RESUMEN
BACKGROUND: An important long-term complication of critical illness is significant weakness and its resulting functional impairment. Recent advances have aimed to prevent critical illness weakness via early mobilisation of patients, minimising sedation, and optimising nutrition. One other potential treatment may be to provide anabolic support in the recovery phase, especially as patients have decreased levels of anabolic hormones. CASE PRESENTATION: We describe a case series of 4 patients who had either (1) profound critical illness myopathy and (2) profound weight loss. All patients were already receiving appropriate nutritional support and physiotherapy. All patients had functional improvements in their muscle strength. CONCLUSIONS: For patients in the recovery phase of critical illness, we provide examples of when anabolic steroid supplementation may assist the treating clinicians in rehabilitating their patients who are still in the Intensive Care Unit. We discuss patient selection and the current supporting literature for anabolic supplementation in critically ill patients.
RESUMEN
Veno-arterial extracorporeal membrane oxygenation (VA ECMO) causes changes in the filling and blood flow of the cardiac chambers and pulmonary vessels as well as alterations in the path of intravenous contrast injected during CT. We present a patient with a potentially misleading CT pulmonary angiogram while on full VA ECMO. We demonstrate circulatory changes as well as alterations in contrast flow when ECMO flows are reduced.
Asunto(s)
Angiografía/métodos , Artefactos , Oxigenación por Membrana Extracorpórea/métodos , Arteria Pulmonar/diagnóstico por imagen , Embolia Pulmonar/diagnóstico por imagen , Tomografía Computarizada por Rayos X/métodos , Adolescente , Reacciones Falso Positivas , Femenino , HumanosRESUMEN
Serotonin toxicity secondary to drug therapy, interaction or overdose is an increasing phenomenon worldwide. A proportion of patients require admission to an intensive care unit, but the treatment needed is usually supportive and of short duration. Prolonged ICU admission to control ongoing or long-lasting serotonin toxicity has not been reported previously. We describe three patients with prolonged serotonin toxicity, lasting 12-18 days. Symptoms of toxicity were easily demonstrable in each and were refractory to currently recommended therapies. We review the pharmacological mechanisms that led to prolonged serotonin toxicity in these patients. Predictors for prolonged serotonin toxicity include involvement of irreversible monoamine oxidase inhibitors (MAOIs) or slow-release preparations resistant to the effects of activated charcoal (eg, lithium). We also discuss the implications of prolonged toxicity for critical care management, to maintain optimal patient outcomes.