Impact of Aspergillus spp. isolation in the first 24 hours of admission in critically ill patients with severe influenza virus pneumonia.

OBJECTIVE: To determine the incidence and impact of Aspergillus spp. isolation (AI) on ICU mortality in critically ill patients with severe influenza pneumonia during the first 24h of admission. DESIGN: Secondary analysis of an observational and prospective cohort study. SETTING: ICUs voluntary participating in the Spanish severe Influenza pneumonia registry, between June 2009 and June 2019. PATIENTS: Consecutive patients admitted to the ICU with diagnosis of severe influenza pneumonia, confirmed by real-time polymerase chain reaction. INTERVENTIONS: None. MAIN VARIABLES OF INTEREST: Incidence of AI in respiratory samples. Demographic variables, comorbidities, need for mechanical ventilation and the presence of shock according at admission. Acute Physiology and Chronic Health Evaluation II (APACHE II) scale calculated on ICU admission. RESULTS: 3702 patients were analyzed in this study. AI incidence was 1.13% (n=42). Hematological malignancies (OR 4.39, 95% CI 1.92-10.04); HIV (OR 3.83, 95% CI 1.08-13.63), and other immunosuppression situations (OR 4.87, 95% CI 1.99-11.87) were factors independently associated with the presence of Aspergillus spp. The automatic CHAID decision tree showed that hematologic disease with an incidence of 3.3% was the most closely AI related variable. Hematological disease (OR 2.62 95% CI 1.95-3.51), immunosuppression (OR 2.05 95% CI 1.46-2.88) and AI (OR 3.24, 95% CI 1.60-6.53) were variables independently associated with ICU mortality. CONCLUSIONS: Empirical antifungal treatment in our population may only be justified in immunocompromised patients. In moderate-high risk cases, active search for Aspergillus spp. should be implemented.

[Use of axillary perivascular blockage of the brachial plexus with a catheter as treatment in accidental intra-arterial injection of drugs]. / Utilización del bloqueo perivascular axilar del plexo braquial mediante catéter como tratamiento de la inyección accidental intraarterial de fármacos.

We report the intraarterial injection of a flunitrazepam tablet dissolved in water in a patient with intravenous drugs addiction. Several ecchymotic lesions were present at different sites of the arm. In order to achieve analgesia and the sympathetic blockade of the arm, we performed an axillary perivascular block of the brachial plexus by means of the intermittent injection through a catheter of 0.25% bupivacaine with a 1:200,000 epinephrine solution. In addition, an anticoagulant treatment with heparin was started as prophylaxis of the thrombosis of the vessel. There was a satisfactory clinical course even though a distal phalange had to be amputated on the 18th day. We propose the continuous perivascular block as the method of choice of this type of medical problem.