COVID-19 presentations range from cold-like symptoms to severe symptoms with the development of acute respiratory distress syndrome (ARDS). We report on a severe COVID-19 patient who was mechanically ...ventilated and who developed ARDS and bacterial infection. Because of rapid clinical deterioration and the exhaustion of other treatment options, the family and attending physicians requested a compassionate use of adult allogeneic bone marrow-derived mesenchymal stem cells (MSC) in addition to commonly used immunosuppressive, antiviral, and supportive therapy. The clinical course is discussed thoroughly, with a special emphasis on the safety and effect of MSC therapy. Compassionate MSC treatment, given in three rounds, affected ARDS regression. The patient was discharged from the intensive care unit after 31 days and from hospital after 49 days in a good general condition. MSC treatment was not associated with any side effects and was well tolerated in a three-week period; therefore, it should be studied in larger trials and considered for compassionate use.
Manjak kompleksa piruvat dehidrogenaze (engl. Pyruvate Dehydrogenase Complex Deficiency, PDCD) rijedak je genetski neurometabolički poremećaj. Pripada u skupinu mitohondrijskih bolesti. Kliničke ...manifestacije se kreću od često smrtonosne, teške, novorođenačke laktacidoze do ozbiljnih neuroloških poremećaja kasnije tijekom života. Većina bolesnika ne doživi odraslu dob i rijetko je ova problematika nazočna u jedinicama intenzivnog
liječenja odraslih bolesnika. Jedan od važnijih terapijskih postupaka kod ovih bolesnika je ketogena prehrana s visokim udjelom masti kojom se proizvode ketoni kao alternativno gorivo za tijelo i mozak. Ponekad može biti potrebna parenteralna ketogena prehrana koja još uvijek nije precizno definirana u postojećim smjernicama za prehranu bolesnika u jedinicama intenzivnog liječenja. Prikazano je provođenje parenteralne ketogene prehrane,
te laboratorijski i klinički nadzor u 18-godišnje bolesnice s mitohondrijskom bolesti (PCDC) i to nakon abdominalnoga zahvata povezanog s upalnim komplikacijama, kada enteralna prehrana nije bila moguća. Prehrana je zahtijevala detaljni izračun osnovnih sastojaka kako bi se osigurala adekvatna opskrba energijom, volumenom i mikronutirijentima, a da bi se pri tome proizvela ketoza. Zajedno s ostalim metodama intenzivnoga liječenja, ovakav način prehrane pomogao je rješavanju komplikacija i ishodu liječenja ove epizode. U zaključku, pravilno propisana parenteralna ketogena prehrana kod bolesnika s PCDC smanjuje laktacidozu i učestalost neuroloških komplikacija. Treba je provoditi isključivo u jedinicama intenzivnoga liječenja, poglavito zbog nužnosti trajnog laboratorijskog i kliničkog nadzora. Kad god je moguće, treba ponovo što prije prijeći na enteralnu prehranu. Poželjno bi bilo imati
i točno definirane smjernice za parenteralnu ketogenu prehranu.
COVID-19 presentations range from cold-like symptoms to severe symptoms with the development of acute respiratory distress syndrome (ARDS). We report on a severe COVID-19 patient who was mechanically ...ventilated and who developed ARDS and bacterial infection. Because of rapid clinical deterioration and the exhaustion of other treatment options, the family and attending physicians requested a compassionate use of adult allogenic bone marrow-derived mesenchymal stem cells (MSC) in addition to commonly used immunosuppressive, antiviral, and supportive therapy. The clinical course is discussed thoroughly, with a special emphasis on the safety and effect of MSC therapy. Compassionate MSC treatment, given in three rounds, affected ARDS regression. The patient was discharged from the intensive care unit after 31 days and from hospital after 49 days in a good general condition. MSC treatment was not associated with any side effects and was well tolerated in a three-week period; therefore, it should be studied in larger trials and considered for compassionate use.
COVID-19 presentations range from cold-like symptoms to severe symptoms with the development of acute respiratory distress syndrome (ARDS). We report on a severe COVID-19 patient who was mechanically ...ventilated and who developed ARDS and bacterial infection. Because of rapid clinical deterioration and the exhaustion of other treatment options, the family and attending physicians requested a compassionate use of adult allogeneic bone marrow-derived mesenchymal stem cells (MSC) in addition to commonly used immunosuppressive, antiviral, and supportive therapy. The clinical course is discussed thoroughly, with a special emphasis on the safety and effect of MSC therapy. Compassionate MSC treatment, given in three rounds, affected ARDS regression. The patient was discharged from the intensive care unit after 31 days and from hospital after 49 days in a good general condition. MSC treatment was not associated with any side effects and was well tolerated in a three-week period; therefore, it should be studied in larger trials and considered for compassionate use.
Kartagener syndrome (KGS) is a rare inherited disorder characterized by situs inversus viscerum (including dextrocardia) and primary ciliary dyskinesia resulting in chronic respiratory tract ...infections, bronchiectasis and sinusitis. Possible anesthesiologic challenges are related to the respiratory system and increased susceptibility to infectious complications. There are several case reports of general anesthesia in these patients, but mainly in the adult population . Here, we report on a 3-year old female child with KGS, who underwent adenoidectomy because of sleep disordered breathing (SDB). Preoperative preparation consisted of intravenous antibiotics, steroids, as well as postural drainage and inhalations of bromhexine and salbutamol. Anesthesia was induced with propofol, fentanyl and vecuronium and maintained with a continuous infusion of propofol (150-200 gkg-1min-1) and supplemental doses of fentanyl. The child was ventilated with oxygen/air mixture (50%:50%) in the pressure-controlled mode of ventilation to keep end-tidal CO2 between 30 and 35 mmHg. During anesthesia the child’s hemodynamic and respiratory parameters were stable. Extubation, after thorough endotracheal and oral suction, was uneventful. After two hours in the post-anaesthesia care unit (PACU), the child was transferred to the ward. To the best of our knowledge, this is the youngest reported child with KGS and SDB that underwent intravenous general anesthesia. We also stress here the importance of comprehensive pre-anesthetic preparation, i.e. postural drainage, inhalations, bronchodilators, i.v. antibiotics and steroids. Furthermore, the condition of the respiratory system in the patient with KGS is seldom appropriate at the time of surgery, so the decision to anesthetize or not, should be made on an individual basis.
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