Severe pulmonary leptospirosis (SPFL), characterized by diffuse alveolar haemorrhage (DAH) and acute respiratory distress syndrome (ARDS), carries a high mortality, often due to diagnostic delays and complex management. We report a case of a 42-year-old male with outdoor occupational exposure who presented with fever and hemoptysis, rapidly progressing to severe respiratory failure and thrombocytopenia. Chest imaging confirmed DAH/ARDS. For refractory hypoxemia, veno-venous extracorporeal membrane oxygenation (VV-ECMO) was initiated without systemic anticoagulation due to active pulmonary haemorrhage. Metagenomic next-generation sequencing (mNGS) of bronchoalveolar lavage fluid rapidly identified Leptospira interrogans, enabling targeted antimicrobial therapy alongside multidisciplinary support. The patient gradually improved, was successfully weaned from ECMO and ventilator support, and was discharged without residual organ dysfunction. This case demonstrates that early application of anticoagulation-free VV-ECMO combined with mNGS-based rapid diagnosis and multidisciplinary care can improve outcomes in SPFL, highlighting the importance of considering this diagnosis in febrile patients with DAH and environmental exposure.

Assembly 2 members attended sessions relevant to respiratory critical care, including ERS guidelines on telemonitoring in home ventilation, high-flow therapy applications, infections, precision medicine and treatment of acute respiratory failure https://bit.ly/3MLXZsT.

Inconsistencies in healthcare access, varying infrastructure, resource constraints and diverse local practices as well as practical and political issues restrict the global applicability of currently available guidelines. There is a need for universal recommen- dations that address the unique challenges faced by patients and healthcare providers worldwide. Our iCARDIO Alliance Global Implementation Guidelines emphasize the incorporation of novel therapies, while integrating standard of care with the most up-to-date evidence to enable clinicians to optimize patient care. This document is about heart failure (HF), including acute and chronic heart failure, heart failure with reduced ejection fraction and heart failure with preserved ejection fraction as well as cardiomyopathies. Context-specific recommendations tailored to individual patient needs are highlighted providing a thorough evaluation of the risks, benefits, and overall value of each therapy, aiming to establish a standard of care that improves patient outcomes and reduces the burden of hospitalization in this susceptible population. These guidelines provide evidence-based recommendations that represent a group consensus considering the many other published guidelines that have reviewed many of the issues discussed here, but they also make new recommendations where new evidence has recently emerged. Most importantly these guidelines also provide recommendations on a number of issues where resource limitations may put constraints on the care provided to HF patients. Such "economic adjustment" recommendations aim to provide guidance for situations when "Resources are somewhat limited" or when "Resources are severely limited". Hence, this document presents not only a comprehensive but also concise update to HF management guidelines thereby aiming to provide a unified strategy for the pharmacological, non-pharmacological, invasive and interventional management of this significant global health challenge that is applicable to the needs of healthcare around the globe.

Pulseless electrical activity (PEA) arrest in patients with end-stage heart failure with reduced ejection fraction (HFrEF) most commonly reflects profound circulatory collapse rather than a primary arrhythmogenic event. Although post-resuscitation encephalopathy often prompts early neurologic prognostication, myocardial dysfunction and refractory shock frequently dominate outcomes in this population. We report the case of a 59-year-old woman with end-stage HFrEF, severe multivessel coronary artery disease, chronic lung disease, HIV infection, and active cocaine use who presented with acute hypoxic respiratory failure and decompensated heart failure and subsequently developed prolonged PEA arrest. Her post-arrest course was complicated by refractory cardiogenic shock, focal cerebellar infarction with delayed MRI due to hemodynamic instability and vasopressor dependence, and multisystem organ failure. Taken together, these findings underscore an important post-resuscitation diagnostic pitfall: neurologic abnormalities may coexist; however, refractory hemodynamic collapse often predominates. An integrated framework incorporating shock physiology, substance-associated cardiotoxicity, and competing neurologic injury is essential for accurate clinical assessment and informed goals-of-care discussions.

This systematic review aims to assess the prevalence and incidence of pressure injury associated with non-invasive ventilation (NIV) in adult patients treated for acute respiratory failure (ARF).

Acrolein is a highly toxic chemical substance commonly found in industrial production. This article analyzes the clinical data of 5 patients suspected of acute acrolein poisoning. The patients presented symptoms such as bilateral bronchitis, cyanosis of the lips and face, pharyngalgia, chest tightness, shortness of breath, etc. Severe poisoning patients also experienced acute respiratory failure and acute respiratory distress syndrome (ARDS). After comprehensive treatments including high-flow humidified oxygen inhalation, corticosteroid pulse therapy, and blood purification, 4 of the moderate-to-severe poisoning patients gradually improved and were discharged from the hospital, while 1 severe poisoning patient significantly improved after treatment with extracorporeal membrane oxygenation (ECMO), but died later due to secondary infection. This article provides valuable experience for clinicians in identifying, diagnosing, and treating acrolein poisoning, and highlights the risk of secondary infection in severe patients during treatment, which is significant for improving the success rate of treatment.

Retrograde type A aortic dissection (RTAD) after thoracic endovascular aortic repair (TEVAR) is a rare but potentially fatal complication. We report a case of very late-onset RTAD occurring 9 years after hybrid aortic arch repair. An 81-year-old man with a history of TEVAR with cervical debranching for subacute thrombosed RTAD, which later developed an ulcer-like projection, presented with dizziness and back pain. Acute RTAD with cardiac tamponade was diagnosed, and emergent ascending aortic replacement with resection of the entry tear-located at the proximal edge of the stent on the lesser curvature-was performed. Postoperatively, the patient required prolonged ventilatory support for respiratory failure and developed pyothorax secondary to aspiration pneumonia. He was ultimately discharged home on postoperative day 188 after rehabilitation. This case underscores the importance of a distinct pathophysiology in late RTAD, in which progressive aortic wall degeneration and biomechanical fatigue over time-rather than procedural factors-may contribute to dissection. Continuous imaging surveillance and strict cardiovascular risk factor management are essential, even in the absence of early complications.

The class Bunyaviricetes encompasses a diverse group of vector- and rodent-borne viruses, many of which are major human pathogens causing severe and often lethal diseases worldwide. These include Lassa fever virus (Arenaviridae), hantaviruses such as Hantaan and Andes viruses (Hantaviridae), Crimean-Congo hemorrhagic fever virus (Nairoviridae), La Crosse and Oropouche viruses (Peribunyaviridae), and Rift Valley fever, severe fever with thrombocytopenia syndrome, and Toscana viruses (Phenuiviridae). Clinical syndromes range from hemorrhagic fever with multiorgan failure, vascular leak, and shock to acute encephalitis and severe respiratory distress. Despite their public health impact, safe and effective vaccines or targeted therapeutics are lacking for most bunyaviricetes diseases, leaving supportive care as the primary intervention. This review provides a comparative analysis of the immunopathogenesis of major human-pathogenic bunyaviricetes, highlighting shared and virus-specific strategies for innate immune evasion, cytokine modulation, and host cell targeting. Severe disease often arises from viral interference with key sensing pathways, such as RIG-I/MDA5 and downstream IRF and NF-κB signaling, which either suppresses interferon responses or leads to dysregulated inflammation. By integrating molecular, immunological, and clinical insights, we outline how these immune-virus interactions shape disease trajectory and severity. Understanding these mechanisms is critical for guiding the rational design of vaccines, antivirals, and immunomodulatory therapies, and for strengthening preparedness against these persistent zoonotic threats.

Guillain-Barré syndrome (GBS) is an acute polyneuropathy with an incidence of 0.69 per 100 000 children annually. Electrophysiological variants vary geographically, with the axonal subtype more common in parts of Asia; however, pediatric data from Latin America remains limited, underscoring the need for regional studies to inform clinical management. This retrospective cohort study examined the incidence, electrophysiological variants, and clinical outcomes of children under 16 years hospitalized for GBS in an intensive care unit serving approximately 8% of the Chilean population in Santiago (2013-2023). Twenty-one patients (median age: 10 years) were included, with 11 presenting with axonal involvement and 8 with demyelinating features. Four patients required mechanical ventilation-2 in the axonal and 2 in the demyelinating group (median = 22 days, IQR = 9-43)-and 2 patients required tracheostomy. The predominance of the axonal subtype highlights critical considerations for early prognostication, critical care planning, and future inclusion in clinical trials.

IntroductionChilean Patagonia faces major challenges due to geographic isolation and harsh climate, which limit access to emergency healthcare and result in a heavy reliance on air transport. We aimed to quantify the demand for healthcare and describe the epidemiologic profile of acute, time-sensitive conditions requiring aeromedical evacuation in the Los Lagos and Aysén regions.MethodsThis was a descriptive observational study analyzing aeromedical evacuations to higher levels of care during the 2022-24 period. We included trauma, myocardial infarction, stroke, respiratory failure, obstetric emergencies, psychiatric emergencies, and other clinical conditions. Data from the Emergency Medical Care System of Los Lagos and the Aysén Health Service were analyzed using descriptive statistics and χ2 tests to compare population-adjusted transfer incidences.ResultsWe analyzed 2415 evacuations (57% in Aysén, 43% in Los Lagos). The transfer incidence in Aysén was nearly 12 times higher than in Los Lagos. Severe trauma was the most common cause (15%), followed by acute abdomen (10%) and respiratory diseases (9%). Significant regional differences were found in Aysén, where trauma and respiratory conditions predominated, whereas in Los Lagos, trauma and acute abdomen were most frequent. Older adults in Aysén had the highest incidences per 100,000 inhabitants.ConclusionsRegional disparities in evacuation rates reveal profound territorial inequalities and logistical barriers. Addressing these systemic failures requires the decentralization of advanced diagnostic tools and the establishment of dedicated aeromedical crews stationed within isolated regions to ensure health equity in Chilean Patagonia.

A 52-year-old female presented with one week of progressive quadriparesis followed by the development of diplopia, dysphonia and dysphagia over 48 h. Initial impression was of an inflammatory myelitis given mild cerebrospinal fluid pleocytosis and diffuse cervical cord swelling extending to the lower brainstem on MRI. Treatment with intravenous methylprednisolone was commenced. Her condition continued to progress with a brief cardiac arrest secondary to diaphragmatic insufficiency due to brainstem involvement. She survived the cardiac arrest after a period of cardiopulmonary resuscitation and was admitted to the intensive care unit. Subsequent MRI suggested a chronic right sigmoid venous sinus thrombosis with venous congestion in the brainstem and upper cervical cord. Digital subtraction angiogram revealed a right dural arteriovenous fistula (DAVF) between the right transverse venous sinus and perimesecephalic veins. The dural arteriovenous fistula was embolised with subsequent rapid improvement in bulbar function. Limb weakness also improved, and she was transferred to a rehabilitation unit for physiotherapy. Our case highlights the importance of rapid recognition of an intracranial DAVF mimicking an inflammatory myelitis in the setting of an acute brainstem syndrome. Symptoms can progress quickly if untreated with the risk of progression following the administration of corticosteroids.