The Southwest Respiratory and Critical Care Chronicles

Impact of liposomal bupivacaine transversus abdominis plane blocks on patient outcomes in minimally invasive colorectal surgery

2024-08-23T06:17:40-07:00

Background and Objectives: As part of enhanced recovery after surgery protocols, there has been an increased interest in improving analgesic techniques. This study compares the efficacy of liposomal bupivacaine transverse abdominis plane blocks on outcomes in colorectal surgery patients.

Methods: This retrospective study compared patients who had minimally invasive colorectal surgery and perioperative liposomal bupivacaine blocks with patients who did not receive this block on post-operative outcomes, including lengths of stay, opioid consumption, and postoperative pain scores.

Results: The mean length of stay in the control group was 4.79 days; in the liposomal bupivacaine group, it was 4.14 days (p = 0.011). There were no differences in opioid use, acetaminophen use, or pain scores in these 2 cohorts. There was a decrease in NSAID use in the liposomal bupivacaine group.Conclusion: This study shows that liposomal bupivacaine blocks can improve some postoperative outcomes in minimally invasive colorectal surgery patients, especially by decreasing length of stay and possibly by decreasing use of other analgesics.

Keywords: Minimally invasive surgical procedures; analgesics, nerve block; post-operative pain management; bupivacaine

Management of post-extubation anxiety in the intensive care unit

2024-07-17T06:11:58-07:00

Post-extubation anxiety causes significant distress in intensive care unit patients. This review provides treatment recommendations for managing anxiety during weaning and extubation from mechanical ventilation. Factors predisposing to anxiety include cerebral vascular disease, endocrine disorders, cardiopulmonary decompensation, disrupted sleep-wake cycles, and the stressful ICU environment. This review analyzed 21 articles sourced from Google Scholar and PubMed, focusing on case reports, case series, systematic reviews, and meta-analyses. These studies reported that dexmedetomidine effectively reduces extubation time and ICU length of stay through its anxiolytic properties. Antipsychotics, like quetiapine, showed potential in managing anxiety during ventilator weaning, but high-dose haloperidol posed risks. Benzodiazepines were linked to paradoxical agitation and respiratory suppression. Non-pharmacological treatments, such as aromatherapy, music therapy, and massage therapy, appeared to reduce anxiety and improve sleep quality. Caregiver approaches, including parental presence and psychological training, also reduced anxiety. In conclusion, non-pharmacological approaches should be prioritized, and pharmacological treatments considered when necessary. More research is essential to identify optimal treatments for post-extubation anxiety with minimal patient risk and effective symptom control.

Keywords: Anxiety, ICU patients, critically ill patients, post-extubation

Cardiopulmonary exercise testing in post-COVID-19 patients

2024-07-17T06:10:35-07:00

Abstract

Patients with prior COVID-19 infection can have residual symptoms and significant disability. In particular, some patients have abnormal lung function with reduced volumes and diffusion capacities. However, some patients have relatively normal lung function and chest x-rays but have significant dyspnea. These patients have been evaluated using cardiopulmonary exercise testing (CPET) to determine their peak O₂ consumption and their cardiac and respiratory responses during standardized testing. In general, these studies demonstrate that the level of impairment correlates with the severity of the initial infection. In addition, some patients have little or no improvement in their VO₂ over time. This test can provide some insight as to exact system limitations resulting in impairment. Six-minute walk tests provide alternative approaches for evaluating patients when CPET testing is not available. Most patients who have had prior COVID infection improve with standard pulmonary rehabilitation.

Keywords: COVID-19 infection, dyspnea, cardiopulmonary exercise testing, rehabilitation

Nafcillin-induced thrombocytopenia: An uncommon complication

2024-07-17T06:11:31-07:00

Drug-induced thrombocytopenia is a challenging clinical dilemma that is often overlooked. Nafcillin is a beta-lactam anti-staphylococcal penicillin antibiotic used as a first-line treatment for methicillin-susceptible Staphylococcus aureus (MSSA) bacteremia and severe infections. Nafcillin has been associated with a higher rate of premature antibiotic discontinuation than cefazolin. Here we report a 58-year-old woman with multiple comorbid conditions who presented with a prosthetic right hip joint infection due to MSSA and was treated with nafcillin but developed profound thrombocytopenia due to a possible nafcillin side effect on the 14th day of therapy. Thrombocytopenia resolved after discontinuation of nafcillin, and the patient was treated successfully with cefazolin.

Keywords: Nafcillin-induced thrombocytopenia, drug-induced thrombocytopenia, thrombocytopenia

Pneumocystis jirovecii pneumonia secondary to chronic steroid use: An uncommon cause of pneumocystis pneumonia

2024-07-17T06:11:14-07:00

Patients on long-term immunosuppression, including corticosteroids or immunomodulatory drugs, are susceptible to opportunistic infections, such as like Pneumocystis jirovecii pneumonia (PJP). Corticosteroid use can increase the frequency of fungal infection, mask symptoms, and delay the diagnosis, and thus warrant preventive measures. Maintaining a high index of suspicion is important, and prophylactic antibiotics, particularly trimethoprim-sulfamethoxazole, should be considered for high-risk patients. This case underscores the diagnosis of PJP in a patient with interstitial lung disease receiving prolonged steroid therapy, despite lacking HIV and conventional risk factors for this infection. Notably, PJP can present as a more severe infection in non-HIV patients, leading to higher mortality rates and stressing the need for swift and effective diagnosis and treatment by healthcare providers.

Keywords: Pneumocystis jirovecii; pneumonia; chronic corticosteroid treatment use; fungal pneumonia; interstitial lung disease

Lentil aspiration pneumonitis

2024-07-17T06:12:08-07:00

This patient has a complex medical history that includes intellectual disability, blindness, deafness, seizure disorder, tracheomalacia, and recurrent aspiration. He had a percutaneous endoscopic gastrostomy in place for tube feeding. He again presented with acute respiratory distress, hypoxemia, fever, and leukocytosis. Chest computed tomography (CT) revealed bilateral infiltrates and nodular densities. A previous chest CT done 6 years prior to admission revealed multiple micronodules scattered throughout both lung fields. The patient had had a previous lung biopsy 20 years prior to admission which revealed lentil starch material in bronchioles and multifocal foreign body giant cell reactions. The patient was treated with an empiric antibiotic regimen and improved. This case demonstrates the radiographic and histologic changes associated with lentil pneumonia which is an unusual type of aspiration pneumonia.

Keywords: Lentil pneumonia, granulomas, aspiration, nodules

Subacute inferior vena cava occlusion after treatment for advanced colorectal cancer: presentation and management

2024-07-17T06:11:48-07:00

Thrombosis of the inferior vena cava is an uncommon condition and may not be recognized until the affected patient develops severe symptoms. It is associated with a higher risk of complications than other locations of deep venous thrombosis. Here we present a case of a 72-year-old man with bilateral occlusion of the external iliac veins and inferior vena cava.

Keywords: Inferior vena cava, thrombosis, managemen

Navigating a Candida albicans liver abscess case in an immunocompromised patient

2024-08-13T10:14:30-07:00

This case report describes a rare instance of Candida albicans liver abscess in a 46-year-old immunocompetent male with extensive medical history. The report underscores the diagnostic challenges in such atypical presentations and emphasizes the critical role of a multidisciplinary approach for effective management, highlighting the unusual nature of the case in the context of the patient's immune competence.

Diabetic ketoacidosis resolution: From the traditional way to guideline-based management in the MICU at University Medical Center, Lubbock, Texas

2024-07-17T06:10:45-07:00

Diabetes is a chronic, metabolic disease characterized by hyperglycemia which eventually can cause serious organ damage. The prevalence of diabetes has steadily increased over the past few decades, and approximately 1.4 million Americans are diagnosed with diabetes every year. Diabetes was the seventh leading cause of death in the United States in 2019. Diabetic ketoacidosis (DKA) is a serious complication of diabetes that can be life-threatening. It occurs more frequently in the patients with type 1 diabetes but can also develop in people with type 2 diabetes. It was determined that the average cost per DKA episode was $6,444, and that the annual cost of medical treatment in a diabetic patient with a prior episode of DKA was 2.67 times higher than a diabetic patient with no history of DKA. The criteria for DKA resolution at University Medical Center (UMC) in Lubbock, Texas, are different from current American Diabetes Association (ADA) guidelines. At UMC, a plasma bicarbonate ≥18 mEq/L, a venous pH > 7.3, and anion gap ≤12 mEq/L must be recorded twice (4 hours apart) before bridging to subcutaneous long-acting insulin administration. This time requirement could contribute to a longer time for DKA resolution and longer intensive care unit and hospital stays.Keywords: Diabetic ketoacidosis, DKA resolution

Relative risk, odds ratio and hazard ratio

2024-07-17T06:12:17-07:00

Update-Exposure to dust events and hospitalizations in West Texas cities: The human health consequences of dust

2024-07-17T06:10:55-07:00

Severe outcome in rare upper extremity phlegmasia cerulea dolens

2024-07-17T06:10:25-07:00