Publications

Introduction: The aim of our study was to determine the degree of edema in the organs of patients who died with severe sepsis. Hypothesis: In severe sepsis, alterations in vascular permeability result in organ edema. The increase in weight may vary according to the organ considered. Methods: Autopsies are still routinely performed in patients who die in our 35 bed Multidisciplinary Department of Intensive Care. We reviewed the data and the organ weights of all patients who had a postmortem examination in the years 2008- 2011. We extracted a group (n=171) of patients with severe sepsis and a control group of patients who died without evidence of infection (n=54). Results: Total lung weight was significantly greater in septic than in non-infected patients (1591 ± 541 vs. 1306 ± 417 g, p<.001). These differences remained when only septic patients without pulmonary infection (n=74) were kept in the analysis (1509 ± 570 g, p=.028). The spleens were heavier in the sepsis group than in the control group (262 ± 175 vs. 180 ± 83 g, p<0.001) and changes in kidney weight almost reached statistical significance (346 ± 116 vs. 312 ± 100 g, p=.058). No significant difference was found in the weight of heart, liver, brain and thyroid gland. Septic patients with cirrhosis (n=59) had particularly heavy lung, spleen and kidney weight. Conclusions: Among non-survivors, septic patients have more edema in their lungs and spleen and perhaps kidneys than non-infected patients. However, their heart, liver, and brain are not heavier than in other ICU patients.

In this cohort of septic patients with MDR GN infections, HDA combined with high-flow CVVHDF represented a valuable therapeutic option. The effectiveness of this approach should be further evaluated in larger studies.

INTRODUCTION. Elevated ammonium levels (EAL) are one of the side effects of valproic acid (VPA) treatment. This complication has been described during long-term VPA treatment, but less in critically ill patients.OBJECTIVES. The aim of this study was to evaluate the incidence and the factors associated with EAL in those patients.METHODS. A retrospective study in a mixed 35-bed ICU care of a tertiary university hospital was conducted over a 4-year period (2007-2010). Inclusion criteria were; a) VPA therapy for more than 72 hours; b) age > 18 years; c) at least one measurement of ammonium levels during the ICU stay; d) Child C liver cirrhosis. EAL was defined as ammonium levels above 50 mcg/dL. Demographic data, comorbidities, reason for VPA treatment, biological data, concomitant therapies, presence of infection and ICU mortality were collected.RESULTS. A total of 168 patients met the inclusion criteria (median age 64 years, 95 male gender). Most of them (137/168) were admitted for neurological reasons. Overall ICU mortality was 23%. Median ammonium levels were 88 [55-121] mcg/dL. EAL was found in 121 (72%) patients; of those, 38 (31%) had ammonium levels between 100-150 mcg/dL, 11 (9%) between 150-200 mcg/dL and 13 (11%) above 250 mcg/dL. Median time from start of VPA therapy to EAL was 4 [3-5] days. Median maximum VPA level during therapy was 72 [51-88] and was significantly higher in EAL patients than in the others (76 [58-92] mcg/mL vs. 56 [39-81] mcg/mL, p< 0.01). EAL were more frequently observed in patients with sepsis (p< 0.01) and in those treated with mechanical ventilation (p< 0.01), vasopressors (p=0.05) and at least one other antiepileptic drug (p=0.02); these patients tended to have a higher ICU mortality (28% vs. 13%, p = 0.06).CONCLUSIONS. Ammonium levels are often elevated during treatment with valproic acid in ICU patients, especially in those with the greatest severity. This alteration may contribute to their alteration in brain function.

Background: Plasma concentrations of endocan, a proteoglycan preferentially expressed in the pulmonary vasculature, may represent a biomarker of lung (dys)function. We sought to determine whether the measurement of plasma endocan levels early in the course of acute respiratory distress syndrome (ARDS) could help predict risk of death or of prolonged ventilation. Methods: All patients present in the department of intensive care during a 150-day period were screened for ARDS (using the Berlin definition). Endocan concentrations were measured at the moment of ARDS diagnosis (T0) and the following morning (T1). We compared data from survivors and non-survivors and data from survivors with less than 10 days of ventilator support (good evolution) and those who died or needed more than 10 days of mechanical ventilation (poor evolution). Results are presented as numbers (percentages), mean ± standard deviation or medians (percentile 25–75). Results: Ninety-six consecutive patients were included [median APACHE II score of 21 (17–27) and SOFA score of 9 (6–12), PaO2/FiO2 ratio 155 (113–206)]; 64 (67%) had sepsis and 51 (53%) were receiving norepinephrine. Non-survivors were older (66 ± 15 vs. 59 ± 18 years, p = 0.045) and had higher APACHE II scores [27 (22–30) vs. 20 (15–24), p

aPTT waveform analysis is an easy and rapid method for identification of sepsis; its combination with PCT increases its specificity.