Successful heparin desensitization after anaphylactic shock due to heparin.

A successful desensitization protocol in a patient with low molecular weight heparin induced anaphylactic reaction is being presented. A 72-years-old patient who was known to have multiple drug allergies and asthma was admitted with acute renal insufficiency. She had an anaphylactic reaction with a low molecular weight heparin during a hemodialysis session. Peritoneal dialysis was not feasible. Anticoagulation with warfarin was not considered appropriate; alternative anticoagulants were not available. Therefore a desensitization protocol was planned and applied, comprising of IV administration of diluted heparin by gradually increasing doses (0.1 to 5000 units), at 15 minute intervals, completing 8 hours before the procedure. By this way, IV heparin could be administered during the subsequent hemodialysis sessions with no reactions. The Naranjo probability scale revealed a probable adverse reaction associated with nadroparin for this patient. Anaphylactic reaction to low molecular weight heparins is reported rarely in the literature. To the best of our knowledge, this is the third case of successful heparin desensitization. When other anticoagulants are not available and anticoagulation is indispensible, heparin desensitization can be an option.

Ventilator-associated pneumonia caused by high risk microorganisms: a matched case-control study.

UNLABELLED: To determine the impact of ventilator-associated pneumonia (VAP) caused by high risk microorganisms (HRM) on patient outcome. DESIGN: Matched case-control study. The study was conducted in a medical intensive care unit (ICU) of a university hospital. Thirty-five patients with VAP caused by HRM, including Pseudomonas aeruginosa, Acinetobacter spp., Stenotrophomonas maltophilia and/or methicillin-resistant Staphylococcus aureus were accepted as the case the patients. Thirty-five control patients, who did not develop VAP were matched to the case patients, according to APACHE II score, age, date of admission and duration of mechanical ventilation (MV). ICU and hospital mortality rates were similar between the case and the control patients (p= 0.58 and p= 1.00, respectively). However, length of ICU stay was longer in the case patients than in the control patients [20 (11-30) days (median-interquartile range-) and 13 (8-19) days, respectively; p< 0.01]. Length of hospital stay was also longer in the case patients than in the control patients [29 (20-44) days and 22 (13-37) days, respectively; p= 0.05]. In addition, duration of MV was longer in the case patients than in the control patients [18 (10-25) days and 8 (6-11) days, respectively; p< 0.01]. VAP caused by HRM independently prolonged ICU (OR: 6) and hospital stay (OR: 4) and duration of MV (OR: 11). VAP caused by HRM was not significantly associated with mortality. However, it was an independent risk factor, increasing length of ICU stay and hospital stay by seven days, and duration of MV by 10 days.