledge Centers
- Ace Inhibitor
- Bleeding
- Cardiogenic Shock
- Cirrhosis
- Dehydration
- Sepsis
- Heart Failure
- Creatinine
- Assessment of Kidney Function
- Ace Inhibitor
- NONsteroidal Anti-Inflammatory Drug