Respiratory manifestations of near-drowning in adult immersion victims are often severe. Nevertheless, in noncomatose patients at least, intubation can often be avoided and quick improvement is the rule while a good outcome is usually expected even in elderly patients.

The fat embolism syndrome (FES) represents a condition, usually with traumatic etiology, which may pose challenges to diagnosis while its treatment usually requires supportive measures in the intensive care units (ICUs). The clinical criteria, including respiratory and cerebral dysfunction and a petechial rash, along with imaging studies help in diagnosis. Here we present three case reports of young male who developed FES and were admitted to our ICUs after long bones fractures emerging after vehicle crashes and we briefly review FES literature. All patients' treatment was directed towards: 1) the restoration of circulating volume with fresh blood and/or plasma; 2) the correction of acidosis; and 3) immobilization of the affected part. All patients recovered and were released to the orthopedic wards. The incidence of cases of patients with FES admitted in our ICUs records a significant decrease. This may be explained in terms effective infrastructure reforms in Greece which brought about significant improvement in early prevention and management.

Background: The aim of the present case report is to assess the efficiency of plasmapheresis in patients detected with meningococcemia since this procedure seems to lower circulating levels of endotoxin while it may also eliminate activated complement, clotting factors and lysosomal enzymes resulting from thromboplastin and activated granulocytes. Objective: Pay attention to plasmapheresis in Adult Respiratory Distressed Syndrome (ARDS) due to meningococcemia with disseminated intravascular coagulation (DIC). Material and methods: A 23-year-old woman with no prior medical history has been monitored for 14 days after being admitted with a 12-hour history of vomiting, headache, confusion, and hypothermia (35.6ºC). Results: Plasmapheresis had been used as adjunctive therapy during septic shock. Conclusion: Patient was treated with five sessions of plasmapheresis and recovered without sequelae. No complications associated with this procedure were observed.

Background: Differentiated diagnosis of meningoencephalitis in elderly patients, when an uncommon picture of respiratory infection leading to acute hypercapnic respiratory failure (AHRF) and without neurological signs is present, may raise serious difficulties. Case report: Two patients aged 72 (patient 1) and 75 (patient 2), without any medical history of respiratory problems, were hospitalized during spring with influenza symptoms. Within less than 24 hours from their admission, patients developed AHFR, which led to disturbances of arterial blood gases (ABGs). They were intubated and transferred, mechanically ventilated, to our intensive care unit (ICU). After normalization of ABGs, a weaning process followed. Weaning was unsuccessful, as unexpected neurological semiotics occurred. The imaging of neurological MRI revealed no special damage apart from microangiopathy. Further investigations through lumbar puncture with cerebrospinal fluid (CSF) testing revealed meningoencephalitis. Antiviral treatment was applied and the outcome was successful for both patients. Conclusion: Critical care medical personnel should be aware of the event of viral meningoencephalitis in elderly patients with AHRF. Especially in the middle of influenza endemic periods, the management of elderly patients may not be appropriate, thus resulting in serious delays for a proper treatment of disease. Laboratory screening of blood and urine, as well as other body fluids, can help detect and determine brain infection. Results from these tests can help exclude other diseases that mimic meningoencephalitis. In cases of patients who are hospitalized in the ICU due to AHRF and do not exhibit neurological abnormalities from the onset of illness, lumbar puncture and check of CSF should be a routine examination. Prophylactic vaccination of high-risk groups may be of crucial importance for preventing complications in patients who develop meningoencephalitis. However, once infected with this disease, the positive outcome is highly dependent on the immediate diagnosis and proper treatment of patients in the ICU.