1
|
Bahloul M, Regaieg K, Dlela M, Turki O, Nouri H, Bradaii S, Ben Hamida C, Bouaziz NK, Chabchoub I, Haddar S, Chelly H, Bouaziz M. Pulmonary embolism in intensive care units: More frequent or more Known? Prospective study of 75 cases. Clin Respir J 2019; 13:513-520. [PMID: 31287237 DOI: 10.1111/crj.13053] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 01/15/2019] [Accepted: 07/01/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE to evaluate the current rate of pulmonary embolism (PE) in our medico-surgical intensive care unit (ICU), to identify risk factors, and to determine the outcome of PE in ICU. METHODS We performed a prospective cohort study of consecutive patients requiring intensive care admission during a one-year period. We included, in this prospective study, all the patients with confirmed PE admitted in ICU with more than 18 years of age, and expected to stay in ICU for more than 48 hours. Only the patients who had a clinical suspicion (unexplained hypoxemia and/or shock) for PE underwent diagnostic studies. RESULTS During the study period, 842 patients were admitted in our ICU. One hundred and two patients were excluded. The diagnosis of PE was confirmed in 75 patients (10.1%). In our study, all patients (100%) had received some forms of pharmaceutical prophylaxis (PP) during ICU stay. The median time from ICU admission to diagnosis of PE was 6 days. The diagnosis of PE was made by spiral CT in 74 patients (98.7%), and by echocardiography in 1 case (1.3%). The mean ICU stay was 26.3 ± 26.5 days (median: 20 days). During their ICU stay, 73 patients (97.3%) developed one, or more, organ failure. Respiratory failure was the most observed (97.3%). Moreover, 38 patients (50.6%) developed nosocomial infections and 29 (38.6%) died. The multivariate analysis showed that the risk factors associated with mortality were the presence of shock the day of PE diagnosis and the presence of right ventricular dilatation on echocardiography. CONCLUSION Our findings confirm that subjects in the ICU are at high risk of PE, due to a high number of risk-factors. PE was associated with higher ICU mortality and a significantly higher ICU LOS. Our results invite to revise the preventive strategies of deep venous thrombosis and PE in patients requiring ICU admission.
Collapse
Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Kais Regaieg
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Mariem Dlela
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Olfa Turki
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Hana Nouri
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Sabrine Bradaii
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Chokri Ben Hamida
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | | | - Imen Chabchoub
- Department of Pediatrics Hedi Chaker University Hospital, Sfax University, Sfax, Tunisia
| | - Sondes Haddar
- Department of Radiology Habib Bourguiba University Hospital, Sfax University, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia.,Faculté de medicine de Sfax, Sfax University, Sfax, Tunisia
| |
Collapse
|
2
|
Bahloul M, Dlela M, Khlaf Bouaziz N, Turki O, Chelly H, Bouaziz M. Early post-traumatic pulmonary-embolism in patients requiring ICU admission: more complicated than we think! J Thorac Dis 2018; 10:S3850-S3854. [PMID: 30631496 PMCID: PMC6297454 DOI: 10.21037/jtd.2018.09.49] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Accepted: 09/12/2018] [Indexed: 08/30/2023]
Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mariem Dlela
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | | | - Olfa Turki
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, Sfax, Tunisia
| |
Collapse
|
3
|
Bahloul M, Chtara K, Turki O, Khlaf Bouaziz N, Regaieg K, Hammami M, Ben Amar W, Chabchoub I, Ammar R, Ben Hamida C, Chelly H, Ayedi A, Bouaziz M. Yarrowia lipolytica fungemia in patients with severe polytrauma requiring intensive care admission: analysis of 32 cases. Intensive Care Med 2017; 43:1921-1923. [PMID: 28780658 DOI: 10.1007/s00134-017-4900-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Accepted: 07/27/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Mabrouk Bahloul
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia.
| | - Kamilia Chtara
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Olfa Turki
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | | | - Kais Regaieg
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Maha Hammami
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Wiem Ben Amar
- Department of Forensic Medicine, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Imen Chabchoub
- Department of Pediatrics, Hedi Chaker University Hospital, Sfax, Tunisia
| | - Rania Ammar
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Chokri Ben Hamida
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Hedi Chelly
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| | - Ali Ayedi
- Fungal and Parasitic Molecular Biology Laboratory, Habib Bourguiba University Hospital, Sfax, Tunisia
| | - Mounir Bouaziz
- Department of Intensive Care, Habib Bourguiba University Hospital, 3029, Sfax, Tunisia
| |
Collapse
|
4
|
Bahloul M, Ksibi H, Khlaf Bouaziz N, Dammak H, Ben Hamida C, Kallel H, Chelly H, Bouaziz M. [Acute fatty liver of pregnancy. "Incidence, pathogenesis, diagnosis, treatment and prognosis"]. Tunis Med 2008; 86:525-528. [PMID: 19216441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Acute fatty liver of pregnancy (AFLP) is a rare, potentially fatal complication that occurs in the third trimester or early postpartum period. It generally appears between weeks 30 and 38. Usually the APLF symptoms start one to two weeks before hospitalization with nausea, emesis, general uneasiness, jaundice, epigastric pain and other symptoms. A careful history and physical examination, in conjunction with compatible laboratory and imaging results, are often sufficient to make the diagnosis, and liver biopsy is rarely indicated. The maternal outcome has improved enormously during the last decade. Early diagnosis, pregnancy termination and handling in special care or treating complications has lead to good maternofetal results.
Collapse
Affiliation(s)
- Mabrouk Bahloul
- Service de Réanimation médicale CHU Habib Bourguiba Route el Ain Km 1 3029
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Kallel H, Bouaziz NK, Chaari A, Bahloul M, Krichène MS, Bouaziz M. [Contribution of liver biopsy in intensive care unit. (180/2004)]. Tunis Med 2007; 85:29-34. [PMID: 17424706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
AIM Our aim was to evaluate the indications and contribution of liver biopsy (LB) in intensive care (ICU) and to compare them to those of LB in gastroenterology. METHODS We included retrospectively 37 successive LB achieved in ICU and 38 successive LB achieved in gastroenterology. All data were reviewed by three intensivists and three gastroenterologists to determine the contribution of the LB. RESULTS The indications of LB were different in the two units. The most frequent indications were cirrhosis (36.8%), isolated biological hepatic disruptions (26.3%) and histological classification of viral hepatitis (18.4%) in gastroenterology and isolated biological hepatic disruptions (48.6%), hepatopathy during pregnancy (27%) and fever of unknown origin (10.8%) in intensive care unit. According to the six reviewers, LB was enough contributive in the two units, (78.4% in ICU and 71.1% in gastroenterology -p=0.46-). It allowed to eliminate, to confirm, or to change a diagnosis in more than 70% of cases and allowed to modify the course of therapy in 21.6% of cases in ICU and in 26.3% of cases in gastroenterology (p-0.6). CONCLUSION The LB is a feasible technique in ICU and can be as contributive as it is in gastroenterology.
Collapse
Affiliation(s)
- Hatem Kallel
- Service de Réanimation Médicale, CHU Habib Bourguiba, Sfax, Tunisie
| | | | | | | | | | | |
Collapse
|