Negative pressure pulmonary edema may present as acute left ventricular failure: a case report

Negative pressure pulmonary edema [NPPE] also known as post obstructive pulmonary edema is a potentially life threatening condition with a multifocal pathogenesis. Type 1 NPPE is due to forceful inspiratory effort in the context of an acute airway obstruction, while Type 2 NPPE occurs after relief of a chronic partial upper airway obstruction. Once developed, it impairs gas exchange and causes hypoxemia and if not treated promptly may lead to respiratory failure. The diagnosis of negative pressure pulmonary edema is usually made on the basis of a history of a precipitating incident and symptoms. However, it is basically a diagnosis of exclusion. We present here a case of negative pressure pulmonary edema, which presented as acute left ventricular failure. The cause was eventually found to be acute airway obstruction due to an obstructive goiter precipitated by an upper respiratory tract infection

audit on ventilator associated pneumonia in the intensive care unit at teaching hospital Karapitiya, Galle, Sri Lanka

Critical care is one of the most expensive services provided by a hospital. The aim of this audit was to ascertain the incidence of ventilator associated pneumonia in the intensive care unit. A descriptive study. Teaching Hospital Karapitiya, Galle [Sri Lanka]. 1[st] June 2010 to 30[th] August 2010. All patients, who were admitted to ICU and who stayed there for more than 48hrs during a period of three months were studied. Infections were identified on clinical parameters such as fever and on laboratory investigations such as full count, CRP and cultures. Out of 82 patients, 48[58.5%] were subsequently discharged to the ward and 30[36.6%] succumbed to their illness. 68[82.9%] were ventilated and 26 of them had an underlying pathology related to an infection. A total of 20[29.4%] patients of this ventilated group subsequently developed a lower respiratory tract infection. The main nosocomial infection was ventilator associated pneumonia and had an incidence of 21.9%. The most prevalent organisms were mixed gram negative bacilli and Acinetobacter spp. Nosocomial infections are a cause of increased mortality and morbidity in the intensive care unit. Awareness of the risk factors together with simple preventive measures and surveillance will help to reduce its occurrence

audit of cost on maintaining a critical care unit

Critical care is one of the most expensive services provided by a hospital. The aim of this audit was to analyze the different expenditures in a critical care unit and to calculate the average cost for a bed to be maintained a day. Data on cost in providing critical care during one month were calculated. It included cost of drugs, consumables, medical gases, investigations, staff wages, electricity, water, telephone and indirect expenses as administration, cleaning services, laundry and security. Most costs were direct, but some had to be estimated. Estimations were mainly investigations, oxygen and indirect expenses. The cost of maintaining the 7 bed critical care unit was Rs 51 49 998.20/month. Medical gases and staff wages were the highest costs. The cost of maintaining a bed/day was Rs 24 523.80. With clinical audit and financial data a patient costing system can be developed easily which will immensely help the health administrators

Haemorrhage not amenable to surgery managed successfully with recombinant activated factor VII [Novoseven

Haemorrhage, hypothermia and acidosis are considered the triangle of death in surgical mortality. Prompt control of bleeding and adequate replacement will prevent the patient getting into an irreversible vicious cycle. We present three cases of significant bleeding not amenable to surgery and which were successfully managed with recombinant activated factor VII [rFVlIa]