Intensive Care of a Weil's Disease With Multiorgan Failure

Leptospirosis is a commonly encountered type of zoonosis, especially in tropical regions. There is insufficient data regarding its frequency in non-tropical regions such as Turkey. Although leptospirosis presents with a mild icteric form in nearly 90% of cases, it can lead to Weils disease characterized by fever as well as fulminant hepatorenal and respiratory failure, in approximately 5 - 10% of cases. In this case report, we present a patient with Weil's disease, complicated with multiorgan failure

Spontaneous pneumothorax during laparoscopy-assisted Billroth-I gastrectomy -A case report-

Pneumothorax associated with a pneumoperitonium in laparoscopic surgery is rare but can cause life-threatening complications. A 62-year-old man was scheduled for a laparoscopy-assisted Billroth-I gastrectomy under general anesthesia. Approximately 70 minutes after insufflating carbon dioxide into the intraabdominal cavity at a pressure of 12 mmHg, the peak inspiratory pressure increased, while the oxygen saturation decreased. The pneumothorax of the left lung was evident on the intraoperative chest radiograph. The pneumothorax improved after inserting a catheter into the affected area. The cause of the pneumothorax was unknown but an anatomical defect is believed responsible. This report shows that pneumothorax developed under an intraabdominal pressure in the conventional safety range. Careful monitoring and immediate treatment is necessary to prevent the condition from worsening

Assessment of the effectiveness of a ventilator associated pneumonia prevention bundle that contains endotracheal tube with subglottic drainage and cuff pressure monitorization

The effectiveness of prevention bundles on the occurrence and mortality of ventilator associated pneumonia (VAP) was evaluated in many studies. However, the effectiveness of endotracheal tube with subglottic secretion drainage (ETT-SD) and cuff pressure monitorization in VAP bundles have not been adequately assessed. In this study, we aimed to evaluate the effectiveness of VAP bundle containing ETT-SD and cuff pressure monitorization. This was a prospective, controlled study that was carried out between March 2011 and April 2012 including intubated patients. The study was conducted at the Anesthesiology Intensive Care Unit 1 and 2 (10 beds each) in a 898-bed university hospital. Occurrence of VAP and compliance with the parameters of the VAP prevention bundles were assessed daily. Patients intubated with the standard endotracheal tube were recruited as controls, mainly in the first six months of the study as ETT-SD and cuff pressure monometer had not yet been implemented. In the second term, patients intubated with ETT-SD were included as cases. Occurrence of VAP, mortality, and compliance with VAP prevention bundles were monitored. A total of 133 patients, 37 cases and 96 controls were recruited. VAP incidence declined from 40.82 to 22.16 per 1000 ventilator days among controls and cases, respectively (p < 005). On average, VAP occurred 17.33 ± 21.09 days in the case group and 10.43 ± 7.83 days in the control group (p = 0.04). However, mortality of cases and controls at the 14th and 30th days was not different. VAP prevention bundles including the utilization of ETT-SD, monitoring cuff pressure, and oral care with chlorhexidine were efficient in reducing the rate of VAP. Keywords: Ventilator associated pneumonia, VAP prevention bundles, Subglottic secretion drainage, Cuff pressure monitorizatio