TY  - CHAP
M1  - Book, Section
TI  - Severe Sepsis and Septic Shock
A1  - Zanotti-Cavazzoni, Sergio L.
A2  - Lee, Kiwon
PY  - 2012
T2  - The NeuroICU Book
AB  - A  32-year-old  man  was  admitted  to  the  neurologic  intensive  care  unit  (ICU)  after  presenting  to  the  hospital  with  complaints  of  difficulty  walking  and  numbness  in  the  lower  extremities.  Initial  workup  supported  a  diagnosis  of  Guillain-Barré  syndrome.  The  patient  was  started  on  treatment  with  intravenous  immunoglobulin  (IVIG)  and  on  day  2  of  his  ICU  stay  was  intubated  and  placed  on  mechanical  ventilation  because  of  worsening  vital  capacity  measurements.  The  patient  completed  a  5-day  course  of  IVIG  treatments.  One  week  after  admission  the  patient  remained  intubated  on  mechanical  ventilation.On  day  7  of  the  ICU  admission  the  patient  developed  a  new  fever  with  tachycardia,  and  increased  oxygen  requirements  on  the  ventilator.  Vital  signs  were  temperature  38.9°C  (102.1°F),  heart  rate  120  bpm,  respiratory  rate  22  breaths/min,  and  blood  pressure  100/65  mm  Hg.  Ventilator  settings  at  the  time  included  the  following:  assist-control  mode  at  a  rate  of  14  with  a  set  tidal  volume  of  450  mL,  and  the  fraction  of  inspired  oxygen  (FiO2)  increased  to  60%  from  30%  to  maintain  an  arterial  oxygen  saturation  (SaO2)  greater  than  or  equal  to  92%.  On  examination,  the  patient  has  an  endotracheal  tube  and  is  on  mechanical  ventilation.  Neurologic  assessment  is  as  follows:  the  patient  is  lethargic  but  arousable  and  able  to  follow  simple  commands.  Strength  is  decreased  in  the  upper  extremities  (2/5  bilaterally)  and  lower  extremities  (2/5  right,  3/5  left).  Cardiac  examination  shows  tachycardia  with  a  regular  rate  and  no  gallops,  rubs,  or  murmurs.  Lung  auscultation  reveals  coarse  breath  sounds  bilaterally.  The  abdominal  examination  is  unremarkable.  The  patient  has  a  left  subclavian  triple-lumen  catheter  with  mild  erythema  around  the  insertion  site,  which  is  nontender  on  palpation,  and  a  urinary  Foley  catheter.  Laboratory  data  obtained  that  day  were  significant  for  a  white  blood  cell  (WBC)  count  of  17,000/mm3  with  80%  neutrophils,  a  platelet  count  of  120,000/mm3,  a  creatinine  level  of  2.1  mg/dL  (increased  from  1.1  mg/dL),  and  an  international  normalized  ratio  (INR)  of  1.7.  A  chest  radiograph  shows  a  possible  infiltrate  in  the  right  lower  lobe  and  that  the  endotracheal  tube  and  central  line  are  in  good  position.  
SN  - 
PB  - McGraw-Hill Education
CY  - New York, NY
Y2  - 2024/04/19
UR  - neurology.mhmedical.com/content.aspx?aid=1101645777
ER  -