BackgroundThe first few hours after intensive care unit (ICU) admission, where a patient’s condition is stabilized and treatment plans are formulated, are crucial to patient outcome. Although admission of patients who are unstable to ICU occurs 24 hours a day, not all units maintain the same level of staffing during off hours. We evaluated whether ICU admission during off hours affects mortality in a Moroccan ICU with the same level of staffing.MethodsThis prospective study was carried out at an ICU in a Moroccan hospital during 6 months. Demographic, clinic, acute physiology and chronic health evaluation score, length of stay, time of admission (day time or off hours), and ICU mortality data were collected. The mortality in the ICU was the end point of the study. Logistic regression analysis was used to identify risk factors associated with ICU mortality at various day and time of admission.ResultsA total of 195 patients were included in the study; 125 (63.6%) were admitted during the day time and 70 (36.4%) were admitted during off hours. Most of the patients admitted during the off hours were male (75% versus 58% during the day time, P=0.01). Patients admitted in off hours after traumatism were more frequent than those admitted during the day time (64% versus 24%, P=0.001). There was no significant difference in ICU mortality for time of ICU admission (P=0.05).ConclusionWe can conclude that off hours care is not necessarily inadequate. For ICU managers, it is important to know how to maintain adequate quality of care around the clock.

Difficulties have risen while managing Acute Respiratory Distress Syndrome (ARDS) caused by COVID-19, although it meets the Berlin definition. Severe hypoxemia with near-normal compliance was noted along with coagulopathy. Understanding the precise pathophysiology of this atypical ARDS will assist researchers and physicians in improving their therapeutic approach. Previous work is limited to postmortem studies, while our report addresses patients under protective lung mechanical ventilation. An open-lung minithoracotomy was performed in 3 patients who developed ARDS related to COVID-19 and were admitted to the intensive care unit to carry out a pathological and microbiological analysis on lung tissue biopsy. Diffused alveolar damage with hyaline membranes was found, as well as plurifocal fibrin microthrombi and vascular congestion in all patients’ specimens. Microbiological cultures were negative, whereas qualitative Reversed Transcriptase Polymerase Chain Reaction (RT-PCR) detected SARS-CoV-2 in the pulmonary parenchyma and pleural fluid in two patients. COVID-19 causes progressive ARDS with onset of severe hypoxemia, underlying a dual mechanism: shunt effect through diffused alveolar damage and dead space effect through thrombotic injuries in microvascular beds. It seems reasonable to manage this ventilation-perfusion ratio mismatch using a high dose of anticoagulant combined with glucocorticoids.

The scarcity of data concerning pregnant patients gravely infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) makes their management difficult, as most of the reported cases in the literature present mild pneumonia symptoms. The core problem is laying out evidence on coronavirus’s implications on pregnancy and delivery, as well as vertical transmission and neonatal mortality. A healthy 30-year-old pregnant woman, gravida 6, para 4, at 31 weeks of gestation, presented severe pneumonia symptoms promptly complicated with premature rupture of membranes (PROM). A nasopharyngeal swab returned positive for SARS-CoV-2 using reverse transcription polymerase chain reactions (RT-PCR). The parturient underwent a cesarean delivery. This paper is an attempt to outline management of the critical condition of COVID-19 during pregnancy.

Pneumatic tourniquet is a technique widely used in orthopedic surgery, in particular, for reducing intraoperative bleeding and facilitation of surgery. That said, it may cause local and systemic complications which can be life-threatening. The description of this kind of complications is usually made after lower limb utilization. We report the case of a patient, operated for fractures of the two upper limbs, who presented after the second tourniquet deflation, a cardiac arrest with a good recovery after cardio-pulmonary resuscitation. The most likely cause of this cardiac arrest, is the ischemia reperfusion syndrome caused by successive excessively inflated tourniquet, since pulmonary embolism and myocardial infarction are eliminated. In the light of this exceptional clinical observation, we insist on the respect of usual recommendations of use, such as duration and inflation pressure, especially when successive upper limbs tourniquets are used.

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