The physiological changes induced by liberation from mechanical ventilation are usually well tolerated by patients deemed to have passed a “spontaneous” breathing trial. However, a subset of patients with acceptable indices of respiratory load while on very low ventilator support will subsequently experience cardiopulmonary collapse following removal of the endotracheal tube. These patients typically have underlying co-morbid cardiopulmonary disease whereby poor physiological reserve in either organ system induces and perpetuates pathophysiology in the other. Knowledge of these deleterious interactions may help the clinician anticipate abnormal cardio-respiratory load and hemodynamic embarrassment after extubation.
As of May 2014, over 530 cases of human infection with the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) have been reported. We describe the first case of MERS-CoV in the Qassim region of Saudia Arabia, a 69-year-old man who rapidly developed severe acute respiratory distress syndrome (ARDS) and expired on hospital day nine. MERS-CoV was confirmed by DNA testing postmortem. Novel coronavirus infection should be suspected in high-risk patients living in or visiting geographical regions where other cases have been reported.
Critical care: what’s old is new As compared to the exciting technological and pharmacological advances we have witnessed in some other medical specialties, progress in critical care medicine often resembles the recycling of fashion trends: the adage “what’s old is new” comes to mind. While rheumatologists are improving lives with the anti-TNF antibodies that failed […]
Triglycerides are an independent risk factor for adverse cardiovascular events and a potential mediator for pancreatic induced inflammation. We present a case of hypertriglyceride-induced pancreatitis that resolved after plasmapheresis, and review the current literature on plasmapheresis as a treatment for pancreatitis caused by hypertriglyceridemia.
We present the case of a patient with community-acquired pneumonia unresponsive to empiric azithromycin, and discuss the diagnostic and therapeutic considerations of this clinical scenario.
New research is the lifeblood of medical progress. Thanks to the proliferation of more than 50 good-quality medical journals publishing articles in critical care and respiratory medicine every month, most well-conducted research today will find publication. But will it be read? The sheer numbers of published articles and the extent of their dispersion have made […]