Maladies systémiques en réanimation : aspects pratiques

The ICU admission of patients with systemic diseases is most of the time related to the complications induced by immunosuppressive status and/or treatments. Sometimes, one of the organ dysfunction of the disease is associated with life-threatening symptoms leading to ICU admission. Schematically, four main clinical conditions are encountered in ICU patients: acute respiratory failure with diffuse lung injury; central neurologic dysfunction; acute renal failure; hemolysis associated with thrombocytopenia. Whatever the clinical symptoms, it is necessary to look for the following: previous clinical history that may have been underestimated (e.g. arthritis, skin abnormalities, pleuro-pericarditis…; subacute onset of the symptoms, simultaneous multi-organ injury; lack of efficacy of initial therapies. The evidence of auto-antibodies is quite important for the diagnosis. However, they have to be associated with the diagnostic criteria of the disease. Organ biopsy (skin, liver, kidney, muscle, lung, salivarius gland) is frequently of crucial interest. However, they might be difficult to perform in some ICU patients. Treatments of systemic diseases require frequently high dosage corticosteroid therapy, immunosuppressive drugs and/or plasmapheresis. Due to the severity of the clinical condition in ICU, the treatment needs frequently to be started quickly. However, infectious risk should be taken in account before initiating such treatments.