PCEB-ACE activity decreases early during ALI, correlates with the clinical severity of both the lung injury and the underlying disease, and may be used as a quantifiable marker of underlying pulmonary capillary endothelial dysfunction.

Although restrictive lung disease is the predominant abnormality of pulmonary function in patients with thalassaemia major (TM), its aetiology and its association with pulmonary hypertension (PH) detected in some patients with TM remains unknown. We report a patient with TM, iron overload, frequent pulmonary infections, and progressive severe precapillary PH over the previous 5 years. A severe restrictive pattern and interstitial lung fibrosis were revealed by pulmonary function tests and high resolution computed tomography, respectively. This presentation suggests that interstitial fibrosis may complicate lung involvement in TM and can significantly contribute to the development of PH. (Thorax 2001;56:737-739) Keywords: thalassaemia major; pulmonary hypertension; interstitial lung fibrosis Impairment of cardiac function is a well documented complication of thalassaemia major (TM) attributed to haemochromatosis, and congestive heart failure resulting from decreased left ventricular systolic function is the main cause of early mortality.1 2 Pulmonary hypertension (PH) is relatively rare, 3 4 especially in the absence of left ventricular dysfunction. Its aetiology remains uncertain.The predominant abnormality of pulmonary function in TM is restrictive disease.5 6 Although transfusional iron burden and increasing age seem to play a role, 5 the nature of this restrictive pattern is still unknown as no systematic pathological studies or studies using computed tomographic (CT) scanning have been performed.We report a patient with TM who presented with severe PH, markedly increased pulmonary vascular resistance (PVR), right ventricular failure, preserved left ventricular function, a severe restrictive pattern in pulmonary function tests, and interstitial fibrosis revealed by high resolution CT (HRCT) scanning of the lung. Case reportA 29 year old man with TM who had never smoked was admitted to the intensive care unit (ICU) with pneumonia requiring the use of a non-rebreathing mask (FiO 2 ≅ 100%) to maintain an SaO 2 of >90%. The patient had bronze coloured skin and had started blood transfusions at the age of 4, having received a total of 640 blood units to maintain haematocrit values of 26-30%. Inadequate iron chelation therapy with subcutaneous injection of desferrioxamine had been started 5 years previously (25 mg/kg/day, 2 days per week). At this time splenectomy was performed and mild systolic PH (36 mm Hg) was diagnosed by continuous wave (C-W) Doppler echocardiography through minimal tricuspid regurgitation. 7More severe systolic PH was detected 2 years later (48 mm Hg) when dyspnoea on exertion was present. PH progressed to 57 mm Hg at the age of 27; a magnetic resonance imaging (MRI) scan of the heart was within normal limits. Frequent pulmonary infections were reported during the previous 4 years.On admission right heart failure was present (audible S 3 , prominent jugular veins to the angle of the jaw, pitting ankle oedema, palpable liver 15 cm below the right costal margin, and bilateral transud...

Patients whose SvO2 does not decrease during weaning failure do not have increased oxygen consumption probably due to respiratory center depression in some of them. Patients whose SvO2 decreases have increased oxygen consumption.

To determine the epidemiology, risk factors for and outcome of candidaemia in critically ill patients, a matched case-control study was performed in a 25-bed intensive care unit (ICU) from August 2004 to January 2006. Candidaemia occurred in 33 patients; each patient was matched to four controls according to admission illness severity, diagnostic category and length of ICU stay. Candida non-albicans species predominated (67.7%). The presence of acute respiratory distress syndrome (ARDS) was the only independent risk factor for candidaemia development (OR, 2.93; 95% CI 1.09-7.81, P = 0.032). Mortality was 60.6% among patients with candidaemia and 22% among controls (P < 0.001). The presence of candidaemia (OR, 9.37; 95% CI 3.48-25.26, P < 0.001) and the illness severity on admission (acute physiologic and chronic health evaluation II score, OR, 1.17; 95% CI 1.12-1.24, P < 0.001) were independently associated with mortality. Among candidaemic patients, risk factors for mortality were the severity of organ dysfunction (sequential organ failure assessment score, OR, 1.57; 95% CI 1.00-2.46, P = 0.05) and a low serum albumin level (OR, 0.74; 95% CI 0.59-0.94, P = 0.012) both of them occurred on candidaemia onset. We conclude that in critically ill patients matched for illness severity and length of ICU stay, the only independent risk factor for candidaemia was the presence of ARDS. Mortality was independently associated with acquisition of candidaemia and with the illness severity at candidaemia onset.

Aspergillus tracheobronchitis should be considered in immunocompromised patients with suspected lung infection even when the main radiographic finding is atelectasis. Bronchoscopy and histologic examination of identified intraluminal material should be performed as soon as possible.

For critically ill patients with coronavirus disease 2019 (COVID-19) who require intensive care unit (ICU) admission, extremely high mortality rates (even 97%) have been reported. We hypothesized that overburdened hospital resources by the extent of the pandemic rather than the disease per se might play an important role on unfavorable prognosis. We sought to determine the outcome of such patients admitted to the general ICUs of a hospital with sufficient resources. We performed a prospective observational study of adult patients with COVID-19 consecutively admitted to COVID—designated ICUs at Evangelismos Hospital, Athens, Greece. Among 50 patients, ICU and hospital mortality was 32% (16/50). Median PaO2/FiO2 was 121 mmHg (interquartile range (IQR), 86–171 mmHg) and most patients had moderate or severe acute respiratory distress syndrome (ARDS). Hospital resources may be an important aspect of mortality rates, since severely ill COVID-19 patients with moderate and severe ARDS may have understandable mortality, provided that they are admitted to general ICUs without limitations on hospital resources.

Optimal use of antibiotics is a key component of the management of sepsis. The purpose of this study was to develop a modification of the time-to-positivity (T(pos)) assay for use in the acute management of septic patients. Initial laboratory experiments, followed by ex-vivo validation and pilot studies, were performed with a small number of healthy human volunteers and 46 septic patients on a general intensive care unit, chosen on the basis of their antibiotic regimen. The study demonstrated that the T(pos) assay could be used as a surrogate for antimicrobial activity, and provided preliminary data to demonstrate how this approach might be used to monitor the efficacy of antibiotic therapy in septic patients. The T(pos) assay might offer a quick and convenient way to improve the efficacy of antibiotic therapy in septic patients, and further prospective large-scale studies are now warranted.

Although restrictive lung disease is the predominant abnormality of pulmonary function in patients with thalassaemia major (TM), its aetiology and its association with pulmonary hypertension (PH) detected in some patients with TM remains unknown. We report a patient with TM, iron overload, frequent pulmonary infections, and progressive severe precapillary PH over the previous 5 years. A severe restrictive pattern and interstitial lung fibrosis were revealed by pulmonary function tests and high resolution computed tomography, respectively. This presentation suggests that interstitial fibrosis may complicate lung involvement in TM and can significantly contribute to the development of PH.