Guillain-Barré syndrome in pregnancy

OBJECTIVE: A case report of a 23-year-old pregnant woman diagnosed with Guillain-Barré syndrome in the 31st week of pregnancy. CASE REPORT: We present a case study of a patient in the 31st week of pregnancy hospitalized at the University Hospital in Brno for expressed bulbar syndrome, neck muscle weakness, paresthesia of the arms and medical history of diarrhea in the previous week. During hospitalization, there was a rapid progression of symptoms and respiratory failure, requiring orotracheal intubation. The diagnosis of Guillain-Barré syndrome was determined and intravenous immunoglobulin therapy was initiated. The pregnancy was terminated in the 32nd week of gestation based on the maternal indication after a completed lung maturation of the fetus. CONCLUSION: Guillain-Barré syndrome is a neurological disease that can rarely occur during pregnancy and puerperium. The syndrome presents a serious pregnancy complication with an uncertain prognosis and risk for both mother and fetus. If the syndrome is diagnosed in time and treated correctly, the prognosis is favorable despite the complicated course.

Comparison of continuous versus intermittent enteral nutrition in critically ill patients (COINN): study protocol for a randomized comparative effectiveness trial.

BACKGROUND: Enteral nutrition is part of the treatment of critically ill patients. Administration of enteral nutrition may be associated with signs of intolerance, such as high gastric residual volumes, diarrhea, and vomiting. Clinical trials regarding the effects of the mode of administration of enteral nutrition on the occurrence of these complications have yielded conflicting results. This trial aims to investigate whether the mode of administration of enteral nutrition affects the time to reach nutritional targets, intolerance, and complications. METHODS: COINN is a randomized, monocentric study for critically ill adult patients receiving enteral nutrition. Patients will be randomly assigned to two groups receiving (1) continuous or (2) intermittent administration of enteral nutrition. Enhancement of enteral nutrition will depend on signs of tolerance, mainly the gastric residual volume. The primary outcome will be the time to reach the energetic target. Secondary outcomes will be the time to reach the protein target, tolerance, complications, hospital and ICU lengths of stay, and 28-day mortality. DISCUSSION: This trial aims to evaluate whether the mode of application of enteral nutrition affects the time to reach nutritional targets, signs of intolerance, and complications. TRIAL REGISTRATION: ClinicalTrials.gov NCT03573453. Registered on 29 June 2018.

Therapeutic influence of 20 % albumin versus 6% hydroxyethylstarch on extravascular lung water in septic patients: a randomized controlled trial.

BACKGROUND/AIMS: Recent studies demonstrated that extravascular lung water (EVLW) is a reliable and independent marker for outcome. The primary therapeutically goal in critically ill patients is to resuscitate and retain adequate organ perfusion by fluid administration, where is necessary to achieve adequate intravascular filling, but avoid initiation of pulmonary edema. METHODOLOGY: Patients with severe sepsis were randomly allocated to a group treated with 20% Albumin 100 ml every 12 hours (ALB; n = 30) or with 6% hydroxyethylstarch 130/0, 4 250 ml every 6 hours (HES; n = 26). Both treatments were completed by crystalloids or norephinephrin as necessary. We analyzed amount of developed EVLW, and relation with mortality, PaO2/FiO2 and alveolo-arterial oxygen difference. RESULTS: We observed significantly greater decrease of EVLW when compared with baseline during whole monitored period of 72 hours in ALB group in contrast to HES patients (p < 0.05). Despite no significant changes of EVLW in HES group, we noted improve of PaO2/FiO2 and AaDO2 in both groups. We did not observed significant difference in mortality. CONCLUSION: The present study results show can summarize that albumin reduces in a higher amount and earlier the extravascular lung water than HES, but this reduction was not associated with improvement of oxygenation functions, which was better in HES group.

Central venous catheter-related thrombosis in intensive care patients - incidence and risk factors: A prospective observational study.

BACKGROUND: One of the complications associated with central venous catheter (CVC) placement is catheter related deep vein thrombosis (CR-DVT). However a literature search revealed little evidence of this recognised complication. The primary aim of this study was to establish the incidence rate and risk factors for the development of CR-DVT in our critically ill adult patients. METHODS: All critically ill adult patients admitted to the medical-surgical ICU with CVC inserted were included in this observational prospective study. After catheter removal we performed duplex ultrasound examination to assess the patency of the vein and establish if CR-DVT was present. RESULTS: A total number of 308 catheters met the inclusion criteria of which 198 were included in the statistical analysis. The CVC was inserted into a subclavian vein (SCV) in 139 (70%) cases and in an internal jugular vein (IJV) in 59 (30%) cases. The 28-day mortality rate was 14.1%. We found CR-DVT during duplex ultrasound examination in 47 (26%) of all cases. 33 (70%) of the CR-DVT were diagnosed in the IJV and 14 (30%) in the SCV. The risk factors for the development of CR-DVT we identified included cannulation of the IJV and the use of treatment dose of LMWH. The effect of CR-DVT on 28-day mortality was not statistically significant. CONCLUSION: The risk factors for CR-DVT we identified were IJV as a site for CVC cannulation and the use of therapeutic anticoagulation prior to cannulation. Our recommendation would be preferential cannulation of a subclavian vein as opposed to an internal jugular vein in order to reduce the risk of CR-DVT.