management | The Journal of Critical Care Medicine

Critical Care Management of Decompensated Right Heart Failure in Pulmonary Arterial Hypertension Patients – An Ongoing Approach

Ioan Tilea^1,2, Andreea Varga¹, Anca-Meda Georgescu^1,3, Bianca-Liana Grigorescu^1,4

1 George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Romania
2 Department of Cardiology II, Emergency Clinical County Hospital, Targu Mures, Romania
3 Infectious Disease Clinic, Clinical County Hospital, Targu Mures, Romania
4 Department of Anaesthesia and Intensive Care, Emergency Clinical County Hospital, Targu Mures, Romania

DOI: 10.2478/jccm-2021-0020

Despite substantial advancements in diagnosis and specific medical therapy in pulmonary arterial hypertension patients’ management, this condition continues to represent a major cause of mortality worldwide. In pulmonary arterial hypertension, the continuous increase of pulmonary vascular resistance and rapid development of right heart failure determine a poor prognosis. Against targeted therapy, patients inexorable deteriorate over time. Pulmonary arterial hypertension patients with acute right heart failure who need intensive care unit admission present a complexity of the disease pathophysiology. Intensive care management challenges are multifaceted. Awareness of algorithms of right-sided heart failure monitoring in intensive care units, targeted pulmonary hypertension therapies, and recognition of precipitating factors, hemodynamic instability and progressive multisystem organ failure requires a multidisciplinary pulmonary hypertension team. This paper summarizes the management strategies of acute right-sided heart failure in pulmonary arterial hypertension adult cases based on recently available data.

The Management of Staphylococcal Toxic Shock Syndrome. A Case Report

Victoria Bîrluțiu^1,2*, Ofelia Criștiu³, Marius Baicu⁴, Rareș Mircea Bîrluțiu^1,5

1 Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, Romania
2 Sibiu County Clinical Emergency Hospital, Infectious Diseases Department, Sibiu, Romania
3 Pediatric Clinical Hospital Sibiu, Infectious Diseases Department, Sibiu, Romania
4 Pediatric Clinical Hospital Sibiu, Intensive Care Department, Sibiu, Romania
5 Foişor Clinical Hospital of Orthopedics, Traumatology and Osteoarticular Tuberculosis, Bucharest, Romania

DOI: 10.1515/jccm-2016-0011

Staphylococcal toxic shock syndrome (TSS) is most frequently produced by TSS toxin-1 (TSST-1) and Staphylococcal enterotoxin B (SEB), and only rarely by enterotoxins A, C, D, E, and H. Various clinical pictures can occur depending on severity, patient age and immune status of the host. Severe forms, complicated by sepsis, are associated with a death rate of 50-60%. The case of a Caucasian female infant, aged seven weeks, hospitalized with a diffuse skin rash, characterized as allergodermia, who initially developed TSS with axillary intertrigo, is reported. TSS was confirmed according to 2011 CDC criteria, and blood cultures positive for Methicillin-sensitive Staphylococcus aureus (MSSA). Severe development occurred initial, including acidosis, consumption coagulopathy, multiple organ failures (MOF), including impaired liver and kidney function. Central nervous system damage was manifest by seizures. Clinical management included medical supervision by a multidisciplinary team of infectious diseases specialist and intensive care specialist, as well as the initiation of a complex treatment plan to correct hydro electrolytic imbalances and acidosis. This treatment included antibiotic and antifungal therapy, diuretic therapy, immunoglobulins, and local treatment similar to a patient with burns to prevent superinfection of skin and mucous membranes lesions. There was a favourable response to the treatment with resolution of the illness.