Temperature control in sepsis.

Fever can be viewed as an adaptive response to infection. Temperature control in sepsis is aimed at preventing potential harms associated with high temperature (tachycardia, vasodilation, electrolyte and water loss) and therapeutic hypothermia may be aimed at slowing metabolic activities and protecting organs from inflammation. Although high fever (>39.5°C) control is usually performed in critically ill patients, available cohorts and randomized controlled trials do not support its use to improve sepsis prognosis. Finally, both spontaneous and therapeutic hypothermia are associated with poor outcomes in sepsis.

Post-traumatic pulmonary embolism: incidence, physiopathology, risk factors of early occurrence, and impact outcome. A narrative review.

BACKGROUND: Venous thromboembolism (VTE) is a well-established complication of trauma. So far, the factors that are related to early post-traumatic pulmonary embolism (PE) occurrence have been given little attention. AIMS: We have conducted this literature review in order to analyze the incidence and the physiopathology of post-traumatic PE among intensive care unit (ICU) trauma patients, analyze the incidence of early post-traumatic PE, and elucidate risk factors associated with post-traumatic PE. Moreover, we aim to study the impact/outcome of post-traumatic PE in the ICU. METHODS: We used the PubMed and EMBASE databases and entered the following key words in MeSH research: Deep vein thrombosis (DVT), Post-traumatic Pulmonary embolism, Early pulmonary-embolism, risk factors, and Prognosis. RESULTS: The incidence of PE among trauma patients varies considerably, ranging from 0.35% to 24%. The incidence of early post-traumatic PE varies widely from 10 to 42%. After a traumatic injury, many factors have been found to be responsible for the formation of DVT and PE. In addition to the risk factors of hypercoagulability described by Virchow in his original triad, inflammation acting via endothelial damage may be considered as a fourth factor. The literature review showed that lower limb fractures and age are the most frequent factors associated with PE (particularly in early PE). The heterogeneity among studies limits reliable conclusions regarding the true risk factors for the timing of the occurrence of post-traumatic PE. Fatality from pulmonary embolism (PE) is close to 50% in some series. Moreover, high mortality rates, a high rate of nosocomial infections, and a prolonged stay in an ICU and/or in a hospital were found to be associated with the development of PE. CONCLUSION: Post-traumatic PE is frequent in ICUs. Inflammation acting via endothelial damage may be considered as a fourth factor in addition to the Virchow's triad of risk factors for venous thrombosis. Fractures of the lower extremities, obesity, and age happen to be the most frequent factors associated with PE (in particular early PE). PE development was associated with high rates of mortality, nosocomial infections, and a prolonged stay in an ICU and/or in a hospital. Therefore, prevention is warranted.

Early post-traumatic pulmonary embolism in intensive care unit: incidence, risks factors, and impact outcome.

BACKGROUND: Venous thromboembolism (VTE) is a well-established complication of trauma. Recent studies suggest that pulmonary embolism (PE) may occur very early, and even immediately, after injury. The aim of this study is to analyze the incidence, risk factors and prognosis of early PE among ICU trauma patients. PATIENTS AND METHODS: We conducted a twenty-month-long prospective cohort study, including all trauma patients with a confirmed PE diagnosis admitted to our ICU between January 1st, 2017 and August 31st, 2018. Early post traumatic PE was defined as pulmonary embolism diagnosed within the first 72 hrs of injury. All the patients who were included were systematically screened for early PE on day 3. RESULTS: During the study period, 365 trauma patients were admitted. The diagnosis of post-traumatic PE was confirmed in 66 patients (18%). In our study, 27 patients (41.5%) developed a PE within 72 hrs of trauma. According to our analysis, the factors associated with the development of early post-traumatic PE in multivariate analysis were obesity (P=0.049; OR=4.04), high SOFA score (P=0.003; OR=1.67), and the use of surgical procedures (P=0.033; OR=4.87). Furthermore, sepsis and ventilator-acquired pneumonia were associated with late PE (P=0.019; OR=5.87). Overall, the mortality rate was at 19.7%. Yet, the patients who were diagnosed with early PE had a higher mortality rate compared to the late PE group (33% vs. 10.2%, respectively). We found that the only independent predictive factor of mortality among the patients with early post-traumatic PE included in this study was the APACHEII score on ICU admission (P=0.011; OR=1.44). CONCLUSION: Our study cohort showed that many of the post-traumatic PEs occur early in the post-traumatic period. To the best of our knowledge, this is the first prospective study conducted in an ICU to apply a systematic screening protocol for post-traumatic PE diagnosis. Further studies with larger patient populations are required to create more accurate predictive models.

Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases.

PURPOSE: to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. METHODS: We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. RESULTS: During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. CONCLUSION: Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.

Evidence of Direct Toxicological Effects of Scorpion Venom on Central Nervous System in Tunisian Children.

BACKGROUND: Severe scorpion envenomation can lead to severe neurological manifestations, which are an indicator of the severity of the scorpion sting. The direct action of scorpion venom on the central nervous system can explain partly these neurological disorders. METHODS AND FINDINGS: We report a case of severe scorpion envenomation in 16-month-old boy with no pathological history admitted in ICU for severe scorpion envenomation. The result of cerebral MRI agrees with the hypothesis of direct action of scorpion venom on the central nervous system. Patient had improved; however, he has kept as neurological sequelae language disorders and blindness. The boy was discharged 21 days after ICU admission. CONCLUSION: Our observation confirms that severe scorpion envenomation can be complicated by severe neurological manifestations. Although one case report is not enough to conclude such important hypothesis regarding the direct effect of scorpion venom on central nervous system (especially that the age of patient is more than one year), our case agrees with this hypothesis.