Netherlands Journal of Critical Care

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Netherlands Journal of Critical Care Netherlands Journal of Critical Care Executive editorial board A.B.J. Groeneveld, editor in chief J. Box, language editor COPYRIGHT Netherlands Journal of Critical Care ISSN: 1569-3511 NVIC p/a Domus Medica P.O. Box 2124, 3500 GC Utrecht T.: +31-(0)30-6868761 © 2013 NVIC. All rights reserved. Except as outlined below, no part of this publication may be reproduced, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without prior written permission of the publisher. Permission may be sought directly from NVIC. Derivative works Subscribers may reproduce tables of contents or prepare lists of articles including abstracts for internal circulation within their institutions. Permission of the publisher is required for resale or distribution outside the institution. Permission of the publisher is also required for all other derivative works, including compilations and translations. Electronic storage Permission of the publisher is required to store or use electronically any material contained in this journal, including any article or part of an article. Subscriptions An annual subscription to The Netherlands Journal of Critical Care consists of 6 issues. Issues within Europe are sent by standard mail and outside Europe by air delivery. Cancellations should be made, in writing, at least two months before the end of the year. The annual subscription fee for the Netherlands is 170 euro, for Europe 285 euro, for the rest of the world 380 euro. Subscriptions are accepted on a prepaid basis only and are entered on a calendar year basis. Please make your cheque payable to Van Zuiden Communications B.V., PO Box 2122, 2400 CC Alphen aan den Rijn, the Netherlands or you can transfer the fee to ING Bank, account number 67.87.10.872, Castellumstraat 1, Alphen aan den Rijn, the Netherlands, swift-code: ING BNL 2A. Do not forget to mention the complete address for delivery of the Journal. Claims Claims for missing issues should be made within two months of the date of dispatch. Missing issues will be mailed without charge. Issues claimed beyond the twomonth limit must be prepaid at back copy rates. Advertising-exploitation/business contacts For orders, reprints and advertising, please contact Van Zuiden Communications B.V. Van Zuiden Communications B.V. PO Box 2122 2400 CC Alphen aan den Rijn The Netherlands Tel.: +31 (0)172-47 61 91 E-mail: njcc@vanzuidencommunications.nl Internet: www.njcc.nl inhoud EDITORIAL 3 Pericardial effusion: to drain or not to drain? W.K. Lagrand, J.A.P. van der Sloot REVIEWs 5 The SSEP on the ICU: current applications and pitfalls M.C. Cloostermans, J. Horn, M.J.A.M. van Putten 12 The pharmacologic treatment of alcohol withdrawal syndrome in the ICU D.P.F. van Nunen, D.H.T. Tjan GUIDELINE 10 Recommendations for the timing and dosing of CRRT in critically ill patients with AKI H.M. Oudemans-van Straaten, C.S.C. Bouman, M. Schetz, A.B.J. Groeneveld, A.C. de Pont, A.M. van Alphen, H. de Geus, W. Boer CASE REPORTS 18 Gastric dilatation and perforation due to binge eating: a case report J.A.M. Heijneman, R. Tahmassian, T. Karsten, E.R. van der Vorm, I.A. Meynaar 21 Trichoderma: an unusual bystander in invasive pulmonary aspergillosis K. Ariese, L. Hulshoff, R. Jansen, P.H.J. van der Voort 25 Drug induced lung injury – a case of fatal bleomycin interstitial pneumonitis S. van der Sar-van der Brugge, H. van Ravenswaay Claasen, L. Dawson 30 A rare cause of cardiac failure following transthoracic oesophagectomy D.A. Wicherts, S. Hendriks, W.L.E.M. Hesp, J.A.B. van der Hoeven, H.H. Ponssen 33 Elevated liver enzymes and renal failure, with a surprising outcome. Two similar cases A.E. Boendermaker, D. Boumans, R.A.A. van Zanten, H. Idzerda, H. van de Hout, Th.F. Veneman 37 Editorial board 37 International advisory board 39 Information for authors Netherlands Journal of Critical Care is indexed in: EMBASE EMCare Scopus Neth j crit care – volume 17 – no 1 – february 2013 1
Netherlands Journal of Critical Care Accepted January 2013 EDITORIAL Pericardial effusion: to drain or not to drain? W.K. Lagrand 1 , J.A.P. van der Sloot 1 Department of Intensive Care Adults, room C3-430, Academic Medical Center, Amsterdam, The Netherlands Correspondence W.K. Lagrand – e-mail: w.k.lagrand@amc.uva.nl Key words - Hepatic and renal dysfunction, pericardial effusion, cardiac tamponade In this issue of the Netherlands Journal of Critical Care, Boendermaker et al. describe two cases of hepatic and renal dysfunction caused by neoplastic pericardial effusion and resulting in cardiac tamponade 1 . The incidence of hepatic and renal dysfunction in critically ill patients is high and can have various causes. Because pericardial effusion, of oncologic origin, is not the most likely cause of these organ dysfunctions, critical care clinicians often omit considering cardiac tamponade as the underlying cause. In most cases of pericardial effusion, the condition is found more or less by surprise. Once found, the question arises whether the pericardial effusion is symptomatic (i.e. cardiac tamponade) or asymptomatic (i.e. an innocent bystander without therapeutic consequences). The cases described by Boendermaker et al. nicely illustrate the clinical and therapeutic considerations and place of pericardial effusion and/or tamponade in the differential diagnosis of hepatic and renal dysfunction. The etiology of pericardial effusion is quite diverse: it may be caused by infection (bacterial, viral, fungal, mycobacteria, protozoal), inflammation (auto-immune diseases), myocardial infarction (Dressler syndrome), cardiac surgery, trauma or chemical e.g. uraemia. Pericardial effusion resulting from a malignant process, such as neoplastic pericardial effusion, may occur directly (from the malignant process itself) or as a consequence of therapy e.g. radiotherapy, chemotherapy, necessary to treat the tumour 2,3 . The signs and symptoms of cardiac effusion may manifest gradually, ranging from overt tamponade to no clinical signs at all. Besides this, most symptoms of cardiac tamponade are nonspecific, like anorexia, cough, hypotension, tachycardia, dyspnoea, tachypnoea and sometimes circulatory collapse. Also, like the cases presented by Boendermaker et al., patients may present with the complications of cardiac tamponade due to reduced organ perfusion resulting in hepatic and renal failure. In cases of pericardial effusion, physical examination may also reveal specific and nonspecific findings. Besides tachycardia, heart sounds may be attenuated, due to the isolating effects of the pericardial fluid. Clinically significant tamponade usually results in hypotension or shock. (i.e. Beck’s triad: hypotension, tachycardia and muffled heart tones). Jugular venous distention is usually present but may be absent in cases of hypovolemia. A key finding in cases of cardiac tamponade is pulsus paradoxus (PP) 2,4,5 . PP, however, is not pathognomonic for tamponade. It may also be present in cases of massive pulmonary embolism, profound haemorrhagic shock, and obstructive pulmonary diseases. PP is defined as a decline of 10 mmHg or more in systolic arterial blood pressure after inspiration during normal breathing. It may be palpable, but sometimes arterial catheterisation is needed to identify PP. It has to be emphasized that cardiac tamponade is a clinical diagnosis. Additional investigations, however, may support the diagnosis of tamponade. Electrocardiography (ECG) may reveal signs of pericardial effusion: micro voltages, electrical alternans (as a sign of a swinging heart), PR-segment depression, ST-T segment alterations such as elevation and/or depression. These ECG findings are also not specific but may fit in with the diagnosis of pericardial effusion. Chest radiography may depict an enlarged cardiac silhouette with a tent-like shape. The cardiac silhouette, however, may also remain normal despite a large amount of pericardial effusion. Echocardiography is the principal tool for making the diagnosis pericardial effusion. Echocardiographic signs of cardiac tamponade include collapse of the right atrium and/or right ventricle. Left atrial collapse occurs in approximately 25% of patients and is highly specific for tamponade. Doppler echocardiography may show respiratory variations in transvalvular blood flow. This would be an indication that signs of PP can be demonstrated by Doppler echocardiography. By subcostal echocardiographic examination the inferior vena cava (IVC) can be visualized. In cases of tamponade, the IVC is usually dilated, with little or no collapse after inspiration during normal breathing. CT-scanning, MRI and right and left heart catheterisation may be considered but are generally not needed in the evaluation of pericardial effusion, unless it is necessary to search for underlying diseases such as malignancies 2 . So, what do we learn from the cases presented by Boendermaker et al.? First, pericardial effusion and tamponade should be considered in patients with hepatic and renal dysfunction that has been caused by diminished hemodynamics, thereby compromising the function Neth j crit care – volume 17 – no 1 – february 2013 3
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