Critical care emphasizes critical thinking, focuses on the triggers that lead to disease progression, and attaches great importance to early diagnosis of diseases and assessment of the compensatory capacity of vital organs. Pregnancy-associated atypical hemolytic uremic syndrome (P-aHUS) is relatively rare in the intensive care unit (ICU). Most cases occur within 10 weeks after delivery. Severe cases can be life-threatening. It characterized by microangiopathic hemolytic anemia, decreased platelet count (PLT), and acute kidney injury (AKI). Early clinical diagnosis is difficult due to its similarity to various disease manifestations. On January 28, 2024, a 26-year-old pregnant woman at 26⁺³ weeks gestation was transferred to the ICU 19 hours post-vaginal delivery due to abdominal pain, reduced urine output, decreased PLT, elevated D-dimer, tachycardia, increased respiratory rate and declined oxygenation. On the day of ICU admission, the critical care physician identified the causes that triggered the acute respiratory and circulatory events based on the "holistic and local" critical care thinking. The condition was stabilized rapidly by improving the capacity overload. In terms of etiological diagnosis, under the guidance of the "point and face" critical care thinking, starting from abnormality indicators including a decrease in hemoglobin (Hb) and PLT and elevated D-dimer and fibrin degradation product (FDP) without other abnormal coagulation indicators, the critical care physician ultimately determined the diagnosis direction of thrombotic microangiopathy (TMA) by delving deeply into the essence of the disease and formulating a laboratory examination plan in a reasonable and orderly manner. In terms of in-depth diagnosis, combining the disease development process, family history, and past history, applying the two-way falsification thinking of "forward and reverse" as well as "questioning and hypothesis", the diagnosis possibilities of preeclampsia, HELLP syndrome [including hemolysis (H), elevated liver function (EL) and low platelet count (LP)], thrombotic thrombocytopenic purpura (TTP), typical hemolytic uremic syndrome (HUS), and autoimmune inflammatory diseases inducing the condition was ruled out. The diagnosis of complement activation-induced P-aHUS was finally established for the patient, according to the positive result of the complement factor H (CFH). Active decision was made in the initial treatment. The plasma exchange was initiated early. "Small goals" were formulated in stages. The "small endpoints" were dynamically controlled in a goal-oriented manner to achieve continuous realization of the overall treatment effect through phased "small goals". On the 5th day of ICU treatment, the trend of microthrombosis in the patient was controlled, organ function damage was improved, and the patient was transferred out of the ICU. It is possible to reach a favorable clinical outcome for critically ill patients by applying a critical care mindset to quickly integrate diagnostic and therapeutic strategies, accurately identifying the triggers and causes that led to the progression of the disease, and using critical care medical techniques for early and effective intervention.
Humans ; Female ; Pregnancy ; Adult ; Atypical Hemolytic Uremic Syndrome/therapy* ; Intensive Care Units ; Pregnancy Complications, Hematologic/therapy* ; Critical Care

Objective To investigate the epidemiologic characteristics of patients with severe acute pancreatitis (SAP) and the effects of its complications on prognoses in past 7 years in the north area of Guizhou province. Methods Data of 209 patients with SAP admitted to the Department of Critical Care Medicine of Affiliated Hospital of Zunyi Medical College from January 2009 to January2016 were retrospectively analyzed, and they were divided into a survival group (178 cases) and a death group (31 cases) according to the prognosis. The gender, age, diagnosis (primary and recurrent), the length of stay in hospital, the levels of creatinine and total bilirubin (TBil), the time of blood purification, hematocrit (HCT) level on the first day after admission, pathogenesis, complications [infection, pseudocyst, intra-peritoneal hemorrhage, acute renal failure (ARF), acute respiratory distress syndrome (ARDS), abdominal compartment syndrome (ACS), pancreatic encephalopathy, multiple organ dysfunction syndrome (MODS)], sequential organ failure (SOFA) score (maximum SOFA score during hospital stay), application of hormones, surgical interference, etc. related factors were compared, the SAP epidemiological characteristics, factors affecting prognosis and the effect of complications on prognosis in intensive care unit (ICU) were analyzed in the two groups.Results Of the 209 patients 98 cases were diagnosed biliary pancreatitis accounting for the majority (46.9%), hyperlipidemic pancreatitis 76 cases (36.3%), alcoholic pancreatitis 6 cases (2.8%) and idiopathic pancreatitis29 cases (13.9%). The age (years: 47.1±13.5 vs. 53.2±12.0), creatinine (μmol/L: 109.4±100.3 vs. 335.7±222.4), the ration of intra-peritoneal hemorrhage [4.5% (8) vs. 38.7% (12)], ARF [1.1% (2) vs. 54.8% (17)], ACS [1.1% (2) vs. 9.7% (3)], MODS [18.5% (33) vs. 74.2% (23)] and SOFA score (3.3±2.4 vs. 10.5±5.4), percentage of patients using hormones [5.6% (10) vs. 29.0% (9)] were significantly lowered (allP < 0.05) and the time of blood purification was shortened (days: 1.95±1.97 vs. 4.81±5.84) in survival group than those in death group; while the gender, diagnosis, the length of stay in hospital, TBil, HCT on the first day after admission, pathogenesis, complications (infection, pseudocyst, ARDS and pancreatic encephalopathy) and surgical treatment situation were compared between the two groups, no statistical significant differences were seen (allP > 0.05). Logistic regression analysis showed that creatinine > 300μmol/L [odds ratio (OR) was 2.651, 95% confidence interval (95%CI) was 1.459-3.935,P = 0.017], intra-peritoneal hemorrhage (OR was 5.231, 95%CI was 3.517-7.159,P = 0.000), ARF (OR was 3.731, 95%CI was 2.641-4.857,P = 0.000), ACS (OR was 2.517, 95%CI was 1.003-3.098,P = 0.000), use of hormone (OR was 1.012, 95%CI was 0.825-2.051,P = 0.000) and SOFA score (OR was 3.179, 95%CI was 2.630-6.021 andP = 0.000), MODS (OR was 4.716, 95%CI was 2.086-7.902 andP = 0.031) were the risk factors having critical effects on the prognosis of thedisease, The higher the creatinine level, the worse the prognosis. The mortality of ARF was very high reaching 89.5%; the mortalities of patients with complications as intra-peritoneal haemorrhage, ACS, MODS, pancreatic encephalopathy, AKI, infection, pancreatic pseudocyst and ARDS were as follows: 60.0%, 60.0%, 41.1%, 33.3%, 32.1%, 23.1%, 17.7%, 13.1% respectively.Conclusion Biliary disease andhyperlipidemia are the major causes of SAP in north area of Guizhou province, creatinine > 300μmol/L, intra-peritoneal hemorrhage, ARF, ACS, SOFA score, use of hormones are the independent risk factors leading to poor outcome in patients with SAP and the use of hormones cannot ameliorate the disease situation.