Dettol a mixture of 4.8% chloroxylenol, 9% pine oil, and 12% isopropyl alcohol, is a popular household disinfectant. Serious complications of Dettol poisoning include aspiration, pneumonia, adult respiratory distress syndrome, shock, acute coronary syndrome, and cardiopulmonary arrest. We report a patient with Dettol poisoning who developed tracheal ulceration complicated by diffuse subcutaneous emphysema bilateral pneumothorax and pneumomediastinum. To the best of our knowledge, tracheal ulceration following Dettol poisoning was not reported previously.

Introduction: Rotating shift patterns and night shifts are associated with fatigue and sleep deprivation, which in turn contribute to burnout. The aim of this quality improvement initiative at Mayo Clinic Rochester critical care fellowship programs was to implement a new critical care fellow shift schedule in the medical intensive care unit while evaluating the impact on self-reported burnout scores. Materials and Methods: Focus groups of fellows weighed pros and cons of the existing schedule and selected a revision of the schedule in which night shifts were grouped into blocks with limited frequency and incorporated a recovery period. Baseline self-reported burnout amongst critical care fellows was assessed using an abbreviated Maslach burnout inventory (MBI) screening questionnaire and re-evaluated at the end of the implementation period. Results: At baseline, 33 of 45 (73%) fellows responded to a survey with the abbreviated Maslach Burnout Index questionnaire. Median (IQR) scores for each of the domains were 10 (6-12) emotional exhaustion, 3 (1-9) depersonalization, and 15 (13-17) personal accomplishment. For the post-intervention survey, 17 out of 24 (71%) responded. The median (IQR) score for critical care internal medicine and pulmonary and critical care fellows was 7 (4-11), P=.06 and 9 (7-11), P=0.5 for emotional exhaustion; 3 (0-6), P=.07 and 5 (0-11), P=1.0 for depersonalization score; and 16 (11-17), P=.31 and 15 (12-17), P=.75 for personal accomplishment score. Discussion: Reducing the number of day-night rotations, incorporating a scheduled recovery period, and limiting the number of recurrent consecutive nights resulted in a trend towards improvement of self-reported burnout amongst critical care fellows.

Background and Objective: This study aims to evaluate the predictive value of the diaphragmatic excursion for weaning from mechanical ventilation in postoperative patients with rheumatic heart disease complicated with cachexia. Methods: Eighty-four postoperative patients with rheumatic heart disease complicated with cachexia who need mechanical ventilation >72 h were enrolled for this prospective study. All patients were evaluated during the weaning process from June 2015 to March 2018. Patients received SBT for 1 h, and we performed ultrasound for the right hemidiaphragm and tested the diaphragmatic excursion. Patients who passed the SBT and no need for reintubation or non-invasive positive pressure ventilation (NIPPV) within 48 h were classified as Group A and others were classified as Group B. Results: We found that the diaphragmatic excursion of Group B (0.76 ± 0.23 cm) was significantly smaller than that of Group A (1.19 ± 0.62 cm), and the oxygen partial pressure of Group B (70.1 ± 9.2 mmHg) was significantly lower than that of Group A (98.6 ± 7.8 mmHg). Conclusion: The assessment of diaphragmatic excursion using ultrasound may be helpful to predict the outcome of weaning for postoperative patients with rheumatic heart disease complicated with cachexia.

Objective: The objective of the study is to investigate the effect of critical care transition programs (TPs) on the short-term outcomes in critically ill cancer patients. Methods: Data of critically ill cancer patients admitted to the intensive care unit (ICU) at National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College between September 2017 and August 2018 were retrospectively reviewed and analyzed. Patients were grouped as TP group or non-TP (nTP) group according to whether patients received post-ICU follow-up. Results: In unmatched groups, compared with nTP group, patients in TP group were more severe with higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, higher Simplified Acute Physiology Score 3 score, and higher Sequential Organ Failure Assessment score and decreased ICU mortality (0 vs. 3.1%, P = 0.001) and in-hospital mortality (0 vs. 3.2%, P = 0.001). After matching, there were no significant differences in readmission rate, in-hospital mortality, readmission/in-hospital mortality, ICU length of stay (LOS), and hospital LOS between TP and nTP groups (all P > 0.05). Subgroup analysis demonstrated that in severe group (APACHE II >15), compared with nTP group, patients in TP group had increased readmission rate (8.3% vs. 62.5%, P < 0.001) and increased duration of hospital LOS (13.92 ± 10.54 vs. 26.38 ± 15.46 days; P = 0.003). There is a trend that ICU mortality (23.6% vs. 0, P = 0.121) and hospital mortality (25.8% vs. 0, P = 0.108) were decreased in TP group than in nTP group. In less severe group (APACHE II ≤ 15), there were no significant differences in readmission rate (4.5% vs. 3.8%, P = 0.655), ICU LOS (3.00 ± 4.40 vs. 2.92 ± 3.23 days; P = 0.790), ICU mortality (1.0% vs. 0, P = 0.117), and hospital mortality (1.0% vs. 0, P = 0.117). Conclusions: Critical care TPs may decrease ICU mortality and hospital mortality in critically ill cancer patients with APACHE II >15. It has no role in less severe critically ill cancer patients with APACHE II ≤15.

The mucosal immune system plays a central role in the pathophysiology of health and disease. As the home to the largest population of lymphocytes in the body, the mucosal immune system closely communicates within other elements of the intestine, with constant cross talk with the gut microbiome and epithelial layer. Further, the gut's immune system plays a central role in communicating with remote organs. The mucosal immune system is critical in preventing autoimmunity, while simultaneously retaining the capacity to respond vigorously to mucosal invaders. This results in a state where the mucosal immune system not only can help restore homeostasis in critical illness but can also worsen inflammation and organ injury in sepsis. The purpose of this minireview is to provide an overview of mucosal immunity in health and in sepsis, with a focus on intraepithelial lymphocytes. Understanding the role of the mucosal immune system in both controlling and propagating sepsis is vital for future efforts designed to target it for therapeutic gain in the intensive care unit.

Fluid overload is one of the main complications associated with intravenous fluid therapy. Weight-based fluid accumulation is often calculated for fluid balance status in most researches. Fluid overload was defined as more than a 10% increase in body weight relative to baseline. There are many evidences that fluid overload is associated with an increased risk of acute kidney injury (AKI) and mortality. This review focuses on the pathophysiological link between fluid overload and AKI. Disruption of endothelial glycocalyx induced by fluid overload plays an important role in AKI. In addition, the compositions of the fluids (some colloids and chloride-rich fluids) may also contribute to kidney injury. On the other side, fluid overload is more obvious and the outcome in patients with AKI or with more critical illness. Therefore, the relationship between fluid overload and AKI should be fully understood and carefully managed.

Cerebrovascular disease (CVD) has been studied for many years, representing a cause of high morbidity and mortality; it has a great impact at a social, economic, and psychological level in the young adult population. There are different etiological factors that we do not find in the adult population, for that it is important to know how to differentiate them. There is no definitive etiological factor in this population given that the epidemiologic profile fluctuates considerably throughout regions and provinces, even if the same country is considered to make comparisons. CVD in young adults is caused by many etiological factors, predominantly the rare ones, such as cardioembolic, small vessel disease, due to thrombophilias, and undetermined cause. Despite being the main cause, the undetermined etiology is overestimated because it deserves for a detailed investigation in search of one of the rare causes, also, because of the lack of more complex studies in centers worldwide. No atherosclerotic large vessels diseases, such as cervicocephalic artery dissection, moyamoya disease, systemic vasculitis, and other rare syndromes should be considered to make an accurate diagnosis approach.