Emergency department triage of acute heart failure triggered by pneumonia; when an intensive care unit is needed?

Siniorakis, Eftychios; Arapi, Sophia; Panta, Stamatia; Pyrgakis, Vlassios; Ntanos, Ioannis; Limberi, Sotiria

doi:10.1016/j.ijcard.2016.06.228

Cited by 5 publications

(4 citation statements)

References 28 publications

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“…Immobility in patients with catatonic stupor might have kept them from committing suicide. Interestingly, despite having a higher incidence of pneumonia, which often leads to heart failure in some patients ( 21 ), the catatonia group showed a relatively low incidence of heart failure. This result, together with the higher incidence of dehydration as well as hypernatremia and renal failure, which mostly result from dehydration ( 22 – 24 ), clearly reflects the established close relationship between dehydration and catatonia.…”

Section: Resultsmentioning

confidence: 99%

Catatonic Stupor in Schizophrenic Disorders and Subsequent Medical Complications and Mortality

et al. 2018

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ObjectiveAlthough catatonia can occur secondary to a general medical condition, catatonia itself has been known to lead to various medical compolications. Although case reports on the association of catatonia with subsequent medical complications have been documented, no comprehensive large-scale study has been performed. To investigate specific medical complications after catatonia, we conducted a retrospective cohort study of specific medical complications of schizophrenia patients with catatonia.MethodsThe 1719 schizophrenia inpatients in our study were categorized into two groups: the catatonia group, i.e., those who exhibited catatonic stupor while they were hospitalized, and the noncatatonia group, i.e., those who never exhibited catatonic stupor. Differences between the two groups in the occurrence of subsequent medical complications were examined using linear and logistic regression analyses, and models were adjusted for potentially confounding factors.ResultsThe catatonia group had an increased risk for mortality (odds ratio = 4.8, 95% confidence interval = 2.0–10.6, p < .01) and certain specific medical complications, i.e., pneumonia, urinary tract infection, sepsis, disseminated intravascular coagulation, rhabdomyolysis, dehydration, deep venous thrombosis, pulmonary embolism, urinary retention, decubitus, arrhythmia, renal failure, neuroleptic malignant syndrome, hypernatremia, and liver dysfunction (all p values < .01, except for deep venous thrombosis, p = .04 in the multiple linear regression analysis).ConclusionsCatatonic stupor in schizophrenia substantially raises the risk for specific medical complications and mortality. Hyperactivity of the sympathetic nervous system, dehydration, and immobility, which are frequently involved in catatonia, might contribute to these specific medical complications. In catatonia, meticulous care for both mental and medical conditions should be taken to reduce the risk of adverse medical consequences.

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Section: Resultsmentioning

confidence: 99%

Catatonic Stupor in Schizophrenic Disorders and Subsequent Medical Complications and Mortality

et al. 2018

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“…Pneumonia could lead to acute heart failure [11]. Right ventricular diastolic function in pneumonia is reported [12] and TTE will be beneficial [13].…”

Section: Discussionmentioning

confidence: 99%

Malignant Catatonia Requiring High Dose Bromocriptine: Case Report

Meresh¹,

Korneffel²,

Rajah³

et al. 2021

OBM Neurobiology

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Catatonia can occur in patients diagnosed with schizophrenia and bipolar disorder and malignant catatonia is life threatening. Anti-psychotic medications should be discontinued during acute phase of catatonia. Anti-psychotic discontinuation in catatonia is a challenge in patients maintained on long-acting injectable antipsychotics because of the extended release. Case report: We present a case of malignant catatonia developed in a patient with history of schizophrenia and developmental delay. Symptoms lasted several weeks as he was recently administered long acting injectable antipsychotic medication, requiring high dose Bromocriptine treatment. Patient required several days of bromocriptine treatment. Because of the shorter half-life, frequent and higher dosing of bromocriptine led to resolution of malignant catatonia. Malignant catatonia is a medical emergency and prompt treatment including high dose bromocriptine could lead to resolution of catatonia.

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“…Viral pneumonia, depending on the causative organism, commonly has a different set of risk factors for severe disease development, such as pregnancy for influenza viruses or obesity for COVID-SARS-2 and in pre-COVID studies up to 30% of patients admitted for viral CAP went to ICU [29]. Certain common clinical situations, for example pneumonia complicated by acute heart failure, are not Predilection of upper lobe involvement on chest X-ray covered by existing guidelines [24]. Importantly, none of the mentioned decision instruments has been shown to be better than an experienced clinician judgment and should supplement not replace the one [30].…”

Section: Recognition Of Severe Cap In the Emergency Departmentmentioning

confidence: 99%

Pneumonia Update for Emergency Clinicians

Garber

2022

Curr Emerg Hosp Med Rep

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Purpose of Review Many new concepts in diagnosis, management, and risk stratification of patients with pneumonia have been described recently. The COVID pandemic made importance of viruses as dangerous pathogens of pneumonia quite clear while several non-invasive measures for patients with respiratory failure gained a more wide-spread usage. Recent Findings Studies continue to examine feasibility of bedside ultrasound as a tool in accurate diagnosis of pneumonia in the emergency department, and several new antibiotics have been approved for treatment while others are in late-stage clinical trials. Additionally, the Infectious Diseases Society, American Thoracic Society, and their European counterparts published updated guidelines in recent years. For differences important to emergency medicine clinicians and new emphasis as compared to the prior guidelines, please see Table 1. Several new antibiotics have been approved recently but remain relatively unknown to emergency clinicians as their use is frequently restricted to infectious disease specialists. Summary As the emergency physicians gain new tools to rapidly diagnose, treat, and appropriately disposition pneumonia cases that appear to become more complex as people unfortunately accumulate more comorbidities, we hope to offer better care and improve outcomes for our patients while allowing staff to enjoy coming to work. Keywords Pneumonia • Guidelines • EmergencyThis article is part of the Topical collection on Infectious Disease Extended author information available on the last page of the article Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

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Emergency department triage of acute heart failure triggered by pneumonia; when an intensive care unit is needed?

Cited by 5 publications

References 28 publications

Catatonic Stupor in Schizophrenic Disorders and Subsequent Medical Complications and Mortality

Catatonic Stupor in Schizophrenic Disorders and Subsequent Medical Complications and Mortality

Malignant Catatonia Requiring High Dose Bromocriptine: Case Report

Pneumonia Update for Emergency Clinicians

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