BackgroundMiddle East respiratory syndrome (MERS) is caused by a coronavirus (MERS‐CoV) and is characterized by hypoxemic respiratory failure. The objective of this study is to compare the outcomes of MERS-CoV patients before and after the availability of extracorporeal membrane oxygenation (ECMO) as a rescue therapy in severely hypoxemic patients who failed conventional strategies.MethodsWe collected data retrospectively on MERS-CoV patients with refractory respiratory failure from April 2014 to December 2015 in 5 intensive care units (ICUs) in Saudi Arabia. Patients were classified into two groups: ECMO versus conventional therapy. Our primary outcome was in-hospital mortality; secondary outcomes included ICU and hospital length of stay.ResultsThirty-five patients were included; 17 received ECMO and 18 received conventional therapy. Both groups had similar baseline characteristics. The ECMO group had lower in-hospital mortality (65 vs. 100%, P = 0.02), longer ICU stay (median 25 vs. 8 days, respectively, P < 0.01), and similar hospital stay (median 41 vs. 31 days, P = 0.421). In addition, patients in the ECMO group had better PaO2/FiO2 at days 7 and 14 of admission to the ICU (124 vs. 63, and 138 vs. 36, P < 0.05), and less use of norepinephrine at days 1 and 14 (29 vs. 80%; and 36 vs. 93%, P < 0.05).ConclusionsECMO use, as a rescue therapy, was associated with lower mortality in MERS patients with refractory hypoxemia. The results of this, largest to date, support the use of ECMO as a rescue therapy in patients with severe MERS-CoV.

MERS-CoV ICU mortality remains markedly high due to a combination of factors; the disease process of MERS-CoV leads to multiple organ failure, particularly respiratory and renal failure.

A simple, safe and potentially cost effective method of giving intravenous iron to patients receiving regular haemodialysis therapy is described. The heparin and iron are mixed in normal saline and given as a continuous infusion via the syringe pump present on the modern dialysis machine. No pharmacological incompatibility was observed between iron polymaltose and Heparin Choay or Heparin Roche. No adverse reactions attributable to i.v. iron were observed in over 400 patients and more than 30,000 dialyses.

Many complications can occur secondary to carbon monoxide (CO), including serious complications to the cardiovascular system and neurological complications that might even end up with death. It has been estimated that around 30-40% of patients suffering from CO poisoning usually die before presenting at the emergency department. Accordingly, management of these patients is a critical approach to enhance the outcomes and prognosis of the affected patients. In the present literature review, we have discussed the current evidence regarding the assessment, treatment, and outcomes of patients with CO poisoning. Our results indicate that attending clinicians should adequately assess the suspected patients with their clinical manifestations, laboratory parameters, and history of exposure to CO. Besides, imaging techniques can also be indicated in some cases with a suspected brain injury. After the diagnosis has been successfully established, management of symptoms and administration of the validated therapeutic modalities should be rapidly performed to enhance the outcomes and intervene against the development of further complications. However, it should be noted that even after achieving adequate management, long-term complications might develop with the survivors and can even lead to death. Accordingly, further research is needed to help formulate successful interventions that can enhance the prognosis of the condition.

Septic encephalopathy (SE) is the most common complication of sepsis and a major cause of mortality and morbidity worldwide. It occurs in around two third of patients admitted with sepsis in the intensive care units. The objective of this review is to discuss clinical symptoms, diagnosis and outcomes in patients with SE. Robust research was conducted from online databases such as Google Scholar and Cochrane. Studies from the last ten years were included in our review. The pathophysiology of SE is highly dynamic where a complex sequence of events occurs as a host response to an extracranial infection. SE presents a myriad of symptoms ranging from an altered mental state with confusion, disorientation to a more severe presentation with delirium and impaired consciousness. Arriving to a diagnosis of SE requires a rigorous systemic and neurological investigation. Modalities such as neuromonitoring, neuroimaging, clinical biomarkers and mental assessment scales offer limited diagnostic value but can be utilized to co-relate clinical symptoms. It is associated with adverse outcomes such as a high rate of 28-day and 180-day mortality. The quality of life is poor in surviving patients. There is a dearth of original research on SE in the Arab region and worldwide. Major research, both as prospective and retrospective studies is essential to achieve improved management of SE. Therapeutic approaches should be tailored towards modulating pathophysiological processes of sepsis. Follow up studies based on 180 day follow ups should be used to study patient quality of life and outcomes.

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Sedative agents are commonly prescribed for critically ill patients admitted to the intensive care unit (ICU). The literature has reported many indications for using sedation for critically ill patients. These include reducing and managing high intracranial pressure, resolution of ventilator dyssynchrony, and decreasing agitation or anxiety. Different medications were reported in the literature as good sedatives for critically ill patients. Although very efficacious (benzodiazepines, propofol, and dexmedetomidine), many adverse events (as bradycardia, respiratory and myocardial depression, and hypotension) were reported as potential complications. The present literature review has discussed the potential differences and patients’ outcomes after sedation with long-term modalities in the ICU. Overall, clinicians must critically consider balancing the harms and benefits of using sedatives for critically ill patients because of the potential complications encountered during these procedures. In addition, different sedatives were reported in the literature with variable efficacies and adverse events. For example, using dexmedetomidine and propofol has been more advantageous than using benzodiazepines, and some studies also favor dexmedetomidine. However, it should be noted that adverse events are still reported with all of these modalities. Therefore, the administration of long-term sedatives should follow a strict protocol to enhance patients’ outcomes.

Shock is a clinical syndrome that results from lack of oxygen utilization or supply to vital organs resulting in hypoxia. Shock is associated with significant morbidity and mortality as if not treated timely can lead to multiple organ failure and death. The mortality rate of shock ranges from 20% to 50%. Shock has several pathophysiologies including intracardiac etiologies such as myocardial infarction, myopathy, or severe arrhythmia which produce altered maturation and cause heart failure while loss of internal or external fluid due to trauma or bleeding often results in hypovolemia. Also, obstruction by extracardiac causes and activation of inflammatory cascade can induce shock. The purpose of this research is to review the available information about the classification, pathophysiology and principle of therapy of shock. The major classification of shock includes cardiogenic, hypovolemic, obstructive and distributive shock. Distributive shock is further divided into three subclasses of septic, anaphylactic and neurogenic shock. Haemorrhagic shock is also the sub-type of hypovolemic shock. Each class of shock requires a specific treatment and timely management to prevent any further complications. Constant examination, resuscitation and re-evaluation are important in therapy of shock. To treat hypotension and to increase cardiac output, vasopressor drugs and inotropic adrenergic drugs continue to be the most widely used therapies. Endogenous catecholamines such as epinephrine, norepinephrine, and dopamine among other vasopressors have been shown to be effective in treating various types of shocks that are controlled as part of treatment for shock. Early diagnosis and prompt treatment can help in prevention of complications of shock also enhancing the recovery of patients.