Table 1.
Time line table
| Date | Relevant past medical history and interventions | ||
|---|---|---|---|
| 2011 | coat cell lymphoma diagnosed and chemotherapy performed | ||
| 2013 | splenectomy performed | ||
| 2014 | autologous bone marrow transplantation performed | ||
| Dates | Summaries from initial and follow-up visits | Diagnostic testing, including dates | Interventions |
| 10.10. 2015 | -Initial visit (admission to ICU): After 24-h of fever and malaise the patient was admitted somnolent, breathing spontaneously with cold, wet and pale skin, 38 °C of fever; blood pressure 50/40 mmHg, puls 120/min, eupnoeic, with rales over both lungs, without heart murmurs, soft and painless abdomen with audible peristalsis. -After 30–45 min of therapy: Oriented, breathing spontaneously, blood pressure was 110/65 mmHg, puls 120/min -After 2 h of therapy: Oriented, breathing spontaneously, blood pressure was 100/60 mmHg to 120/80 mmHg, puls 120/min, diuresis 20/min, SOFA score 8 |
-pulse oximetry -standard ECG -continuous ECG monitoring -insertion of central venous, arterial and urine catheters to measure arterial blood pressure continuously, central venous pressure intermittently and urine output per hour -ultrasound of vena cava inferior and EF -laboratory tests -Chest roentgenogram -microbiological cultures |
−2 L of oxygen by nasal cannula. -rapid infusion of crystalloids, -noradrenalin iv. infusion -dobutamine iv. -glucocorticoids iv. -vasopressin - Imipenem iv. |
| 11.10.2015 | Oriented, breathing spontaneously, blood pressure was 110/60 mmHg to 120/60 mmHg, puls 140–100/min, diuresis 225 ml/24 h, SOFA score 12 | -pulse oximetry -continuous ECG, arterial blood pressure, intermittent central venous pressure monitoring and hourly urine output -ultrasound of vena cava inferior and EF -laboratory tests -Chest roentgenogram -PiCCO catheter insertion and hemodynamic measurements |
−40% of oxygen by mask -infusion of crystalloids, noradrenalin, dobutamine, vasopressin -glucocorticoids iv. -imipenem iv. |
| 12.10.2015 | Oriented, breathing spontaneously, blood pressure was 100/60 mmHg to 120/80 mmHg, puls 130–100/min, diuresis 225 ml/24 h, SOFA score 13 | -pulse oximetry -continuous ECG, arterial blood pressure, intermittent central venous pressure monitoring and hourly urine output -ultrasound of vena cava inferior and EF -laboratory tests -Hemodynamic measurements by PiCCO catheter |
−40% of oxygen by mask -infusion of crystalloids, noradrenalin, dobutamine, vasopressin -glucocorticoids iv. -imipenem iv. -CVVH and CytoSorb® started |
| 13.10.2015 | Oriented, breathing spontaneously, afebrile, blood pressure was 120/60 mmHg to 120/80 mmHg, puls 130–100/min, diuresis 200 ml/24 h, SOFA score 11 | -pulse oximetry -continuous ECG, arterial blood pressure, intermittent central venous pressure monitoring and hourly urine output -ultrasound of vena cava inferior and EF -laboratory tests -Hemodynamic measurements by PiCCO catheter |
40% of oxygen by mask -infusion of crystalloids, noradrenalin, -glucocorticoids iv. -imipenem iv. -CVVH and Cyrosorb terminated |
| 14.10.2015 | Oriented, breathing spontaneously, afebrile, blood pressure was 120/100 mmHg, puls 120–100/min, diuresis 200 ml/24 h, SOFA score 7 | -pulse oximetry -continuous ECG, arterial blood pressure, intermittent central venous pressure monitoring and hourly urine output -ultrasound of vena cava inferior and EF -laboratory tests -Hemodynamic measurements by PiCCO catheter Chest radiogram |
40% of oxygen by mask -infusion of crystalloids, -imipenem iv. |
| 15.10.2015 | Oriented, breathing spontaneously, afebrile, blood pressure was 140/100 mmHg, puls 110/min, diuresis 690 ml/24 h | -pulse oximetry -continuous ECG, arterial blood pressure, intermittent central venous pressure monitoring and hourly urine output -ultrasound of vena cava inferior and EF -laboratory tests -Hemodynamic measurements by PiCCO catheter |
40% of oxygen by mask -infusion of crystalloids, -imipenem iv. -CVVH |
| 16.10.2015 | Oriented, breathing spontaneously, sub febrile, blood pressure was 150/90 mmHg, puls 100–120/min, diuresis 4455 ml/24 h | -pulse oximetry -continuous ECG, arterial blood pressure, hourly urine output -laboratory tests -Hemodynamic measurements by PiCCO catheter |
−35% of oxygen by mask -infusion of crystalloids, -imipenem iv. -CVVH intermittently |
| 17.10.2015 | Oriented, breathing spontaneously, afebrile, blood pressure was 140/70 mmHg, puls 95–110/min, diuresis 6870 ml/24 h | -pulse oximetry -continuous ECG, arterial blood pressure, hourly urine output -ultrasound of vena cava inferior -laboratory tests |
31% of oxygen by mask -infusion of crystalloids, -imipenem iv. -CVVH intermittently |
| 18.10.2015 | Oriented, breathing spontaneously, afebrile, blood pressure was 150/80 mmHg, puls 90–110/min, diuresis 4540 ml/24 h | -pulse oximetry -continuous ECG, arterial blood pressure, urine output per day -laboratory tests |
3 l of oxygen by nasal cannula -infusion of crystalloids, -imipenem iv. -CVVH intermittently |
| 19.10. 2015 | Oriented, breathing spontaneously, afebrile, blood pressure was 160/80 mmHg, puls 70–80/min, diuresis 4000 ml/24 h | -pulse oximetry -continuous ECG, arterial blood pressure, urine output per day -laboratory tests |
1 l of oxygen by nasal cannula -infusion of crystalloids, -imipenem iv. -CVVH intermittently -transferred to nephrology ward |
Legend: ICU intensive care unit, ECG electrocardiogram, EF ejection fraction, PiCCO Pulse Contour Cardiac Output, CVVH continuous veno-venous hemofiltration